Spasticity is a common post-stroke syndrome that imposes significant adverse impacts on patients and caregivers. This study aims to improve the efficiency of botulinum toxin (BoNT) in managing spasticity, by utilizing a three-dimensional innervation zone imaging (3DIZI) technique based on high-density surface electromyography (HD-sEMG) recordings. Stroke subjects were randomly assigned to two groups: the control group (n = 6) which received standard ultrasound-guided injections, and the experimental group (n = 6) which received 3DIZI-guided injections. The amount of BoNT given was consistent for all subjects. The Modified Ashworth Scale (MAS), compound muscle action potential (CMAP) and muscle activation volume (MAV) from bilateral biceps brachii muscles were obtained at the baseline, 3 weeks, and 3 months after injection. Intra-group and inter-group comparisons of MAS, CMAP amplitude and MAV were performed. An overall improvement in MAS of spastic elbow flexors was observed during the 3-week visit (p < 0.01), yet no statistically significant difference found with intra-group or inter-group analysis. Compared to the baseline, a significant reduction of CMAP amplitude and MAV were observed in the spastic biceps muscles of both groups at 3-week post-injection, and returned to approximate baseline value at 12-week post injection. A significantly higher reduction was found in CMAP amplitude (34.71±5.42% versus 20.92±6.73%, p < 0.01) and MAV (71.51±8.20% versus 44.33±21.81%, p < 0.05) in the experimental group compared to the control group. The study has demonstrated preliminary evidence that precisely directing BoNT to the innervation zones (IZs) localized by 3DIZI leads to a significantly higher treatment efficiency improvement in spasticity management. Results have also shown the feasibility of developing a personalized BoNT injection technique for the optimization of clinical treatment for post-stroke spasticity using proposed 3DIZI technique.

中文翻译：

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使用 3D 神经支配区成像提高肉毒杆菌毒素治疗中风后痉挛的效率

痉挛是一种常见的中风后综合征，对患者和护理人员造成重大不利影响。本研究旨在通过利用基于高密度表面肌电图 (HD-sEMG) 记录的三维神经支配区成像 (3DIZI) 技术来提高肉毒杆菌毒素 (BoNT) 治疗痉挛的效率。中风受试者被随机分配到两组：对照组（n = 6) 接受标准超声引导下的注射，而实验组 (n = 6) 接受了 3DIZI 引导的注射。对于所有受试者，给予的 BoNT 量是一致的。在基线、注射后 3 周和 3 个月时获得双侧肱二头肌的改良 Ashworth 量表 (MAS)、复合肌肉动作电位 (CMAP) 和肌肉激活体积 (MAV)。进行了MAS、CMAP振幅和MAV的组内和组间比较。在为期 3 周的随访中观察到痉挛性肘屈肌的 MAS 总体改善（p < 0.01)，但在组内或组间分析中没有发现统计学上的显着差异。与基线相比，注射后 3 周两组痉挛二头肌的 CMAP 振幅和 MAV 均显着降低，注射后 12 周恢复至接近基线值。CMAP 振幅显着降低（34.71±5.42％ 相对20.92±6.73%,p < 0.01) 和 MAV (71.51±8.20％ 相对44.33±21.81%,p < 0.05) 实验组与对照组相比。该研究已初步证明，将 BoNT 精确引导至 3DIZI 定位的神经支配区 (IZ) 可显着提高痉挛管理的治疗效率。结果还表明，使用提出的 3DIZI 技术开发个性化 BoNT 注射技术以优化卒中后痉挛的临床治疗的可行性。