Ann Rehabil Med.  2016 Jun;40(3):551-555. 10.5535/arm.2016.40.3.551.

Precise Muscle Selection Using Dynamic Polyelectromyography for Treatment of Post-stroke Dystonia: A Case Report

• Jung TM
• Kim AR
• Lee Y
• Kim DH
• Kim DY

• KMID: 2327620
• DOI: http://doi.org/10.5535/arm.2016.40.3.551

Abstract

Dystonia has a wide range of causes, but treatment of dystonia is limited to minimizing the symptoms as there is yet no successful treatment for its cause. One of the optimal treatment methods for dystonia is chemodenervation using botulinum toxin type A (BTX-A), alcohol injection, etc., but its success depends on how precisely the dystonic muscle is selected. Here, we reported a successful experience in a 49-year-old post-stroke female patient who showed paroxysmal repetitive contractions involving the right leg, which may be of dystonic nature. BTX-A and alcohol were injected into the muscles which were identified by dynamic polyelectromyography. After injection, the dystonic muscle spasm, cramping pain, and the range of motion of the affected lower limb improved markedly, and she was able to walk independently indoors. In such a case, dynamic polyelectromyography may be a useful method for selecting the dominant dystonic muscles.

Keyword

Dystonia; Botulinum toxins; Electromyography

MeSH Terms

Botulinum Toxins
Botulinum Toxins, Type A
Dystonia*
Electromyography
Female
Humans
Leg
Lower Extremity
Methods
Middle Aged
Muscle Cramp
Muscles
Nerve Block
Range of Motion, Articular
Spasm
Botulinum Toxins
Botulinum Toxins, Type A

Figure

• 

  Fig. 1 Brain magnetic resonance imaging showed left middle cerebral artery infarction, involving the frontal and parietal lobes.

• 

  Fig. 2 Using the 10-channel electromyography mode, dynamic polyelectromyography was performed during the dystonic event. Motor unit action potentials of each lower extremity were recorded simultaneously.

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  Fig. 3 Findings of dynamic polyelectromyography in the affected lower limb muscles at baseline. TFL, tensor fascia lata; BF LH, biceps femoris long head; BF SH, biceps femoris short head; FDB, flexor digitorum brevis; FDL, flexor digitorum longus; PL, peroneus longus; TA, tibialis anterior; GCM, gastrocnemius.

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  Fig. 4 Changes in the affected lower limb on a lateral view before injection (A); the knee flexor could not be extended by hand almost all day. (B) After injection, her knee could be extended to a near normal range.

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  Fig. 5 Changes in the affected lower limb on a superior view before injection (A); her right hip and knee flexor were hyperactive with severe muscle cramping pain. (B) After injection, the flexed posture and pain were remarkably decreased.

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