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. 2021 Nov 19:12:719030.
doi: 10.3389/fneur.2021.719030. eCollection 2021.

Denervation Dynamics After Intramuscular BNT Injection in Patients With Focal Spasticity Monitored by MRI and Dynamometry-a Blinded Randomized Controlled Pilot Study

Stefan Macher  1 , Ewald Unger  2 , Martin Zalaudek  3 , Michael Weber  3 , Gottfried Kranz  4 , Georg Kranz  5   6   7 , Gregor Kasprian  3 , Thomas Sycha  1
Affiliations

Denervation Dynamics After Intramuscular BNT Injection in Patients With Focal Spasticity Monitored by MRI and Dynamometry-a Blinded Randomized Controlled Pilot Study

Stefan Macher et al. Front Neurol. .

Abstract

Introduction: Botulinumtoxin associated muscle denervation (BNTMD) can be detected by magnet resonance imaging (MRI), MRI may provide further insights into the exact timeline of BNTMD and the potential impact and timing of physical exercise. We aimed to assess the time interval until detection of BNTMD by MRI and whether immediate physical exercise after intramuscular BNT injection has a measurable effect on clinical parameters and the intramuscular denervation dynamics illustrated by MRI. Materials and Methods: Eleven age-matched patients were randomized to an "exercise" or "no-exercise" group. Eighty mouse-units of incobotulinumtoxin were injected into the spastic biceps muscle. MRI of the injected region, hand-held dynamometry of elbow flexor strength and clinical rating scales (mAS, CGI-I) were conducted in predefined intervals. Results: We could not detect BNTMD within 24 h but 7 days after injection independent of group allocation (exercise n = 6, no-exercise n = 5). Denervation signs were more diffuse and spread into adjacent muscles in patients having received exercise. We could not detect differences concerning clinical measures between the two groups. Conclusions: Physical exercise might influence BNTMD dynamics and promote propagation of T2-MR muscle denervation signs from the injected site into adjacent muscles. Trial registration: clinicaltrialsregister.eu, Identifier 2017-003117-25.

Keywords: botulinumtoxin; denervation signs; dynamometry; magnetic resonance imaging (MRI); muscle denervation.

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Conflict of interest statement

SM has participated in meetings sponsored by, received speaker honoraria or travel funding from Merz. GK has participated in meetings sponsored by, received speaker honoraria or travel funding from Merz, Ipsen, and Allergan. TS has participated in meetings sponsored by, received speaker honoraria or travel funding from Merz, Ipsen, and Allergan. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study progress.
Figure 2
Figure 2
(A) Left: Longitudinal change in T2 signal intensity in the MBB with reference to baseline per patient. Right: Time interval until maximum T2 Si- value was reached per patient. Patients having received exercise are labeled gray (B) Median change in strength level (Nm, %) and T2 signal intensity (Si, %) compared to baseline levels across the groups (exercise vs. no exercise).
Figure 3
Figure 3
(A) Denervation sign after intramuscular BNT injection in the MBB of patients allocated to the exercise group and no-exercise group. Pat. 2 was pretreated with BNT. arrows indicate area of denervation. (B) Denervation signs in patients M. brachioradialis.
See this image and copyright information in PMC

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