Imaging of 3D Innervation Zone Distribution in Spastic Muscles from High-Density Surface EMG Recordings

根据高密度表面 EMG 记录对痉挛肌肉的 3D 神经支配区分布进行成像

• 批准号: 9318021
• 负责人: Sheng Li
• 金额: $ 20.4万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9318021
• 关键词: Action Potentials; Adverse effects; Anatomy; Autonomic Nerve Block; Basic Science; Bontoxilysin; Caregivers; Clinic; Clinical; Denervation; Dimensions; Dose; Future; Goals; Image; Impairment; Incidence; Individual; Injectable; Injection of therapeutic agent; Intramuscular; Investigation; Location; Monoclonal Antibody R24; Motor; Muscle; Muscle Spasticity; Muscle Weakness; Muscular Atrophy; Nerve Block; Neurologic; Neuromuscular Diseases; Neuromuscular Junction; Outcome; Patients; Performance; Peripheral; Pilot Projects; Procedures; Publishing; Quality of life; Recruitment Activity; Reporting; Research; Severities; Signal Transduction; Societies; Spastic; Spinal cord injury; Stroke; Surface; Techniques; Testing; Toxin; Training; Treatment outcome; United States National Institutes of Health; biceps brachii muscle; clinical application; clinical effect; clinically significant; cost; density; design; image guided; imaging approach; immunoreaction; improved; innovation; male; nerve supply; neuromuscular; neurotransmitter release; novel; post stroke; presynaptic; research study; spasticity; stroke survivor; validation studies

The incidence of spasticity is reported to be 20%-40% in post-stroke survivors. Botulinum neurotoxin (BTX) is considered as the first-line treatment for focal spasticity management. However, BTX injection is costly and may cause side effects or even severe problems in patients. The occurrence and severity of side effects are dependent on the delivered dose of toxin. BTX blocks release of neurotransmitters presynaptically at the neuromuscular junction (NMJ), estimated by innervation zone (IZ) from surface EMG recordings. Studies have demonstrated that increasing the injection distance by 1cm from the IZ of muscle reduced the effect of BTX by 46%. Therefore, it is critical to accurately localize IZs in the 3-dimentional (3D) space of the target muscles to guild the BTX injection for the best clinical effect with the minimum dose. Unfortunately, the IZ locations vary between muscles and individuals, and currently there is no technique available to define 3D IZ distributions in spastic muscles for guiding BTX injections for specific patients. We recently developed a novel 3D IZ imaging (3DIZI) approach by combining the MAI and surface EMG decomposition approaches to image the distribution of IZs in the 3D space of the target muscles from high- density surface EMG recordings. The developed 3DIZI approach has been validated in two healthy male subjects. The Goal of this project is to further evaluate the novel 3DIZI approach in spastic muscles and to examine the feasibility of utilizing the 3DIZI approach to guide BTX injections in treating muscle spasticity. The hypothesis is that the 3D distribution of IZs in spastic muscles can be accurately reconstructed from high- density surface EMG recordings using the 3DIZI approach, and that IZ-guided BTX injections will generate better clinical outcomes with a lower dose compared to standard injection procedure. We will evaluate the performance of the 3DIZI approach in localizing IZs in the 3D space of the spastic muscles in patients with muscle spasticity with simultaneously recorded high-density surface EMG and intramuscular EMG recordings. We will also examine the feasibility of utilizing the 3DIZI approach to guide BTX injections in patients with biceps spasticity by comparing the treatment outcomes of 3DIZI-guided BTX injections against standard BTX injections. This research represents the first effort to image the 3D distribution of innervation zones or propagating muscle activities in target muscles from high-density noninvasive surface EMG recordings. It provides ample opportunities for future basic research and clinical applications, such as the proposed application for guiding BTX injections. The primary impact of this research will lead to 3DIZ-guided BTX injection technique which is innovative and clinically significant. Because BTX is injected to where its needs to be using this technique, the technique is able or expected to significantly reduce the dose, thus the cost of this very expensive treatment with improved clinical outcomes. Moreover, it is expected to minimize possible adverse effects.

据报道，中风后幸存者的痉挛发生率为20％-40％。肉毒神经毒素（BTX） 被认为是局灶性痉挛管理的一线治疗方法。但是，BTX注入昂贵，并且 可能会导致副作用，甚至可能导致患者的严重问题。副作用的发生和严重程度是 取决于输送剂量的毒素。 BTX阻止神经递质在突触前的释放 神经肌肉连接（NMJ），通过表面EMG记录的神经接触区（IZ）估算。研究有 证明将注射距离增加到与肌肉IZ的1厘米增加可减少BTX的影响 46％。因此，至关重要的是，在目标肌肉的3维（3D）空间中精确定位IZ是至关重要的 通过最低剂量，将BTX注射协会以最佳的临床效果。不幸的是，IZ位置有所不同 在肌肉和个人之间，目前尚无可用的技术来定义3D IZ分布 用于指导特定患者的BTX注射的痉挛肌肉。 我们最近通过组合MAI和表面EMG开发了一种新颖的3D IZ成像（3Dizi）方法 分解方法以从高位中的3D空间中图像IZ的分布 密度表面EMG记录。开发的3Dizi方法已在两个健康的男性中得到验证 主题。该项目的目的是进一步评估痉挛性肌肉中的新型3Dizi方法和 检查利用3DIZI方法指导BTX在治疗肌肉痉挛中的可行性。这 假设是，可以从高 - 可以准确地重建痉挛性肌肉中IZ的3D分布 使用3Dizi方法的密度表面EMG记录，并且IZ引导的BTX注射将产生 与标准注射程序相比，剂量较低的临床结果更好。我们将评估 3Dizi方法在痉挛性肌肉3D空间中定位IZ的性能 肌肉痉挛和同时记录的高密度表面EMG和肌内EMG记录。 我们还将研究利用3Dizi方法指导BTX注射的可行性 通过比较3Dizi引导的BTX注射与标准BTX的治疗结果，通过比较二头肌痉挛 注射。 这项研究代表了图像神经支配区域的3D分布或传播的第一个努力 来自高密度非侵入性表面EMG记录的目标肌肉中的肌肉活性。它提供了足够的 未来的基础研究和临床应用的机会，例如拟议的指导申请 BTX注射。这项研究的主要影响将导致3DIZ引导的BTX注入技术，这是 创新且具有临床意义。因为将BTX注射到需要使用此技术的位置，所以 技术能够或期望大大减少剂量，因此这种非常昂贵的治疗的成本 随着临床结果的改善。此外，预计将最大程度地减少可能的不良影响。