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Guidance in botulinum neurotoxin injection for lower extremity spasticity: Sihler’s staining technique

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Abstract

Spasticity is a motor disease characterized by a velocity-dependent acceleration in muscle tone or tonic stretch reflexes linked to hypertonia. Lower limb spasticity has been successfully treated with botulinum neurotoxin; however, the injection sites have not been generalized. Sihler’s stain has been used to visualize intramuscular nerve distribution to guide botulinum neurotoxin injection. Sihler staining is a whole-mount nerve staining technique that allows visualization of nerve distribution and mapping of entire nerve supply patterns in skeletal muscle with hematoxylin-stained myelinated nerve fibers. This study reviewed and summarized previous lower extremity spasticity studies to determine the ideal injection site for botulinum neurotoxin.

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Acknowledgements

This study was conducted in compliance with the principles set forth in the Declaration of Helsinki. Consent was received from the families of the deceased patients before beginning the dissections. The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

Funding

There are no funding for the study.

Author information

Author notes

  1. Hyewon Hu and Min Ho An have contributed equally.

Authors and Affiliations

  1. Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Maylin Clinic, Yonsei University College of Dentistry, 50-1 Yonsei-Ro, Seoul, 03722, Republic of Korea

    Hyewon Hu & Kyu-Ho Yi

  2. Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea

    Min Ho An

  3. Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea

    Hyung-Jin Lee

  4. Maylin Clinic (Apgujeong), Seoul, South Korea

    Kyu-Ho Yi

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  1. Hyewon Hu
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Contributions

All authors have reviewed and approved the article for submission. K-HY, H-WH, and H-JL were responsible for conceptualization; K-HY and MHA prepared the original draft; K-HY and H-WH contributed to writing—reviewing and editing; H-WH was involved in visualization; and K-HY and H-JL took part in supervision.

Corresponding authors

Correspondence to Hyung-Jin Lee or Kyu-Ho Yi.

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Conflict of interest

I acknowledge that I have considered the conflict of interest statement included in the “Author Guidelines.” I hereby certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to significantly affect my views on the subject I am presenting.

Ethical approval

This study was conducted in compliance with the principles set forth in the Declaration of Helsinki. Consent was received from the families of the deceased patients before beginning the dissections.

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Hu, H., An, M.H., Lee, HJ. et al. Guidance in botulinum neurotoxin injection for lower extremity spasticity: Sihler’s staining technique. Surg Radiol Anat 45, 1055–1062 (2023). https://doi.org/10.1007/s00276-023-03178-9

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  • DOI: https://doi.org/10.1007/s00276-023-03178-9

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