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EP34396
Poster Title: Treatment of Task Specific Upper Limb Dystonia using Ultrasound-guided Botulinum Toxin Injection
Submitted on 02 Nov 2020
Author(s): Dr David G. King FRCR, Dr Philip Duffey FRCP, Dr John Ferrier FRCR
Affiliations: York Teaching Hospital, UK.
This poster was presented at BIR Annual Congress 2020
Poster Views: 832
Submitted on 02 Nov 2020
Author(s): Dr David G. King FRCR, Dr Philip Duffey FRCP, Dr John Ferrier FRCR
Affiliations: York Teaching Hospital, UK.
This poster was presented at BIR Annual Congress 2020
Poster Views: 832
Abstract:
Upper limb task-specific dystonia (ULTSD) is a movement disorder of involuntary, prolonged contraction of one or more forearm or hand muscles provoked by repetitive tasks eg. writing. There is no single established treatment but botulinum toxin (BTx) injections into the muscles which are contracting abnormally have been shown to improve symptoms. Surface anatomy or electromyography have been used to guide this. We describe the use of a combination of clinical and ultrasound assessment to guide injection in a joint clinic with a neurologist and a musculoskeletal radiologist.
We retrospectively analysed the treatment of 108 treatment episodes in 15 consecutive patients over a 17 year period.
When the BTx wore off patients returned to clinic and treatment was adjusted based on their feedback, using a simple 4-point scoring system, until an optimum response was achieved.
Average time to achieve a satisfactory treatment regime was 2.7 visits (range 1-4). Optimisation was not achieved for 2 patients who withdrew from treatment after 1 and 2 injections respectively. Following this initial optimisation phase responses for 75 treatment episodes were: good/very good: 47 episodes (63%); mild/moderate: 21 episodes (28%); no effect: 7 episodes (9%). For 15 individual patients, feedback scores after optimisation were: 10 patients - good or very good; 3 patients – mild; 2 patients - no improvement.
Complications: 4 episodes of excessive individual muscle weakness, lasting 4-8 weeks before resolving.
Summary: We describe the results from our combined clinic, combining the expertise of a neurologist and a radiologist using ultrasound for the treatment of upper limb task-specific dystonia (ULTSD) with botulinum toxin injection..References: References
1. Karp B, Alter K. Muscle Selection for Focal Limb Dystonia. Toxins. 2017 Dec 29;10(1):20.
2. Pearce JMS. A note on scrivener’s palsy. Journal of Neurology, Neurosurgery & Psychiatry. 2005 Apr 1;76(4):513–513.
3. Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung VSC, et al. Phenomenology and classification of dystonia: A consensus update: Dystonia: Phenomenology and classification. Mov Disord. 2013 Jun 15;28(7):863–73.
4. Schuele S, Jabusch H-C, Lederman RJ, Altenmuller E. Botulinum toxin injections in the treatment of musician’s dystonia. Neurology. 2005 Jan 25;64(2):341–3.
5. Lin PT, Hallett M. The Pathophysiology of Focal Hand Dystonia. Journal of Hand Therapy. 2009 Apr;22(2):109–14.
6. Walter U, Dressler D. Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives. Expert Review of Neurotherapeutics. 2014 Aug;14(8):923–36.
7. Chin TYP, Nattrass GR, Selber P, Graham HK. Accu
Upper limb task-specific dystonia (ULTSD) is a movement disorder of involuntary, prolonged contraction of one or more forearm or hand muscles provoked by repetitive tasks eg. writing. There is no single established treatment but botulinum toxin (BTx) injections into the muscles which are contracting abnormally have been shown to improve symptoms. Surface anatomy or electromyography have been used to guide this. We describe the use of a combination of clinical and ultrasound assessment to guide injection in a joint clinic with a neurologist and a musculoskeletal radiologist.
We retrospectively analysed the treatment of 108 treatment episodes in 15 consecutive patients over a 17 year period.
When the BTx wore off patients returned to clinic and treatment was adjusted based on their feedback, using a simple 4-point scoring system, until an optimum response was achieved.
Average time to achieve a satisfactory treatment regime was 2.7 visits (range 1-4). Optimisation was not achieved for 2 patients who withdrew from treatment after 1 and 2 injections respectively. Following this initial optimisation phase responses for 75 treatment episodes were: good/very good: 47 episodes (63%); mild/moderate: 21 episodes (28%); no effect: 7 episodes (9%). For 15 individual patients, feedback scores after optimisation were: 10 patients - good or very good; 3 patients – mild; 2 patients - no improvement.
Complications: 4 episodes of excessive individual muscle weakness, lasting 4-8 weeks before resolving.
Summary: We describe the results from our combined clinic, combining the expertise of a neurologist and a radiologist using ultrasound for the treatment of upper limb task-specific dystonia (ULTSD) with botulinum toxin injection..References: References
1. Karp B, Alter K. Muscle Selection for Focal Limb Dystonia. Toxins. 2017 Dec 29;10(1):20.
2. Pearce JMS. A note on scrivener’s palsy. Journal of Neurology, Neurosurgery & Psychiatry. 2005 Apr 1;76(4):513–513.
3. Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung VSC, et al. Phenomenology and classification of dystonia: A consensus update: Dystonia: Phenomenology and classification. Mov Disord. 2013 Jun 15;28(7):863–73.
4. Schuele S, Jabusch H-C, Lederman RJ, Altenmuller E. Botulinum toxin injections in the treatment of musician’s dystonia. Neurology. 2005 Jan 25;64(2):341–3.
5. Lin PT, Hallett M. The Pathophysiology of Focal Hand Dystonia. Journal of Hand Therapy. 2009 Apr;22(2):109–14.
6. Walter U, Dressler D. Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives. Expert Review of Neurotherapeutics. 2014 Aug;14(8):923–36.
7. Chin TYP, Nattrass GR, Selber P, Graham HK. Accu
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