Category: Other
Objective: To assess the efficacy and safety of ultrasound-guided (USg) botulinum toxin (BT) injections versus electromyography–guided (EMGg)- BT injections for cervical dystonia.
Background: BT is the treatment of choice for cervical dystonia. However, succession rate in many occasions is less than satisfactory. One of the reasons for treatment failure is accuracy of injections. Some physicians prefer using anatomical landmarks (AL) for injections while others use either US or EMG-guidance to improve accuracy.
US has the advantage of visualizing the injected muscles and being able to target deeply allocated muscles while EMG has the advantage to differentiate active from non-active muscles.
Method: A 2-centers-study was conducted comparing retrospectively therapeutic outcomes of EMGg injections at one center to USg injections at the other center. Data was collected between 2019 to 2023. Demographic and clinical assessment of previous visits (VAS score, effect duration, side effects) and of current visit (doses administered) were collected. The first 3 therapeutic cycles were excluded from the analyses to enable dosing and program adaptations.
Results: A total of 49 patients were included in this study, of which 2 patients injected using AL (mean age 42.5±6.4), 14 patients were injected under EMGg (mean age 58.7±16.4), 32 patients were injected under USg (mean age 53.6±21.8). Adjusted doses (in onabotulinum units) were 185.0±54.8, , 257.0±77.1 and 291.5±123.5 units for AL, USg and EMGg respectively. VAS was significantly lower for the AL group (mean 34.0±19.5) compared to either USg or EMGg (mean 75.1±25.3 and 72.5±18.9, respectively; p=0.001). Dysphagia was documented in 7.1% of EMGg and 16% in the USg group (p>0.05).
Conclusion: Our results show that the clinical outcomes of USg and EMGg-BT injections are not different but both techniques are superior to AL. Side effects included mainly dysphagia which was more common in the USg group, without reaching statistical significance.
To cite this abstract in AMA style:
V. Livneh, A. Socher, M. Cohen, Y. Schechter, I. Israel, T. Gurevic, G. Yahalom. A retrospective comparison between EMG and US-guided botulinum injections for cervical dystonia [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/a-retrospective-comparison-between-emg-and-us-guided-botulinum-injections-for-cervical-dystonia/. Accessed June 15, 2025.« Back to 2023 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/a-retrospective-comparison-between-emg-and-us-guided-botulinum-injections-for-cervical-dystonia/