Experimental: - Virgin patients with Botulinum Toxin, first injection
A clinical evaluation of spasticity with the Modified Ashworth Scale by the referent practitioner.
Pain management: according to the patient's wishes, local anaesthetic can be provided on the target area (EMLA patch type)
Single fiber electrophysiological evaluation by the principal investigator: comfortable installation of the patient in decubitus, with the upper limb in the optimal relaxation position, supported by the examiner to achieve minimal tone. Arrangement of the needle electrode at the level of the elbow flexor muscle chosen (biceps brachialis, anterior brachialis), located ultrasonographically.
Repeated measurements at D0, week 4 to 6 and week 12 for the stroke patients. Only one measure for controls subjects

- Injected group: Patients already injected
A clinical evaluation of spasticity with the Modified Ashworth Scale by the referent practitioner.
Pain management: according to the patient's wishes, local anaesthetic can be provided on the target area (EMLA patch type)
Single fiber electrophysiological evaluation by the principal investigator: comfortable installation of the patient in decubitus, with the upper limb in the optimal relaxation position, supported by the examiner to achieve minimal tone. Arrangement of the needle electrode at the level of in one elbow flexor muscle (biceps brachialis, anterior brachialis), located ultrasonographically.
Repeated measurements at D0, week 4 to 6 and week 12 for the stroke patients. Only one measure for controls subjects

healthy patient matched in age and sex to included patients

Stroke Patient

ENMG 5 channel Digital EMG, NCS and EP System, Neurosoft, Skybox. Amplification of the EMG signal BF 500 Hz, HF 3kHz, mains filter at 50 Hz. Acquisition at 2 ms at 100 µv, parameters can be modified. The single-use needle electrode (Neuroline Concentric, Neurology Needle Electrode; 25x0.30 mm(1''x30G)) of reference inserted into one elbow flexor muscle (biceps brachialis, anterior brachialis) on the parietal side with location of the ground reference. The paroetic arm will be supported by the evaluator in order to generate a minimal tone, necessary for the occurrence of potential actions of two muscle fibres present within the same motor unit.

paraclinical evaluation of single fibre

CHU de Nîmes

Variability of the Unique Fiber Potentials of a Spastic Muscle Treated With Botulinum Toxin

Jitter's Recording in a Spastic Muscle Treated by Botulinum Toxin

the variability of the neuro-muscular transmission time is determined by the "jitter" parameter. it is of the order of a few tens of microseconds".

Score (0 = no increase in muscle tone, 4 = major hypertonia, passive movement impossible)

Centre Hospitalier Universitaire de Nīmes

Parallel Assignment Preliminary, mono-centric and prospective pilot study on information obtained using a medical device marketed according to CE standards. The study consists of three clinical electrophysiological evaluations.
The hemiplegic population after stroke, spasticity in in one elbow flexor muscle (biceps brachialis, anterior brachialisl) will be divided into two groups with three clinical and electrophysiological evaluations before injection, at the theoretical peak of efficacy (4-6 weeks) and three to six months after injection:
Virgin BTA patients, first injection
Injected group: Patients already injected, cumulative dose in one elbow flexor muscle (biceps brachialis, anterior brachialisl) > 400 IU

contracture/protease

Variability of the Unique Fiber Potentials of a Spastic Muscle Treated With Botulinum Toxin

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