- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01935544
Effectiveness of Two Techniques in Injection Site Spotting for Botulinum Toxin Injections: Echography or Electro Stimulation.
Botulinum toxin injections are an effective treatment of limb spasticity after stroke. Different tracking techniques are used to locate a proper injection spot. Palpatory technique is barely effective and induces a high risk of error. Localization by electro stimulation is frequently used in adults, but often requires multiple painful repositioning of the needle. Ultrasound tracking is sometimes used in children but not much in adults.
The advantages of ultrasound-guided botulinum toxin injections are a painless localization and greater injection accuracy. Safety is therefore enhanced since intravascular injection is easily avoided.
The few existing publications on the subject are essentially case reports. Few studies have focused on comparing different injection techniques and so far, no well-conducted study has highlighted superior efficiency of ultrasound-guided injections.
Study Overview
Detailed Description
Objectives:
The main objective is to compare the efficiency of botulinum toxin injections depending on the localization technique: ultrasound vs. electrical stimulation.
The secondary objective is to demonstrate less painful localization associated to ultrasound-guidance.
Evaluations:
The primary endpoint is the variation of passive range of motion of ankle dorsiflexion at slow speed and high speed ("Tardieu scale") while keeping knee straight.
The secondary endpoints are:
- The other components of the "Tardieu scale": quality of muscle reaction (X) at slow speed and fast speed, angle of apparition of the muscle reaction (Y) at slow speed and fast speed.
- Assessment of spasticity of the triceps surae on the modified Ashworth scale.
- The walking speed.
- The extent of pain at the injection site by visual analogue scale.
- The duration of tracking and injection.
Methodology:
This prospective, randomized, single-center, single-blind, cross-over, study will be conducted in chronic stroke patients with spasticity of the triceps surae.
Patients will receive two injections during the protocol, each with a different technique of localization. Randomization will determine which technique will be used in the first and the second place.
Patients will be selected from the cohort of patients supported by consultation of Physical Medicine and Rehabilitation Department of the University Hospital of Clermont-Ferrand. Injections of botulinum toxin and assessments will take place in the same department.
The study period is five months for each patient. This study does not present a major risk for the subjects. The main inconvenience is injection pain or side effects of botulinum toxin (increase of motor deficits or dysphagia).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Clermont-Ferrand, France, 63003
- CHU Clermont-Ferrand
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18 to 80 years.
- Hemiplegia sequelae of stroke
- Spasticity of the triceps surae listed at least 1 + / 4 on the modified Ashworth scale
- Ability to give written consent
Exclusion Criteria:
- Injection of botulinum toxin older than 3 months
- Patient who has already received ultrasound-guided injection of botulinum toxin
- Indication of botulinum toxin injection in other muscle groups in the lower limb than triceps surae
- Swallowing impairment
- Ongoing AVK anticoagulation treatment with INR greater than 3 during one week before randomization.
- Ongoing treatment by aminoglycosides
- General anesthesia with injection of curare planned during the participation in the protocol
- Wearing a pacemaker
- History of ankle arthrodesis
- Other cons-indication for botulinum toxin injection: myasthenia gravis, pregnancy, lactation.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: botulinum toxin injections
The main objective is to compare the efficiency of botulinum toxin injections depending on the localization technique: ultrasound vs. electrical stimulation.
|
|
Other: ultrasound guidance
The secondary objective is to demonstrate less painful localization associated to ultrasound-guidance
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Passive range of motion of ankle dorsiflexion (Tardieu scale) while keeping knee straight
Time Frame: at inclusion
|
at inclusion
|
Passive range of motion of ankle dorsiflexion (Tardieu scale) while keeping knee straight
Time Frame: at day 1 (first injection)
|
at day 1 (first injection)
|
Passive range of motion of ankle dorsiflexion (Tardieu scale) while keeping knee straight
Time Frame: at day 60
|
at day 60
|
Passive range of motion of ankle dorsiflexion (Tardieu scale) while keeping knee straight
Time Frame: at day 120 (second injection)
|
at day 120 (second injection)
|
Passive range of motion of ankle dorsiflexion (Tardieu scale) while keeping knee straight
Time Frame: at day 150
|
at day 150
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Tardieu scale: quality of muscle reaction at slow speed and fast speed
Time Frame: at Inclusion, D1, D60, D120 and D150
|
at Inclusion, D1, D60, D120 and D150
|
Angle of apparition of the muscle reaction at slow speed and fast speed
Time Frame: at Inclusion, D1, D60, D120 and D150
|
at Inclusion, D1, D60, D120 and D150
|
Spasticity of the triceps surae on the modified Ashworth scale
Time Frame: at Inclusion, D1, D60, D120 and D150
|
at Inclusion, D1, D60, D120 and D150
|
Walking speed
Time Frame: at Inclusion, D1, D60, D120 and D150
|
at Inclusion, D1, D60, D120 and D150
|
Extent of pain at the injection site by visual analogue scale
Time Frame: at D1, D120
|
at D1, D120
|
Duration of tracking and injection
Time Frame: at D1, D120
|
at D1, D120
|
Collaborators and Investigators
Investigators
- Principal Investigator: Isabelle HAURET, University Hospital, Clermont-Ferrand
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- CHU-0153
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Stroke
-
University Hospital, GhentRecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Stroke HemorrhagicBelgium
-
Moleac Pte Ltd.RecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, CryptogenicSingapore, Philippines
-
Moleac Pte Ltd.Not yet recruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, Cryptogenic
-
IRCCS San Camillo, Venezia, ItalyRecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke HemorrhagicItaly
-
Vanderbilt University Medical CenterPatient-Centered Outcomes Research Institute; University of Alabama at BirminghamEnrolling by invitationStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Engagement, Patient | Stroke HemorrhagicUnited States
-
University of MinnesotaAmerican Occupational Therapy FoundationRecruitingStroke | Stroke Sequelae | Stroke Hemorrhagic | Stroke IschemicUnited States
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Michael Smith Foundation for...RecruitingStroke | Stroke, Ischemic | Stroke Hemorrhagic | Chronic StrokeCanada
-
University of CincinnatiMedical University of South Carolina; University of California, Los Angeles; University...RecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke HemorrhagicUnited States
-
Turkish Stroke Research and Clinical Trials NetworkElectroCore INC; Turkish Neurological SocietyCompletedStroke | Stroke, Ischemic | Stroke, Acute | Stroke, HemorrhagicTurkey
-
University of LiegeCompletedStroke, Acute | Stroke Hemorrhagic | Stroke, ComplicationBelgium
Clinical Trials on Botulinum toxin injection
-
Assistance Publique - Hôpitaux de ParisMerz Pharmaceuticals GmbHUnknownTraumatic Brain Injury | Hemiparesis After StrokeFrance
-
YangHuiUnknown
-
Marmara UniversityCompletedStroke | Spasticity as Sequela of Stroke | Upper Limb HypertoniaTurkey
-
HugelCompletedBenign Masseteric HypertrophyKorea, Republic of
-
Hospices Civils de LyonCompleted
-
Assistance Publique - Hôpitaux de ParisCompleted
-
Zeng ChanghaoRecruitingCricopharyngeal AchalasiaTaiwan
-
HugelCompletedOveractive BladderKorea, Republic of
-
AllerganTerminatedOveractive BladderSerbia, Turkey, Greece, Egypt, Lebanon, India
-
HugelCompletedCervical DystoniaKorea, Republic of