Analyse des facteurs pronostics d’efficacité du traitement de la spasticité par injection de toxine botulinique. De l’analyse du muscle spastique en imagerie ultrasonore à l’immunisation post injection de toxine botulinique

Abstract : The aim was to investigate a muscle evaluation method to determine tissue factors leading to non-responsiveness to an injection of botulinum toxin (BTX) into a spastic muscle in adult post stroke and children with cerebral palsy (CP). A reproducibility study and 3 systematic literature reviews were carried out. 2D ultrasound measurements of thickness and pennation angle of medialis gastrocnemius muscle fibers are reproducible. Measurement of the modulus of elasticity by shear wave ultrasound elastography provides a reliable information about the rigidity of the spastic medial gastrocnemius muscle at rest.Analysis of the post-injection muscle fate found that BTX participates in the remodeling of the spastic muscle with persistent atrophy that is dependent on the repetition of the injections.Analysis of the impact of BTX adjuvant therapies in CP children showed that intensive muscle strengthening, including of the injected muscles, may help combat atrophy without increasing spasticity. Stretching casts are used to optimize joint function, but there is little evidence for a reduction in muscle stiffness. In the description of prognostic efficacy factors, more than half of patients identified as secondariy non-responders to BTX in limb spasticity tests were not immunized against BTX. Neutralizing antibodies were therefore not the main cause for secondary non-responsiveness. An ultrasound evaluation of muscle quality as a prognostic factor for BTX response and to measure the impact of adjuvant treatments must be regularly performed to determine when these treatments are no longer favourable for the muscle system.
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Laure Mathevon. Analyse des facteurs pronostics d’efficacité du traitement de la spasticité par injection de toxine botulinique. De l’analyse du muscle spastique en imagerie ultrasonore à l’immunisation post injection de toxine botulinique. Médecine humaine et pathologie. Université de Lyon, 2018. Français. ⟨NNT : 2018LYSES023⟩. ⟨tel-02172038⟩

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