Effectiveness of Ultrasound-guided VS Electrical-stimulation-guided Botulinum Toxin Injections in Triceps Surae Spasticity after Stroke: A Randomized Controlled Study.

OBJECTIVE: To compare the efficacy of botulinum toxin injections using ultrasound-guidance vs electrical-stimulation-guidance in triceps surae (soleus and gastrocnemius) spasticity after stroke.

DESIGN: A clinical, single-centre, prospective, interventional, single-blind, cross-over, randomized trial, with outpatients in the tertiary care hospital. After randomization, subjects received electrical-stimulation-guided, followed by ultrasound-guided abobotulinumtoxinA injection (n = 15), or the same 2 procedures in the reverse order (n = 15) with the same operator, 4 months apart. The primary endpoint was the Tardieu scale with the knee straight at 1 month after injection.

RESULTS: The 2 groups did not differ in Tardieu scale score (effect size = 0.15, 95% confidence interval (95% CI) -0.22 to 0.51, p = 0.43). In addition, the muscle localization technique used had no influence on walking speed, pain on injection or spasticity, assessed at 1 month after the injection, using the modified Ashworth scale. Ultrasound-guided injections were faster to administer than electrical-stimulation-guided injections.

CONCLUSION: In agreement with previous research, no differences were found in the efficacy of ultrasound-guided or electrical-stimulation-guided abobotulinumtoxinA injections in triceps surae spasticity after stroke. Both techniques are of equal use in guiding muscle localization for botulinum toxin injections in spastic triceps surae.