Abstracts of the German Congress on Parkinson's Disease and Movement Disorders (Deutscher Kongress für Parkinson und Bewegungsstörungen), 7–9 March 2019, Düsseldorf, Germany

2019 Journal of neural transmission  
Spasticity is associated with secondary muscular changes (especially atrophy and increase of connective tissue) that might have implications for the efficacy of botulinum toxin (BTX) treatment. These changes could be visualized by ultrasound, nevertheless the reliability of this method and the degree and distribution of muscular alterations is not clear up to now. Target: We therefore aimed to assess the inter-rater reliability of ultrasound in spasticity and to evaluated muscular changes in a
more » ... uantitative way. Methods: Patients with spastic hemiparesis due to intracerebral ischemia or bleeding (n = 14, age 56.6 years (20-76), duration of spasticity 8.5 years (3-19), duration of BTX treatment 4.3 years (1.8-7.5)) were examined by 5 neurologist using ultrasound. Assessed muscles at the upper limb included flexor carpi ulnaris (FCU), flexor dig. prof./superf. (index finger; FDP/FDS), extensor dig. com. (EDC) and at the lower limb medial gastrocnemius (MG) and tibialis anterior (TA) muscle. We assessed cross sectional area or a-p diameter and echogenicity using offline grey scale analysis and compared measurements of the affected side to the non-affected side. Results: We found an excellent inter-rater reliability (ICC (2,5) 86-96%) concerning all parameters. At the upper limb we found a statistically significant increase in echogenicity on the affected side vs. the non-affected side (EDC 64 vs. 57, p = 0.002; FCU 71 vs. 56, p \ 0.001; FDP 69 vs. 54, p = 0.022; FDS 65 vs. 52, p = 0.003) as well as a significant atrophy on the affected side (EDC 16.7 vs. 20.4, p \ 0.001; FCU 8.2 vs. 10.6, p = 0.002; FDP 3.7 vs. 5.0, p \ 0.001; FDS 5.5 vs. 7.9, p = 0.001). On the other hand, we did not find significant differences at the lower limb. Conclusion: Ultrasound is an easy, quick and reliable method to examine muscular changes in spasticity which confirmed significant atrophy and hyperechogenicity at least at the upper spastic limb. Individual changes might have implications for botulinum toxin treatment concerning selection of muscles and efficacy. Nevertheless, larger and longitudinal studies are needed to assess the influence of duration of spasticity and BTX treatment on these muscular changes and to correlate them with efficacy of BTX treatment.
doi:10.1007/s00702-019-01978-1 pmid:30805733 fatcat:qd4vebobrjcxxma7tqtlu63xoq