The vibrations increase the effectiveness of botulinum toxin in reducing muscle tension

In the symptomatic treatment of many neuromuscular diseases (such as in the case of excessive, abnormal muscle tone, spasticity, torticollis, clubfoot, cerebral palsy or multiple sclerosis) injection of botulinum neurotoxin (BoNT) is used. BoNT lowers muscle tension. In order to achieve sustained improvement, in many cases repeated injections and high doses of BoNT must be used, which favors the development of antibodies that reduce or even neutralize the effects of BoNT. Therefore, various methods are tested to reduce the BoNT dose. In the presented pilot study, German scientists analyzed the behavior of muscle tension, expressed by the size of the compound muscle action potential (CMAP), after administration of BoNT in combination with vibration ergometry training (VET) – vibration on an ergometer. It was assumed that the vibrations would help BoNT to more effectively reduce the muscle tension, i.e. lower the CMAP.

• About 10 hours after the BoNT injection (and after several previous VET sessions) the CMAP of the examined muscle decreased by 48%, and about 12 hours later it was reduced to 18%. It was, according to the authors, the fastest CMAP reduction after BoNT observed so far.
• In addition, VET has shown short-term and long-term positive effects on the strength of lower leg muscles.

Prepared on the basis of:

Enhanced Effect of Botulinum Toxin A Injections into the Extensor Digitorum Brevis Muscle after Local Mechanical Leg Vibration: A Case Report. Hefter H, Beek J, Rosenthal D, Samadzadeh S. Toxins (Basel). 2021;13(6):423.

Study population

A healthy 53-year-old right-handed man.

Test procedure

The participants of the presented study underwent VET twice a day (morning and evening), always for 10 minutes, for 14 days. CMAP of the right and left extensor digitorum brevis (EDB) was analyzed before and after VET 12 times during these 14 days. Then, VET was stopped and 20 units of incobotulinumoxin A (incoBoNT/A, hereinafter BoNT) was injected into the right EDB. Over the next 10 days, the CMAPs of both EDBs were retested 12 times.

Use of vibration in the study

In the presented research, a combination of ergometry and vibration was used. The vibrations were generated by a specially constructed platform connected to the stationary exercise bike on its underside – under the pedals. Basic vibration parameters: frequency 15 Hz, amplitude 4 mm.

Results

About 10 hours after the BoNT, CMAP of the right EDB decreased by 56% and by 48% 20 minutes later. About 24 hours after the BoNT, CMAP of the right EDB was reduced to 27% (3.3 mV) and to 18% 20 minutes later. According to the authors, this is most likely the fastest reduction in CMAP after BoNT observed so far. After 48 hours, CMAP was stabilized at approximately 1.5 mV and remained unchanged over the next 8 days.

Vibration ergometry training has shown positive short- and long-term effects on the strength of lower leg muscles.

Comment

Compared to other reports, in the present study, the reduction of CMAP after BoNT was much faster and more pronounced. Possibly due to VET delivered before BoNT.

The authors conclude that the administration of BoNT in combination with VET significantly improved the effectiveness of BoNT compared to other studies. If future studies show similar results, it could revolutionize BoNT injection therapies such as against excessive muscle tone, spasticity, torticollis, clubfoot, cerebral palsy or multiple sclerosis. Increasing the effectiveness of BoNT by VET may enable the reduction of the BoNT dose per session and thus the extension of the duration of BoNT therapy with a reduced risk of stimulating an immune response against BoNT. Long-term therapy with BoNT is extremely desirable in order to obtain good long-term effects.

Moreover, it has been observed that vibration ergometry training has short- and long-term positive effects on the strength of lower leg muscles in healthy subjects and should be considered in the rehabilitation of patients with weakness of the shins.

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