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Botulinum toxin found its way into a lot of medical treatments improving the quality of life in many clinical situations. When treating spasticity, this toxin is injected in the affected muscle to decrease its tension and hyperactivity. The isolation of the affected muscles for injection is done either by anatomical palpation of the muscle which is also known as non-guided injection technique, or by using the ultrasound or the electromyography also known guided injection technique. In this study which is a prospective observational study that included patients over a 6 months period, 28 patients aged between 2 and 78 years, with spasticity naïve to botulinum toxin injections or had already been injected more than 3 months ago,were injected using guided injection technique. The optimal doses of botulinum toxin were administered based on the age, the severity of the condition, and affected muscle groups. In pediatric population these were also calculated according to the body weight. All patients were evaluated pre and 4 weeks post injection using the MAS Score (Modified Ashworth Scale). Statistical analysis showed a very significant response to treatment as compared to the pre-injection condition, for upper limbs, lower limbs, and all muscle groups with almost absent significant local or systemic side effects (with a p value less than 0.001). Conclusion: guided techniques for botulinum toxin injections showed a great efficacy in the treatment of spasticity along with no regional or systemic side effects and are relatively well tolerated by patients. This finding leads to a better management of spasticity and to a decrease in oral medication intake and secondarily a decrease in their possible side effects.

Guided Botulinum Toxin Injections for Limbs Spasticity: The Winning Duets