Objective: To describe the current situation of training and practices among physicians using guidance techniques for botulinum neurotoxin-A (BoNT-A) injectionsin the treatment of Cervical Dystonia (CD) and Spastic Paresis (SP).

Background: BoNT-A is commonly used as the first line treatment for CD and SP. However, there are no specific recommendations regarding injection techniques in either disorder.

Method: A self-completion, anonymous questionnaire on experience, training and confidence in different BoNT-A injection techniques was designed by a multidisciplinary Steering Committee and sent by email to 518 physicians managing patients with SP and/or CD who attended an Ixcellence Network® training session from 2012 to 2018.

Results: Between June 1st and November 1st 2018, the questionnaire was completed by 112 physicians specialized in physical medicine and rehabilitation (49%), neurology (43%) and neuropaediatrics or orthopaedics (8%), with an average experience of 16.5 years in their field and 11 years in BoNT-A injection. Among respondents, 68% reported treating adult patients with SP and 48% adult patients with CD. When performing BoNT-A injection, guidance techniques such as ultrasound (US), electrostimulation (ES) and electromyography (EMG) were systematically or regularly used by, respectively, 72%, 48% and 34% of physicians treating SP, and 61%, 31% and 42% of physicians treating CD. Respondents had received dedicated training on BoNT-A injection guidance techniques: 82% of physicians treating SP were trained on US (76%), ES (55%) or EMG (41%); in physicians treating CD, 79% had received training on US (78%), ES (39%) and EMG (54%). Respondents reported a change in their practice over the past 5 years, regardless of whether they treated SP or CD: 87% of physicians treating SP and 82% of physicians treating CD reported using more US for BoNT-A injection while the use of EMG or ES remained the same or decreased [Table 1].

Conclusion: In this population, although all three guidance techniques are utilized (US, ES, and EMG), US is the most used when performing BoNT-A injection. The INPUT survey results highlight the growing use of US in recent years. However, this does not prevent the physicians surveyed from continuing to use EMG or ES. Interestingly, the results were similar among respondents treating patients with CD or SP.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/training-and-usage-of-botulinum-neurotoxin-a-guided-injection-in-cervical-dystonia-spastic-paresis-results-from-the-input-survey/