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 electricalstimulation-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 electricalstimulation-guided injections. Conclusion: In agreement with previous research, no differences were found in the efficacy of ultrasoundguided 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.