Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study
Clonus is characterized by involuntary, rhythmic, oscillatory muscle contractions, typically triggered by rapid muscle stretching and is frequently associated with spastic equinovarus foot (SEVF), where it may increase risk of falls and cause discomfort, pain, and sleep disorders. We hypothesize tha...
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2024-11-01
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| author | Mirko Filippetti Stefano Tamburin Ilaria Di Maria Cecilia Angeli Rita Di Censo Elisa Mantovani Nicola Smania Alessandro Picelli |
| author_facet | Mirko Filippetti Stefano Tamburin Ilaria Di Maria Cecilia Angeli Rita Di Censo Elisa Mantovani Nicola Smania Alessandro Picelli |
| author_sort | Mirko Filippetti |
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| description | Clonus is characterized by involuntary, rhythmic, oscillatory muscle contractions, typically triggered by rapid muscle stretching and is frequently associated with spastic equinovarus foot (SEVF), where it may increase risk of falls and cause discomfort, pain, and sleep disorders. We hypothesize that selective diagnostic nerve block (DNB) of the tibial nerve motor branches can help identify which muscle is primarily responsible for clonus in patients with SEVF and provide useful information for botulinum neurotoxin type A (BoNT-A) treatment. This retrospective study explored which calf muscles contributed to clonus in 91 patients with SEFV after stroke (n = 31), multiple sclerosis (n = 21), and cerebral palsy (n = 39), using selective DNB. We found that SEVF-associated clonus was most commonly driven by the soleus muscle, followed by the gastrocnemius lateralis and medialis, tibialis posterior, and flexor digitorum longus, and that frequency differed according to SEVF etiology. Our data suggest that identifying the muscles involved in SEVF-associated clonus may aid clinicians in personalizing BoNT-A treatment to single patients. Also, the findings of this study suggest that applying a ‘stroke model’ to treating spasticity secondary to other etiologies may not always be appropriate. |
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| publishDate | 2024-11-01 |
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| spelling | doaj-art-cc2aa55d02024f5ea47ebbf0aa0d9c992024-12-27T14:56:53ZengMDPI AGToxins2072-66512024-11-01161250310.3390/toxins16120503Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective StudyMirko Filippetti0Stefano Tamburin1Ilaria Di Maria2Cecilia Angeli3Rita Di Censo4Elisa Mantovani5Nicola Smania6Alessandro Picelli7Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, ItalyClonus is characterized by involuntary, rhythmic, oscillatory muscle contractions, typically triggered by rapid muscle stretching and is frequently associated with spastic equinovarus foot (SEVF), where it may increase risk of falls and cause discomfort, pain, and sleep disorders. We hypothesize that selective diagnostic nerve block (DNB) of the tibial nerve motor branches can help identify which muscle is primarily responsible for clonus in patients with SEVF and provide useful information for botulinum neurotoxin type A (BoNT-A) treatment. This retrospective study explored which calf muscles contributed to clonus in 91 patients with SEFV after stroke (n = 31), multiple sclerosis (n = 21), and cerebral palsy (n = 39), using selective DNB. We found that SEVF-associated clonus was most commonly driven by the soleus muscle, followed by the gastrocnemius lateralis and medialis, tibialis posterior, and flexor digitorum longus, and that frequency differed according to SEVF etiology. Our data suggest that identifying the muscles involved in SEVF-associated clonus may aid clinicians in personalizing BoNT-A treatment to single patients. Also, the findings of this study suggest that applying a ‘stroke model’ to treating spasticity secondary to other etiologies may not always be appropriate.https://www.mdpi.com/2072-6651/16/12/503botulinum toxinsclinical decision makingmuscle spasticitynerve blockultrasonography |
| spellingShingle | Mirko Filippetti Stefano Tamburin Ilaria Di Maria Cecilia Angeli Rita Di Censo Elisa Mantovani Nicola Smania Alessandro Picelli Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study Toxins botulinum toxins clinical decision making muscle spasticity nerve block ultrasonography |
| title | Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study |
| title_full | Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study |
| title_fullStr | Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study |
| title_full_unstemmed | Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study |
| title_short | Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study |
| title_sort | diagnostic nerve block to guide botulinum neurotoxin type a injection for clonus in spastic equinovarus foot a retrospective study |
| topic | botulinum toxins clinical decision making muscle spasticity nerve block ultrasonography |
| url | https://www.mdpi.com/2072-6651/16/12/503 |
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