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，中风后幸存者痉挛的发生率为 20%-40%。肉毒杆菌神经毒素（BTX） 被认为是局灶性痉挛管理的一线治疗方法。然而，BTX注射成本高昂且 可能会给患者带来副作用甚至严重的问题。副作用的发生和严重程度是 取决于毒素的输送剂量。 BTX 阻断突触前神经递质的释放 神经肌肉接头 (NMJ)，通过表面肌电图记录的神经支配区 (IZ) 进行估计。研究有 证明将注射距离距离肌肉 IZ 增加 1cm 会降低 BTX 的效果 46%。因此，在目标肌肉的 3 维 (3D) 空间中准确定位 IZ 至关重要 指导BTX注射液以最小剂量获得最佳临床效果。不幸的是，IZ 位置各不相同 肌肉和个体之间的 3D IZ 分布，目前还没有可用的技术来定义 3D IZ 分布 用于指导特定患者进行 BTX 注射的痉挛肌肉。 我们最近开发了一种新颖的 3D IZ 成像 (3DIZI) 方法，将 MAI 和表面 EMG 相结合 分解方法对目标肌肉 3D 空间中 IZ 的分布进行成像 密度表面肌电图记录。开发的 3DIZI 方法已在两名健康男性身上得到验证 科目。该项目的目标是进一步评估新颖的 3DIZI 方法在痉挛肌肉中的应用，并 研究利用 3DIZI 方法指导 BTX 注射治疗肌肉痉挛的可行性。这 假设是痉挛肌肉中 IZ 的 3D 分布可以从高 使用 3DIZI 方法进行密度表面肌电图记录，并且 IZ 引导的 BTX 注射将产生 与标准注射程序相比，以更低的剂量获得更好的临床结果。我们将评估 3DIZI 方法在痉挛患者痉挛肌 3D 空间中定位 IZ 的性能 通过同时记录高密度表面肌电图和肌内肌电图记录来观察肌肉痉挛。 我们还将研究利用 3DIZI 方法指导患有以下疾病的患者注射 BTX 的可行性： 通过比较 3DIZI 引导的 BTX 注射与标准 BTX 的治疗结果来观察二头肌痉挛 注射。 这项研究首次对神经支配区或传播的 3D 分布进行成像 来自高密度无创表面肌电图记录的目标肌肉的肌肉活动。它提供了充足的 未来基础研究和临床应用的机会，例如建议的指导应用 肉毒素注射剂。这项研究的主要影响将导致 3DIZ 引导的 BTX 注射技术的出现 具有创新性和临床意义。因为 BTX 被注入到需要使用这种技术的地方， 技术能够或有望显着减少剂量，从而降低这种非常昂贵的治疗费用 改善临床结果。此外，预计可以最大限度地减少可能的不利影响。