Effect Of Botulinum Toxin Injection Guided By Different Strategies On Spasticity In Patients After Brain Injury

Objectives: To observe the effects of intramuscular injection of botulinum toxin A guided by different strategies on Spasticity in Patients after Brain Injury, and explore more reasonable and effective guidance of botulinum toxin injection for use in clinical.Methods: Forty-five patients diagnosed with triceps surae muscle spasticity after brain injured , and randomized divided into three groups, group A (n=15) treated with intramuscular injection of botulinum toxin guided by Ultrasound-B; group B (n=15) treated with injection guided by electrical stimulation; group C(n=15) treated with injection under the guidance of Ultrasound-B combined with Electrical stimulation, The clinical spasticity index(CSI), the Intergrated EMG(IEMG)were assessed pre-injection , the third day and four weeks after treatment.Results: compared with baseline, the CSI value of group A , B and C on the third day after treatment and CSI value, the IEMG value four weeks after injection all descend significantly. There is not a significant difference between group A and group B in CSI value on the third day after injection (p>0.05). The CSI value of group C is lower than both group A and group B. the difference is significant (7.60±1.50 vs 8.93±1.16,9.27±1.62). and the difference is still exist after adjusted for age, disease duration, body mass index, baseline CSI and baseline IEMG; four weeks after injection, there are not significant difference between group A and group B in Both the CSI value and the IEMG value (p>0.05) .The CSI value(4.73±1.03 vs 5.67±0.97, 6.13±1.06)and the IEMG value (5.04±1.90 vs 7.06±1.68, 7.03±1.58)of group C is lower than that of both group A and group B. The difference is significant (p<0.05). And the difference is still exist after adjusted for age, disease duration, body mass index, baseline CSI and baseline IEMG;Conclusion: Intramuscular injection of botulinum toxin of three strategies all have effects on focal spasticity; there was not a significant difference in the effects of Intramuscular injection of botulinum toxin guided by Ultrasound-B on the spasticity from that guided by Electrical stimulation; Intramuscular injection of botulinum toxin Under the guidance of Ultrasound-B combined with Electrical stimulation can relieve spasticity more effective than that both guided by purely Ultrasound-B and by purely Electrical stimulation.