{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:39:09Z","timestamp":1791545949585,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007819","name":"Allergan","doi-asserted-by":"publisher","award":["Allergan, inc. prior to acquisition by Abbvie, inc"],"award-info":[{"award-number":["Allergan, inc. prior to acquisition by Abbvie, inc"]}],"id":[{"id":"10.13039\/100007819","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["CTSA award UL1TR001433 (to Icahn School of Medicin"],"award-info":[{"award-number":["CTSA award UL1TR001433 (to Icahn School of Medicin"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["Intramural research program"],"award-info":[{"award-number":["Intramural research program"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Botulinum neurotoxin (BoNT) injection is an established therapy for limb spasticity and focal limb dystonia. Comparative benefits of injection guidance procedures have not been rigorously studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We compared 2 targeting techniques for onabotulinumtoxin\u2010A (onabotA) injection for the treatment of focal hand dystonia and upper limb spasticity: electrophysiologic guidance using electrical stimulation (E\u2010stim) and ultrasound (US).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a 2\u2010center, randomized, crossover, assessor\u2010blinded trial. Participants with focal hand dystonia or upper limb spasticity, on stable onabotA therapy for at least 2 previous injection cycles, were randomly assigned to either E\u2010stim or US with crossover at 3\u2009months. The primary outcome was improvement in dystonia or spasticity severity on a visual analog scale (VAS; 0\u2013100) measured 1 month after each injection. The secondary outcome was participant discomfort assessed on a VAS. Repeated\u2010measures analysis of covariance was used with linear mixed\u2010model covariate selection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 19 participants (13 men) completed the study, 10 with upper limb spasticity and 9 with dystonia. Benefit was equivalent between the 2 techniques (VAS least\u2010square mean [LSmean] 51.5\u2009mm with US and 53.1 with E\u2010stim). E\u2010stim was perceived as more uncomfortable by participants (VAS LSmean 34.5 vs. 19.9 for E\u2010stim and US, respectively). Procedure duration was similar with the 2 procedures. There were no serious adverse events related to either approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>US and E\u2010Stim localization guidance techniques provide equivalent efficacy in onabotA injections for spasticity and dystonia. US guidance injections are more comfortable for participants. Both techniques are effective guidance methods, with US potentially preferable based on participant comfort.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.13546","type":"journal-article","created":{"date-parts":[[2022,8,20]],"date-time":"2022-08-20T08:13:02Z","timestamp":1660983182000},"page":"1055-1061","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Comparison of Ultrasound and Electrical Stimulation Guidance for Onabotulinum <scp>Toxin\u2010A<\/scp> Injections: A Randomized <scp>Crossover<\/scp> Study"],"prefix":"10.1002","volume":"9","author":[{"given":"Codrin","family":"Lungu","sequence":"first","affiliation":[{"name":"Division of Clinical Research, National Institute of Neurological Disorders and Stroke National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Nmashie","sequence":"additional","affiliation":[{"name":"Department of Pediatrics New York Medical College\/NYCHealth Hospitals\/Metropolitan  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Catherine","family":"George","sequence":"additional","affiliation":[{"name":"Department of Neurology Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara I.","family":"Karp","sequence":"additional","affiliation":[{"name":"Division of Clinical Research, National Institute of Neurological Disorders and Stroke National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine","family":"Alter","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Clinical Center, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Neurology Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winona","family":"Tse","sequence":"additional","affiliation":[{"name":"Department of Neurology Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Frucht","sequence":"additional","affiliation":[{"name":"Department of Neurology New York University Grossman School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianxia","family":"Wu","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit National Institute of Neurological Disorders and Stroke, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Koo","sequence":"additional","affiliation":[{"name":"Human Motor Control Section National Institute of Neurological Disorders and Stroke, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Considine","sequence":"additional","affiliation":[{"name":"Human Motor Control Section National Institute of Neurological Disorders and Stroke, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Norato","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit National Institute of Neurological Disorders and Stroke, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3180-6811","authenticated-orcid":false,"given":"Mark","family":"Hallett","sequence":"additional","affiliation":[{"name":"Human Motor Control Section National Institute of Neurological Disorders and Stroke, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Neurology Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002560"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.23410"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.58.5.805"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2013.791727"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2010.05.001"},{"key":"e_1_2_7_7_1","volume-title":"Ultrasound\u2010guided chemodenervation procedures: text and atlas","author":"Alter KE","year":"2013"},{"key":"e_1_2_7_8_1","volume-title":"Anatomical Guide for the Electromyographer: The Limbs and Trunk","author":"Perotto AO","year":"2011"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1515\/sjpain-2018-0012"},{"key":"e_1_2_7_10_1","volume-title":"Quantification of neurological deficit","author":"Fahn S","year":"1989"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31829e6f72"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/67.2.206"},{"issue":"7","key":"e_1_2_7_13_1","first-page":"28","article-title":"The clinical global impressions scale: applying a research tool in clinical practice","volume":"4","author":"Busner J","year":"2007","journal-title":"Psychiatry (Edgmont)"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0366"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23504"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25582"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2015.05.002"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215516655589"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2017.09.006"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215513497735"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011751"}],"container-title":["Movement Disorders Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mdc3.13546","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mdc3.13546","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mdc3.13546","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:21:21Z","timestamp":1760962881000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mdc3.13546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,7]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1002\/mdc3.13546"],"URL":"https:\/\/doi.org\/10.1002\/mdc3.13546","archive":["Portico"],"relation":{},"ISSN":["2330-1619","2330-1619"],"issn-type":[{"value":"2330-1619","type":"print"},{"value":"2330-1619","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,7]]},"assertion":[{"value":"2022-03-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}