Noninvasive analysis of overactive muscle structure and elasticity after botulinum toxin type A injection: a systematic review and meta-analysis.

INTRODUCTION: Injections of botulinum toxin type A (BoNT-A) are the first-line treatment for spastic muscle overactivity (MO). Some authors observed that BoNT-A injections lead to changes in muscle structure and muscle elasticity that are probably not completely reversible. This possible effect is critical, as it could lead to negative impacts on the effectiveness of BoNT-A interventions. Our study aimed to evaluate the current literature regarding changes in muscle elasticity and structure after BoNT-A injection, by diagnostic imaging, in neurological populations with MO. Our second objective was to pool all articles published on this topic in order to provide a quantitative synthesis of the data. EVIDENCE ACQUISITION: A systematic search was conducted between October 2021 and April 2023 using different databases in accordance with PRISMA guidelines. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the studies. A meta-analysis was performed to compare muscle elasticity and structure before and after BoNT-A injections. EVIDENCE SYNTHESIS: A sample of 34 studies was selected for qualitative review and 19 studies for quantitative review. Meta-analysis of pre-post studies demonstrated significant improvement with a medium effect size (standardized mean difference=0.74; 95% CI 0.46-1.02; P<0.001) of muscle elasticity assessed by ultrasound elastography (USE) 4 weeks after BoNT-A injection. No statistically significant difference was found for muscle thickness, pennation angle, and muscle echo-intensity assessed by magnetic resonance imaging and/or ultrasonography at short-term. On the other hand, normalized muscle volume decreased with a small effect size (standardized mean difference = -0.17; 95% CI -0.25 - -0.09; P<0.001) 6 months after BoNT-A injection. CONCLUSIONS: Muscle elasticity measured by USE improves with a temporary effect at short-term following BoNT-A injections. Synthesis of studies that assesses muscle structure is hindered by methodological differences between studies. However, based on a small amount of data, normalized muscle volume seems to decrease at long-term after BoNT-A injections in children with CP suggesting that the timing of re-injection should be considered with caution in this population. Further work should focus on the long-term effect of repeated injections on muscle structure and elasticity in neurological populations.

Validation of the French version of the Multiple Sclerosis Intimacy And Sexuality Questionnaire-19: A preliminary study.

INTRODUCTION: Patients with multiple sclerosis (MS) suffer from various symptoms, including sexual dysfunction. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a scale that explores the impact of MS on sexual activity and satisfaction. AIM: This observational cohort study aimed to provide a validated, cross-cultural, French version of the MSISQ-19 in patients with MS. METHODS: The original version of MSISQ-19 was translated into French according to standardized guidelines. Patients were asked to complete all questionnaires during the inclusion visit and the MSISQ-19 a second time two weeks later. Content validity was assessed by face validity. Internal consistency was evaluated using Cronbach's alpha. Construct validity was checked by the exploratory factor analysis. Concurrent validity was assessed by performing Spearman's correlation coefficient with the Female Sexual Function Index (FSFI), the Male Sexual Health Questionnaire (MSHQ), and the Multiple Sclerosis International Quality of Life questionnaire (MusiQoL). Spearman's correlation coefficient was also used to evaluate the relationship with the Expanded Disability Status Scale (EDSS), age, and disease duration. Test-retest reliability was assessed by intraclass correlation coefficient (ICC). Responsiveness was assessed by the standard error of measurement (SEM) and the minimum detectable change (MDC). MAIN OUTCOME MEASURES: MSISQ-19 is the main outcome measure. RESULTS: We enrolled 71 patients with MS (49 female, 22 male). The mean age was 42.6 ± 9.7 years with a median disease duration of 8 [3-16] years. Sixty-four (90%) patients had relapsing-remitting MS, 4 (6%) primary progressive MS, and 3 (4%) secondary progressive MS. French MSISQ-19 showed a Cronbach's alpha coefficient of 0.89. MSISQ-19 scores correlated significantly and moderately between each other and correlated significantly and moderately with scores on the FSFI, MSHQ, MusiQoL and EDSS. Reproducibility was excellent with intraclass correlation coefficients > 0.80. Exploratory factor analysis was performed using principal component analysis. A three-factor solution was adopted giving eigenvalues higher than 1, supporting the primary, secondary, and tertiary dimensions. SEM was 4.55 and MDC was 12.6 (13.3%). CONCLUSION: This study provides a preliminary validation of the French version of the MSISQ-19 which could be a reliable, and reproducible instrument to assess sexual dysfunction in patients with MS. These results need to be confirmed in a larger cohort which will be more representative of the general MS population.

Timed Up-and-Go and 2-Minute Walk Test in patients with multiple sclerosis with mild disability: reliability, responsiveness and link with perceived fatigue.

BACKGROUND: Mobility limitations are frequent in patients with multiple sclerosis (MS), and could already be present in patients with so-called mild neurological disability (Expanded Disability Status Scale≤4). Assessing mobility in these patients is therefore of paramount importance. Timed Up-and-Go Test (TUG) and 2-Minute Walk Test (2MWT) are two clinically feasible tests which reliability and responsiveness are unknown among these patients. Whether fatigue, which is the number one symptom among these patients, is linked to these limitations remains unknown. AIM: The aim of this study was to explore the intrarater reliability and minimal detectable change (MDC95), as an index of responsiveness, of TUG and 2MWT. To explore their link with perceived fatigue among patients with MS. DESIGN: Cross-sectional observational study, including two measures. SETTING: Two university hospital outpatient centers. POPULATION: Patients (N.=63, 49 seen twice) with MS with mild disability (Expanded Disability Status Scale≤4). METHODS: 2MWT and TUG were performed twice in one occasion, and repeated 2 weeks later. Modified fatigue impact scale (MFIS) was used to assess fatigue. Intraclass coefficient correlations were calculated for immediate and 2-week reliability. MDC95 were computed. Correlations between mobility indices and fatigue were explored using Spearman's ρ. RESULTS: Mobility was impaired in comparison to normative values (2MWT: -4.9% from normative distance; TUG: +32% from normative time). The immediate reliability was excellent for both the 2MWT (ICC=0.98) and TUG (ICC=0.98). Reliability at 2 weeks was excellent for 2MWT (ICC=0.95) and very good for TUG (ICC=0.90). MDC95 were respectively 20m (2MWT) and 1.3s (TUG). Both measures were significantly weakly correlated to total MFIS (ρ=-0.37 and 0.39, respectively; P<0.01). CONCLUSIONS: The 2MWT and TUG are highly reliable and responsive in the assessment of respectively the walking capacity and general mobility of patients with MS with mild disability. Mobility impairments are linked to perceived fatigue among these patients. CLINICAL REHABILITATION IMPACT: TUG and 2MWT are easy to administer and could be reliably used in so called mildly disabled patients with MS to assess mobility limitation.