@article{6ee7cca65ce24b59bce54a768d91cc1d,
title = "Comparison of Ultrasound and Electrical Stimulation Guidance for Onabotulinum Toxin-A Injections: A Randomized Crossover Study",
abstract = "Background: Botulinum neurotoxin (BoNT) injection is an established therapy for limb spasticity and focal limb dystonia. Comparative benefits of injection guidance procedures have not been rigorously studied. Objectives: We compared 2 targeting techniques for onabotulinumtoxin-A (onabotA) injection for the treatment of focal hand dystonia and upper limb spasticity: electrophysiologic guidance using electrical stimulation (E-stim) and ultrasound (US). Methods: This was a 2-center, randomized, crossover, assessor-blinded trial. Participants with focal hand dystonia or upper limb spasticity, on stable onabotA therapy for at least 2 previous injection cycles, were randomly assigned to either E-stim or US with crossover at 3 months. The primary outcome was improvement in dystonia or spasticity severity on a visual analog scale (VAS; 0–100) measured 1 month after each injection. The secondary outcome was participant discomfort assessed on a VAS. Repeated-measures analysis of covariance was used with linear mixed-model covariate selection. Results: A total of 19 participants (13 men) completed the study, 10 with upper limb spasticity and 9 with dystonia. Benefit was equivalent between the 2 techniques (VAS least-square mean [LSmean] 51.5 mm with US and 53.1 with E-stim). E-stim was perceived as more uncomfortable by participants (VAS LSmean 34.5 vs. 19.9 for E-stim and US, respectively). Procedure duration was similar with the 2 procedures. There were no serious adverse events related to either approach. Conclusions: US and E-Stim localization guidance techniques provide equivalent efficacy in onabotA injections for spasticity and dystonia. US guidance injections are more comfortable for participants. Both techniques are effective guidance methods, with US potentially preferable based on participant comfort.",
keywords = "botulinum toxin, dystonia, electrical stimulation, spasticity, ultrasound",
author = "Codrin Lungu and Alexandra Nmashie and George, {Mary Catherine} and Karp, {Barbara I.} and Katharine Alter and Susan Shin and Winona Tse and Frucht, {Steven J.} and Tianxia Wu and Vivian Koo and Elaine Considine and Gina Norato and Mark Hallett and Simpson, {David M.}",
note = "Funding Information: Dr. Lungu reports honoraria for editorial work from Elsevier, Inc. The work submitted here was conducted in the course of employment for the National Institute of Neurological Disorders and Stroke, an agency of the US government. Dr. Karp has been an investigator on clinical trials for which the National Institutes of Health (NIH) received support from Allergan, Inc. and Merz. The work submitted here was conducted in the course of employment for the National Institute of Neurological Disorders and Stroke, an agency of the US government. Dr. Alter, Dr. Wu, Ms. Koo, Ms. Considine, and Dr. Norato report no conflicts of interest. The work submitted here was conducted in the course of employment for the National Institute of Neurological Disorders and Stroke, an agency of the US government. Dr. Hallett is an inventor of patents held by NIH for an immunotoxin for the treatment of focal movement disorders and the H‐coil for magnetic stimulation; in relation to the latter, he has received license fee payments from the NIH (from Brainsway). He is on the Medical Advisory Boards of CALA Health and Brainsway (both unpaid positions). He is on the editorial boards of approximately 15 journals and receives royalties and/or honoraria from publishing from Cambridge University Press, Oxford University Press, Springer, Wiley, Wolters Kluwer, and Elsevier. He has research grants from Medtronic, Inc. for a study of deep brain stimulation for dystonia and CALA Health for studies of a device to suppress tremor. The work submitted here was conducted in the course of employment for the National Institute of Neurological Disorders and Stroke, an agency of the US government. Dr. Simpson receives research grant support and consulting fees from Allergan/AbbVie, Merz, and Ipsen. Dr. Nmashie, Dr. George, Dr. Shin, Dr. Tse, and Dr. Frucht report no conflicts of interest. Financial Disclosures for the Previous 12 Months: Funding Information: The study was supported with National Institute of Neurological Disorders and Stroke intramural funds, by the Clinical and Translational Science Awards Grant UL1TR001433 from the National Center for Advancing Translational Sciences, National Institutes of Health (to Icahn School of Medicine at Mount Sinai), and research funding from Allergan, Inc. prior to the acquisition by AbbVie, Inc. (to Icahn School of Medicine at Mount Sinai). Funding Sources and Conflicts of Interest: Publisher Copyright: {\textcopyright} 2022 International Parkinson and Movement Disorder Society.",
year = "2022",
month = nov,
doi = "10.1002/mdc3.13546",
language = "English",
volume = "9",
pages = "1055--1061",
journal = "Movement Disorders Clinical Practice",
issn = "2330-1619",
publisher = "John Wiley and Sons Ltd",
number = "8",
}