Objective: to demostrate the abdominal internal oblique muscle hypertrophy with ultrasound in patients with Parkinson’s Disease (PD) affected by axial problems, as a possible target for Botulinum Toxin type A (BoNTA) injection.

Background: it’s widely recognized that abdominal muscles can be involved in trunk abnormal postures in PD with a dystonic activation already demostrated by surface/needle electromiography (EMG) studies (1). However, only the abdominal external oblique muscle is described as a possible target of BoNTA injection (2). Furthermore only few ultrasound studies documented different abdominal muscles volumes (3).

Method: in our Movement Analysis Laboratory we collected data from a cohort of patients affected by Pisa Syndrome/camptocormia in PD. They all underwent an ultrasound study to detect the target muscles for BoNTA.

Results: we reported data from 10 patients (5 females, age 75 +/- 5.3 years, 10.5 +/- 5.3 years of PD duration), reapeteadly injected by BoNTA (total injection sessions: 22; 8 patients were treated twice, 3 patiens thrice). These patiens received BoNTA after accurate ultrasound study of all abdominal muscles (abdominal external oblique muscle/ abdominal internal oblique muscle, transverse abdominal muscle,  rectus abdominis muscle). We noted that mostly abdominal internal oblique muscle was injected because hypertrofic. We performed a needle EMG recording of different muscles before BoNTA injection, that confirmed the dystonic activation and the muscle selection. The BoNTA mean dosage of abdominal internal oblique muscle was 27 U (incobotulinum toxin A, dilution 1 cc). No side effects were reported and clinical benefit was variably sustained.

Conclusion: we propose an accurate ultrasound study before abdominal muscles BoNTA injection and we suggest the role of abdominal internal oblique muscle in PD trunk postural abnormalities as a target of BoNTA.

References: 1) Tassorelli C, De Icco R, Alfonsi E, Bartolo M, Serrao M, Avenali M, De Paoli I, Conte C, Pozzi N.G, Bramanti P et al. Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: A placebo controlled study. Park. Relat. Disord. 2014, 20, 1140–1144.
2) Nils G. Margraf, Marten Rogalski, Günther Deuschl, Johann P. Kuhtz-Buschbeck,. Trunk muscle activation pattern in parkinsonian camptocormia as revealed with surface electromyography. Parkinsonism & Related Disorders, Volume 44, 2017, Pages 44-50, ISSN 1353-8020, https://doi.org/10.1016/j.parkreldis.2017.08.028. (https://www.sciencedirect.com/science/article/pii/S1353802017303243).
3) CA Artusi, S Bortolani, A Merola, M Zibetti, M Busso, S De Mercanti, P Arnoffi, S Martinetto, E Gaidolfi, A Veltri, P Barbero, L Lopiano. Botulinum toxin for Pisa syndrome: An MRI-, ultrasound- and electromyography-guided pilot study, Parkinsonism & Related Disorders, Volume 62, 2019, Pages 231-235, ISSN 1353-8020,https://doi.org/10.1016/j.parkreldis.2018.11.003. (https://www.sciencedirect.com/science/article/pii/S1353802018304851).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/can-abdominal-internal-oblique-muscle-be-a-possible-target-for-ultrasound-guided-botulinum-toxin-injection-in-patients-with-parkinsons-disease-affected-by-axials-problems-an-ultrasound-study/