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Background <p>Technetium-sestamibi single-photon emission computed tomography (<sup>99m</sup>Tc-MIBI SPECT) guidance has been shown to significantly improve the efficacy of botulinum toxin (BTX) injection in dystonic postural abnormalities. But its effect in parkinsonian postural abnormalities remains unknown.</p> Methods <p>Eligible PD patients with postural abnormalities all underwent <sup>99m</sup>Tc-MIBI SPECT muscle metabolic imaging and baseline evaluation followed by SPECT-guided BTX injection. The primary efficacy outcome was the improvement in resting forward and lateral trunk flexion angle (RTF and RTL) at 1 month. Secondary efficacy outcomes included subjective efficacy, pain VAS score and PDQ-39 score. Adverse events (AEs) were also assessed.</p> Results <p>A total of 29 PD patients (14 males, 15 females) were analyzed with a mean age of 68.5 ± 8.9 years. The RTF increased (37.71 ± 16.82° vs. 40.17 ± 17.03°, Estimated Mean Difference = -2.46, 95% CI [-5.97, 1.06], <i>p</i> = 0.027) significantly while the RTL decreased (9.61 ± 8.78° vs. 8.28 ± 7.62°, Estimated Mean Difference = 1.34, 95% CI [-0.99, 3.67], <i>p</i> = 0.208) slightly at 1 month compared to baseline, though the difference was not significant. At 1 month, 4 patients (13.8%) experienced an improvement of more than 5° in RTF, 13 patients (44.8%) reported minimal to much subjective improvement and 10 patients (34.5%) saw an improvement of more than 1 point in the pain VAS score. Eleven AEs occurred, with no serious adverse events (SAEs). Related AEs mainly included transient worsening of postural abnormalities and low-back pain, which typically alleviated within 2 weeks to 2 months.</p> Conclusions <p>The <sup>99m</sup>Tc-MIBI SPECT-guided BTX treatment for parkinsonian postural abnormalities demonstrated acceptable safety but was not as effective as expected. Future studies should focus on identifying potential candidates who shall benefit from this method.</p> Clinical trials registration <p>the Chinese Clinical Trial Registry, number ChiCTR2000039775, Nov. 8th, 2020.</p>

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Efficacy and safety of 99mTc-MIBI SPECT-guided botulinum toxin injection in parkinsonian postural abnormality

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月17日

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  • Ronghua Hong,
  • Zhuang Wu,
  • Sha Zhu,
  • Lizhen Pan,
  • Yougui Pan,
  • Xiaolong Zhang,
  • Shuzhen Chen,
  • Qiang Guan,
  • Lingjing Jin

摘要

Background

Technetium-sestamibi single-photon emission computed tomography (99mTc-MIBI SPECT) guidance has been shown to significantly improve the efficacy of botulinum toxin (BTX) injection in dystonic postural abnormalities. But its effect in parkinsonian postural abnormalities remains unknown.

Methods

Eligible PD patients with postural abnormalities all underwent 99mTc-MIBI SPECT muscle metabolic imaging and baseline evaluation followed by SPECT-guided BTX injection. The primary efficacy outcome was the improvement in resting forward and lateral trunk flexion angle (RTF and RTL) at 1 month. Secondary efficacy outcomes included subjective efficacy, pain VAS score and PDQ-39 score. Adverse events (AEs) were also assessed.

Results

A total of 29 PD patients (14 males, 15 females) were analyzed with a mean age of 68.5 ± 8.9 years. The RTF increased (37.71 ± 16.82° vs. 40.17 ± 17.03°, Estimated Mean Difference = -2.46, 95% CI [-5.97, 1.06], p = 0.027) significantly while the RTL decreased (9.61 ± 8.78° vs. 8.28 ± 7.62°, Estimated Mean Difference = 1.34, 95% CI [-0.99, 3.67], p = 0.208) slightly at 1 month compared to baseline, though the difference was not significant. At 1 month, 4 patients (13.8%) experienced an improvement of more than 5° in RTF, 13 patients (44.8%) reported minimal to much subjective improvement and 10 patients (34.5%) saw an improvement of more than 1 point in the pain VAS score. Eleven AEs occurred, with no serious adverse events (SAEs). Related AEs mainly included transient worsening of postural abnormalities and low-back pain, which typically alleviated within 2 weeks to 2 months.

Conclusions

The 99mTc-MIBI SPECT-guided BTX treatment for parkinsonian postural abnormalities demonstrated acceptable safety but was not as effective as expected. Future studies should focus on identifying potential candidates who shall benefit from this method.

Clinical trials registration

the Chinese Clinical Trial Registry, number ChiCTR2000039775, Nov. 8th, 2020.