Shear wave elastography combined with electromyography to assess the effect of botulinum toxin on spastic dystonia following stroke : A pilot study
Campanella, William (IRCCS Ospedale Policlinico San Martino)
Corazza, Angelo (Istituto Ortopedico Galeazzi di Milano)
Puce, Luca (University of Genova)
Privitera, Laura (University of Genova)
Pedrini, Riccardo (University of Genova)
Mori, Laura (IRCCS Ospedale Policlinico San Martino)
Boccuni, Leonardo (Institut Germans Trias i Pujol. Institut Guttmann)
Turtulici, Giovanni (S.C. Radiodiagnostica Ospedale Evangelico Internazionale di Genova)
Trompetto, Carlo (IRCCS Ospedale Policlinico San Martino)
Marinelli, Lucio (IRCCS Ospedale Policlinico San Martino)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	Shear wave elastography (SWE) is a method for carrying out a quantitative assessment of the mechanical properties of soft tissues in terms of stiffness. In stroke survivors, the paretic muscles may develop hypertonia due to both neural-mediated mechanisms and structural alterations with consequent muscular fibrous-fatty remodeling. Fourteen adult patients with spastic dystonia following stroke were recruited. Muscle hypertonia was assessed using the modified Ashworth scale (MAS). Muscle activation was measured by surface electromyography (sEMG) with the selected muscle in shortened (spastic dystonia) and stretched (dynamic stretch reflex) positions. SWE was performed on a selected paretic muscle and on the contralateral non-paretic one to calculate shear wave velocities (SWV) along and across muscular fibers. The modified Heckmatt scale (MHS) pattern was also determined. All evaluations were performed shortly before BoNT-A injections (T0) and one month later (T1). All SWV on paretic muscles were higher than contralateral non-paretic ones (p < 0. 01). After BoNT-A injection, a significant reduction in MAS (p = 0. 0018), spastic dystonia (p = 0. 0043), and longitudinal SWE measurements, both in shortened (p = 0. 001) and in stretched muscular conditions (p = 0. 0029), was observed. No significant changes in SWV on non-paretic muscles were observed. Higher SWV resulted along the direction of muscular fibers vs. across them (p = 0. 001). No changes resulted from the MHS evaluations after BoNT-A. There was a positive correlation between MHS scores and SWV values while the muscle was in the shortened position, but not with spastic dystonia recorded by sEMG. This is the first study evaluating the effect of BoNT-A on muscle hypertonia following stroke, assessed by both SWE and sEMG. These findings support SWE as a useful method to disclose intrinsic muscular remodeling, independently of the effect of spastic dystonia, in particular, while muscles were assessed in a neutral position. SWE measurements of muscle stiffness cannot tell apart neural-mediated and intrinsic muscle hypertonia. Interestingly, when sEMG activity is very limited, as in spastic muscles kept in a shortened position, SWE can provide a measurement of stiffness due almost completely to intrinsic muscle changes. Alongside sEMG, SWE could aid clinicians in the assessment of responses to treatments.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Elastosonography ; Muscle tone ; Muscle hypertonia ; Shear wave ; Spasticity ; Stiffness
Published in:	Frontiers in neurology, Vol. 13 (october 2022) , ISSN 1664-2295

DOI: 10.3389/fneur.2022.980746
PMID: 36299267

13 p, 2.6 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles