Imaging of 3D Innervation Zone Distribution in Spastic Muscles from High-Density Surface EMG Recordings

据报道，中风后幸存者的痉挛发生率为20%-40%。肉毒神经毒素(BTX) 被认为是局灶性痉挛治疗的一线治疗方法。然而，BTX注射成本很高，而且 可能会引起副作用，甚至会给患者带来严重的问题。副作用的发生和严重程度如下 取决于输送的毒素剂量。BTX在突触前阻断神经递质的释放 神经肌肉接头(NMJ)，由体表肌电记录的神经支配带(IZ)估计。研究表明， 结果表明，增加距肌肉IZ 1 cm的注射距离可通过以下方式降低BTX的效果 46%。因此，在目标肌肉的三维(3D)空间中准确地定位IZ是至关重要的 以最小的剂量指导BTX注射剂取得最佳的临床效果。不幸的是，IZ的位置各不相同 在肌肉和个人之间，目前还没有可用的技术来定义3D IZ分布 用于指导特定患者注射BTX的痉挛肌肉。 我们最近开发了一种新的3DIZ成像(3DIZI)方法，将MAI和表面肌电相结合 利用分解方法从高位图像获取靶肌IZs在三维空间的分布 密度表面肌电信号记录。开发的3DIZI方法已在两名健康男性身上得到验证 研究对象。该项目的目标是进一步评估新的3DIZI方法在痉挛肌肉中的应用，并 研究利用3DIZI方法指导BTX注射治疗肌肉痉挛的可行性。这个 假说是痉挛肌肉中IZs的三维分布可以从高位重建得到精确的重建 使用3DIZI方法的密度表面肌电记录，以及IZ引导的BTX注射将产生 与标准注射程序相比，较低剂量的临床结果更好。我们将评估 3DIZI方法在痉挛肌三维空间定位中的应用 肌肉痉挛患者同时记录高密度表面肌电信号和肌内肌电信号。 我们还将研究利用3DIZI方法指导BTX注射治疗的可行性。 3DIZI引导下注射BTX与标准BTX治疗二头肌痉挛的疗效比较 打针。 这项研究是首次尝试对神经支配区域或传播的三维分布进行成像 高密度非侵入性表面肌电信号记录中靶肌肉的肌肉活动。它提供了充足的 未来基础研究和临床应用的机会，例如拟议的指导申请 BTX注射。这项研究的主要影响将导致3DIZ引导的BTX注射技术，即 具有创新性和临床意义。因为BTX被注入到它需要使用这种技术的地方，所以 这项技术能够或有望显著减少剂量，因此这种非常昂贵的治疗费用 改善了临床结果。此外，预计它将最大限度地减少可能的不利影响。

The incidence of spasticity is reported to be 20%-40% in post-stroke survivors. Botulinum neurotoxin (BTX) is considered as the first-line treatment for focal spasticity management. However, BTX injection is costly and may cause side effects or even severe problems in patients. The occurrence and severity of side effects are dependent on the delivered dose of toxin. BTX blocks release of neurotransmitters presynaptically at the neuromuscular junction (NMJ), estimated by innervation zone (IZ) from surface EMG recordings. Studies have demonstrated that increasing the injection distance by 1cm from the IZ of muscle reduced the effect of BTX by 46%. Therefore, it is critical to accurately localize IZs in the 3-dimentional (3D) space of the target muscles to guild the BTX injection for the best clinical effect with the minimum dose. Unfortunately, the IZ locations vary between muscles and individuals, and currently there is no technique available to define 3D IZ distributions in spastic muscles for guiding BTX injections for specific patients. We recently developed a novel 3D IZ imaging (3DIZI) approach by combining the MAI and surface EMG decomposition approaches to image the distribution of IZs in the 3D space of the target muscles from high- density surface EMG recordings. The developed 3DIZI approach has been validated in two healthy male subjects. The Goal of this project is to further evaluate the novel 3DIZI approach in spastic muscles and to examine the feasibility of utilizing the 3DIZI approach to guide BTX injections in treating muscle spasticity. The hypothesis is that the 3D distribution of IZs in spastic muscles can be accurately reconstructed from high- density surface EMG recordings using the 3DIZI approach, and that IZ-guided BTX injections will generate better clinical outcomes with a lower dose compared to standard injection procedure. We will evaluate the performance of the 3DIZI approach in localizing IZs in the 3D space of the spastic muscles in patients with muscle spasticity with simultaneously recorded high-density surface EMG and intramuscular EMG recordings. We will also examine the feasibility of utilizing the 3DIZI approach to guide BTX injections in patients with biceps spasticity by comparing the treatment outcomes of 3DIZI-guided BTX injections against standard BTX injections. This research represents the first effort to image the 3D distribution of innervation zones or propagating muscle activities in target muscles from high-density noninvasive surface EMG recordings. It provides ample opportunities for future basic research and clinical applications, such as the proposed application for guiding BTX injections. The primary impact of this research will lead to 3DIZ-guided BTX injection technique which is innovative and clinically significant. Because BTX is injected to where its needs to be using this technique, the technique is able or expected to significantly reduce the dose, thus the cost of this very expensive treatment with improved clinical outcomes. Moreover, it is expected to minimize possible adverse effects.