Related Experiment Video

Updated: Aug 28, 2026

Intramuscular Injections Along the Motor End Plates: A Minimally Invasive Approach to Shuttle Tracers Directly into Motor Neurons
10:57

Intramuscular Injections Along the Motor End Plates: A Minimally Invasive Approach to Shuttle Tracers Directly into Motor Neurons

Published on: July 13, 2015

Botulinum toxin injection without electromyographic assistance

Enrique Chipont Benabent1, Pedro García Hermosa, María T Arrazola

  • 1Instituto Oftalmologico de Alicante, Spain.

Journal of Pediatric Ophthalmology and Strabismus
|August 1, 2002
PubMed

Insights

Electromyographic (EMG) guidance is not necessary for successful botulinum toxin injections in infantile esotropia. Results and complications are similar without EMG, potentially reducing anesthetic risks.

Area of Science:

  • Ophthalmology
  • Pediatric Strabismus Surgery
  • Neurotoxin Applications

Background:

  • Infantile esotropia is a common form of strabismus in children.
  • Botulinum toxin injections are used to treat medial rectus muscle overaction.
  • The necessity of electromyographic (EMG) guidance during these injections is debated.

Purpose of the Study:

  • To evaluate if electromyographic (EMG) control is required for effective botulinum toxin injections in the medial rectus muscles of pediatric patients under sedation.
  • To assess the impact of EMG guidance on ocular alignment and postoperative complications.

Main Methods:

  • A consecutive series of 40 neurologically normal children (6-48 months) diagnosed with essential infantile esotropia were included.
  • Botulinum toxin (7 IU) was injected into both medial rectus muscles under sevoflurane sedation without EMG guidance.
  • Postoperative assessments for tropia, paralysis, and complications were conducted at 3 days, 3 weeks, 3 months, and 6 months.

Main Results:

  • The mean postoperative esotropia at 6 months was 8.47 prism diopters.
  • 53% of patients achieved an esotropia between 0 and 10 prism diopters.
  • Common complications included ptosis (23%) and vertical deviation (21%); conjunctival hemorrhage occurred in 7%.

Conclusions:

  • Botulinum toxin injections without electromyographic (EMG) guidance yield comparable results to those with EMG in treating congenital esotropia.
  • Avoiding EMG guidance may reduce anesthetic risks in pediatric patients.
  • The study advocates against the routine use of EMG guidance for botulinum toxin injections in congenital esotropia.
Abstract

More Related Videos

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea07:05

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

Published on: November 9, 2016

An Implantable System For Chronic In Vivo Electromyography09:52

An Implantable System For Chronic In Vivo Electromyography

Published on: April 21, 2020

Related Concept Videos

Myasthenia Gravis: Diagnostic Tests01:15

Myasthenia Gravis: Diagnostic Tests

Myasthenia gravis is an autoimmune condition affecting neuromuscular transmission, causing generalized weakness in skeletal muscles. Initial diagnoses rely on patients' signs, symptoms, and medical history. The challenge lies in distinguishing myasthenia from other muscular dystrophies. An important diagnostic feature is the significant improvement of symptoms after administering anticholinesterase inhibitors.
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
Classification of Skeletal Muscle Relaxants01:28

Classification of Skeletal Muscle Relaxants

Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action01:17

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action

Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin01:26

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin

Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...