Injection Guidance References
Myoguide References
Myoguide Cited In the Literature
- Dr. Gordon D. Ko, MD, CCFP(EM), FRCPC, FABPMR, FABPM, has published two articles citing Myoguide in his clinical work:
- Ko G,D. Platelet-rich Plasma Prolotherapy for Low Back Pain Caused by Sacroiliac Joint Laxity. Practical Pain Management 2010;10(7):55-68. This article states: “EMG guided injections (into muscle) can be done incorporating the handheld Myoguide portable unit that provides both visual and auditory feedback. It also allows for E-stim to accurately localize muscles, motor points and peripheral nerves.”
- Ko G,D. Fibromyalgia Disability: Is There Any Hope?, Can J Diagnosis, March 2011; pp 58-62. This article references Myoguide in a figure showing: Figure 3: BTX-A injection into Pec minor muscle (Myoguide EMG guidance used in Cervical dystonia)
- http://fauquierent.blogspot.ca/2013/01/compact-emg-system-for-targeted-muscle.html
This Blog entry covers Myoguide use to support Spasmodic Dysphonia (vocal chord injections) - Jay KARRI, MD, MPH, Manuel F. MAS, MD, Gerard E. FRANCISCO, MD and Sheng LI, MD, PhD, PRACTICE PATTERNS FOR SPASTICITY MANAGEMENT WITH PHENOL NEUROLYSIS From the Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston (UTHealth) McGovernMedical School and The NeuroRecovery Research Center at TIRRMemorial Hermann, Houston, TX, USAJ Rehabil Med 2017; 49: 482–488
- Samotus O, Lee J, Jog M. Personalized Bilateral Upper Limb Essential Tremor Therapy with Botulinum Toxin Using Kinematics. Toxins. 2019; 11(2):125. https://doi.org/10.3390/toxins11020125
- Samotus O, Lee J, Jog M. Developing a Consistent, Reproducible Botulinum Toxin Type A Dosing Method for Upper Limb Tremor by Kinematic Analysis. Toxins. 2021; 13(4):264. https://doi.org/10.3390/toxins13040264
https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-2239
Grigoriu AI, Dinomais M, Rémy-Néris O, Brochard S. Impact of Injection-Guiding Techniques on the Effectiveness of Botulinum Toxin for the Treatment of Focal Spasticity and Dystonia: A Systematic Review. Arch Phys Med Rehabil. 2015 Nov;96(11):2067-78.e1.doi: 10.1016/j.apmr.2015.05.002. Epub 2015 May 14.PMID: 25982240
This review article showed strong evidence that instrumented guided injections (Ultrasound, EMG, STIM) were more effective than manual needle placement for the treatment of Spasmodic Torticollis, and both upper and lower limb spasticity.
Latest Articles Supporting Injection Guidance
Grigoriu AI, Dinomais M, Rémy-Néris O, Brochard S. Impact of Injection-Guiding Techniques on the Effectiveness of Botulinum Toxin for the Treatment of Focal Spasticity and Dystonia: A Systematic Review. Arch Phys Med Rehabil. 2015 Nov;96(11):2067-78.e1.doi: 10.1016/j.apmr.2015.05.002. Epub 2015 May 14.PMID: 25982240
The review article by Grigoriu et al., showed strong evidence that instrumented guided injections (Ultrasound, EMG, STIM) were more effective than manual needle placement for the treatment of Spasmodic Torticollis, and both upper and lower limb spasticity.
Alex Schnitzler, MD, Nicolas Roche, MD, Philippe Denormandie, MD, Christine Lautridou , MD, Bernard Parratte , MD, PhD, and Franc, Ois Genet, MD. Manual Needle Placement: Accuracy of Botulinum Toxin A Injections ; October 2012; Muscle and Nerve 46 531-534;
Findings show a poor success rate, regardless of injector experience. Muscle palpation and anatomical landmarks are insufficient to ensure the accuracy of BoNt-A injections, even for large, superficial muscles.
Both novice and expert injector groups did significantly better with EMG guidance
Injection Guidance References
Literature by Title
- Botulinum toxin injection for spasmodic torticollis :increased magnitude of benefit with electromyographic assistance. Comella CL, Buchman AS, Tanner CM, Brown-Toms NC, Goetz CG.: Neurology, 1992 APr;42(4):878-82
- Automated analysis of electromyography (EMG) recordings during botulinum injection. Hunter DG, Nguyen T, Patel SN, Repka MX : Pediatr Ophthalmol Stabismus. 1996 Sep-Oct;33(5):241-6
- Injection techniques for Botulinum toxin using electromyography and electrical stimulation. O’Brien CF: Muscle NErve Suppl. 1997;6:S176-80
- Electromyographic evaluation of cervical dystonia for planning of Botulinum toxin therapy. Dressler D.: Eur J Neurol, 2000Nov;7(6):713-8
- Surface electromyography apparatus as a measurement device for biofield research: results from a single case study. Forbes MA, Rust R. Becker GJ; J Altern Complement MEd. 2004 Aug;10(4):617-26
- Utility of an EMG mapping study in treating Cervical Dystonia. Van Ferpen JA, Matxumoto Jy, Ahiskog JE, Maraganore DM, McManis PG: Muscle Nerve. 2000 Nov;23(11):1752-6
- Electromyographic guidance in injecting Botulinum toxin. Klein AW, Mantell A. Dermatol Sureg. 1998 Nov;24(11):1184-6
- Accuracy of muscle localization without EMG: implications for treatment of limb dystonia. Molloy FM, Shill HA, Kaelin-Lang A, Karp BI. Neurology 2002 Mar 12;58(5):805-7
- EMG support in Botulinum toxin treatment. Monnier G, Parratte B. Tatu L, Cosson A, Michel F, Metton G. Ann Readapt Med Phys 2003 Jul;46(6):380-5
- Localizing muscles for botulinum toxin treatment of focal hand dystonia. Geenen C, Consky E, Ashby P. Can J Neurol Sci 1996 Aug;23(3):194-7
- Needle EMG guidance for injection of botulinum toxin. Needle EMG guidance is useful. Barbano RL. Muscle Nerve 2001 Nov;24(11):1567-8
- Needle EMG guidance for injection of botulinum toxin. Needle EMG guidance is rarely required. Jankovic J. Muscle nerve. 2001 NOve;24(11):1568-70
- The finding and evaluation of EMG-guided Botox® injection in cervical dystonia. Lee LH, Chang WN, Chang CS. Acta Neurol Taiwan 2004; 13(2): 71–6
- Dilution, storage, and electromyographic guidance in the use of botulinum toxins. Mantell AM.Dermatol Clin 2004; 22(2): 135–6
- Clinical Uses of Botulinum Toxin. Fishman, P.S. Johns Hopkins Advanced Studies in Medicine. Vol.5, No.4 April 2005: 176-182
- Electromyographic guidance of botulinum toxin treatment in cervical dystonia. Dubinsky RM, Gray CS, Vetere-Overfield B, Koller WC. Clin Neuropharmacol. 1991 Jun;14(3):262-7.
- Botulinum toxin in cervical dystonia: low dosage with electromyographic guidance. Brans JW, de Boer IP, Aramideh M, Ongerboer de Visser BW,Speelman JD. Neurol. 1995 Aug;242(8):529-34.
- Pain Management, vice-president’s column, Farmer, B. ST Quarterly, Vol 8, Issue 1: Spring 2006 (National Spasmodic Torticollis Association)
- Treatment of cervical dystonia with botulinum toxins. Comella, C. L. & Thompson, P. D. (2006) European Journal of Neurology 13 (s1), 16-20.
- Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Hong CZ, Simons DG: Arch Phys Med Rehabil 1998 Jul; 79(7): 863-72
- Botulinum Toxin Type A in Pain Management. Martin K. Childers, Daniel J. Wilson and Diane Simison. Demos Medical Publishing, New York, 1999. 136 pp., ISBN 0-986342-22-4.
- Crocodile tears syndrome: botulinum toxin treatment under EMG guidance. Kizkin S, Doganay S, Ozisik HI, Ozcan C. Funct Neurol. 2005 Jan-Mar;20(1):35-7.
- Botulinum toxin in cervical dystonia: low dosage with electromyographic guidance. J. W. M. Brans1 , I. P. de Boer1, M. Aramideh1, J. D. Speelman1and B. W. Ongerboer de Visser2Journal of Neurology, Volume 242, Number 8 / August, 1995
- Secondary nonresponsiveness to botulinum toxin A in cervical dystonia: the role of electromyogram-guided injections, botulinum toxin A antibody assay, and the extensor digitorum brevis test. Cordivari C, Misra VP, Vincent A, Catania S, Bhatia KP, Lees AJ. Mov Disord. 2006 Oct;21(10):1737-41
- Feasibility of electromyography (sEMG) in measuring muscular activity during spinal anaesthesia in patients undergoing knee arthroplasty. L. Niemi-Murola1* and M. Paloheimo. Acta Anaesthesiologica Scandinavica Volume 49 Issue 4 Page 558 – April 2005
- Treatment of bruxism in Huntington’s disease with botulinum toxin. Nash MC, Ferrell RB, Lombardo MA, Williams RB. Neuropsychiatry Clin Neurosci. 2004 Summer;16(3):381-2.
- Low-Dose Treatment of Cervical Dystonia, Blepharospasm and Facial Hemispasm with Albumin-Diluted Botulinum Toxin Type A under EMG Guidance
- An Open Label Study. Jens D. Rollnika, Mike Matzkea, Kai Wohlfartha, Reinhard Denglera, Hans Bigalke European Neurology 2000;43:9-12
- Grigoriu AI, Dinomais M, Rémy-Néris O, Brochard S. Impact of Injection-Guiding Techniques on the Effectiveness of Botulinum Toxin for the Treatment of Focal Spasticity and Dystonia: A Systematic Review. Arch Phys Med Rehabil. 2015 Nov;96(11):2067-78.e1.
doi: 10.1016/j.apmr.2015.05.002. Epub 2015 May 14.PMID: 25982240
Shows strong evidence that instrumented guided injections (Ultrasound, EMG, STIM) were more effective than manual needle placement for the treatment of Spasmodic Torticollis, and both upper and lower limb spasticity.
