Influence of voluntary contractions on the basal sEMG activity of the pelvic floor muscles

[EN] Chronic pelvic pain (CPP) is a complex clinical condition that affects many women, being sometimes misdiagnosed or mistreated,which can be treated with the infiltration of botulinum toxin (BoNTA). The pelvic floor musculature (PFM) condition from CPP patients can be assessed by means of surface electromyography (sEMG). The evaluation of the basal activity can help to detect a muscular dysfunction, therefore it is important to ensure that the PFM shows a minimum activation when its sEMG is being analysed. In this study, we recorded the sEMG of 25 women with CPP before and 8, 12 and 24 weeks after their treatment with BoNTA while they performed a protocol of 5 voluntary contractions. The root mean square (RMS) and sample entropy (SampEn) of basal segments pre- (B[PRE]), inter- (B[I]) and post- (B[POST]) contractions of the sEMG were computed and normalized according to the minimum (RMSnorm) and maximum (SampEnorm) of the recording. B(PRE) showed the lowest RMSnorm median both before and after the treatment with BoNTA, which proved that the activity of the PFM is minimum before the first contraction. As for SampEnnorm, although results were not so conclusive, they also indicated that B(PRE) should be taken as a reference to analyse the PFM function at its state of minimum activity. Future works aiming to characterize the effects of BoNTA in PFM by means of sEMG should consider basal segments before contractions to assess basal tone conditions.This study was funded by ISCIII, MCIU, VLC Campus in Convocatoria Ayudas: UPV-La Fe (INBIO): 2016 SPEHG (ID:C18), 2019 sEMG_BONTAv (ID:C06) and with funds from private contracts with Merz Pharma España S.L.Albaladejo-Belmonte, M.; Tarazona-Motes, M.; Nohales-Alfonso, FJ.; Alberola-Rubio, J.; Garcia-Casado, J. (2020). Influence of voluntary contractions on the basal sEMG activity of the pelvic floor muscles. Sociedad Española de Ingeniería Biomédica. 240-243. http://hdl.handle.net/10251/178256S24024

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

[EN] Chronic pelvic pain (CPP) is a highly disabling disorder in women usually associated with hypertonic dysfunction of the pelvic floor musculature (PFM). The literature on the subject is not conclusive about the diagnostic potential of surface electromyography (sEMG), which could be due to poor signal characterization. In this study, we characterized the PFM activity of three groups of 24 subjects each: CPP patients with deep dyspareunia associated with a myofascial syndrome (CPP group), healthy women over 35 and/or parous (>35/P group, i.e., CPP counterparts) and under 35 and nulliparous (RMS), a predominance of low-frequency components (DI), greater complexity (>SampEn) and lower synchronization on the same side (35/P group. The same trend in differences was found between healthy women (35/P) associated with aging and parity. These results show that sEMG can reveal alterations in PFM electrophysiology and provide clinicians with objective information for CPP diagnosis.This study was funded by Universitat Politecnica de Valencia in Programa de Ayudas de Investigacion y Desarrollo (PAID-01-20), ISCIII, MCIU, VLC Campus in Convocatoria Ayudas: UPV-La Fe (INBIO): 2016 SPEHG (ID:C18), 2019 sEMG_BONTAv (ID:C06) and funds from private contracts with Merz Pharmaceuticals GmbH S.Albaladejo-Belmonte, M.; Tarazona-Motes, M.; Nohales-Alfonso, FJ.; De-Arriba, M.; Alberola-Rubio, J.; Garcia-Casado, J. (2021). Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography. Sensors. 21(6):1-17. https://doi.org/10.3390/s21062225S11721

Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients' Characteristics

[EN] The treatment of chronic pelvic pain (CPP) with botulinum neurotoxin type A (BoNT/A) has increased lately, but more studies assessing its effect are needed. This study aimed to evaluate the evolution of patients after BoNT/A infiltration and identify potential responders to treatment. Twenty-four women with CPP associated with dyspareunia were treated with 90 units of BoNT/A injected into their pelvic floor muscle (PFM). Clinical status and PFM activity were monitored in a previous visit (PV) and 12 and 24 weeks after the infiltration (W12, W24) by validated clinical questionnaires and surface electromyography (sEMG). The influence of patients' characteristics on the reduction in pain at W12 and W24 was also assessed. After treatment, pain scores and the impact of symptoms on quality of life dropped significantly, sexual function improved and sEMG signal amplitude decreased on both sides of the PFM with no adverse events. Headaches and bilateral pelvic pain were risk factors for a smaller pain improvement at W24, while lower back pain was a protective factor. Apart from reporting a significant clinical improvement of patients with CPP associated with dyspareunia after BoNT/A infiltration, this study shows that clinical characteristics should be analyzed in detail to identify potential responders to treatment.This study was funded by Universitat Politecnica de Valencia in Programa de Ayudas de Investigacion y Desarrollo (PAID-01-20), ISCIII, MCIU, VLC Campus in Convocatoria Ayudas: UPV-La Fe (INBIO): 2016 SPEHG (ID:C18), 2019 sEMG_BONTAv (ID:C06) and funds from private contracts with Merz Pharmaceuticals GmbH S.L.Tarazona-Motes, M.; Albaladejo-Belmonte, M.; Nohales-Alfonso, FJ.; De-Arriba, M.; Garcia-Casado, J.; Alberola-Rubio, J. (2021). Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients' Characteristics. International Journal of Environmental research and Public Health. 18(16):1-12. https://doi.org/10.3390/ijerph18168783S112181

Treatment of Vestibulodynia with Submucosal Injections of IncobotulinumtoxinA into Targeted Painful Points: An Open-Label Exploratory Study

The studies carried out to date on vulvodynia treatment with botulinum neurotoxin type A (BoNT/A) have followed generic injection protocols and reported contradictory outcomes on its effects. The aim of the present study was thus to propose a protocol for injecting BoNT/A into targeted painful points, to comprehensively assess the clinical effect of BoNT/A treatment and identify the risk/protective factors for successful treatment. Thirty-five vestibulodynia patients were treated with submucosal injections of incobotulinumtoxinA and assessed 8, 12 and 24 weeks after their treatment. Their clinical and pelvic statuses were assessed from self-reported questionnaires (Visual Analogue Scale (VAS), Female Sexual Function Index (FSFI), Marinoff’s Dyspareunia Scale (MDS), Hospital Anxiety and Depression Scale (HADS), Catastrophizing Scale (CS)), physical examinations and surface electromyography (sEMG). The patients reported a reduction in provoked vestibulodynia (p FSFI, p p = 0.01) and psychological status (p p = 0.01). Factors such as smoking, painful comorbidities, vulvar pain sensitivity and sexual function were significantly associated with successful treatment. The results indicate the beneficial effects of BoNT/A in treating vestibulodynia and reinforce the importance of adapting the treatment according to its clinical presentation and the patient’s medical background

Effect of BoNT/A in the Surface Electromyographic Characteristics of the Pelvic Floor Muscles for the Treatment of Chronic Pelvic Pain

[EN] Chronic pelvic pain (CPP) is a complex condition with a high economic and social burden. Although it is usually treated with botulinum neurotoxin type A (BoNT/A) injected into the pelvic floor muscles (PFM), its effect on their electrophysiological condition is unknown. In this study, 24 CPP patients were treated with BoNT/A. Surface electromyographic signals (sEMG) were recorded at Weeks 0 (infiltration), 8, 12 and 24 from the infiltrated, non-infiltrated, upper and lower PFM. The sEMG of 24 healthy women was also recorded for comparison. Four parameters were computed: root mean square (RMS), median frequency (MDF), Dimitrov¿s index (DI) and sample entropy (SampEn). An index of pelvic electrophysiological impairment (IPEI) was also defined with respect to the healthy condition. Before treatment, the CPP and healthy parameters of almost all PFM sides were significantly different. Post-treatment, there was a significant reduction in power (MDF), lower fatigue index (SampEn) in all sites in patients, mainly during PFM contractions, which brought their electrophysiological condition closer to that of healthy women (<IPEI). sEMG can be used to assess the PFM electrophysiological condition of CPP patients and the effects of therapies such as BoNT/A infiltration.This study was funded by Universitat Politecnica de Valencia in Programa de Ayudas de Investigacion y Desarrollo (PAID-01-20), ISCIII, MCIU, VLC Campus in Convocatoria Ayudas: UPV-La Fe (INBIO): 2016 SPEHG (ID:C18), 2019 sEMG_BONTAv (ID:C06) and funds from private contracts with Merz Pharmaceuticals GmbH S.L.Albaladejo-Belmonte, M.; Nohales-Alfonso, FJ.; Tarazona-Motes, M.; De-Arriba, M.; Alberola-Rubio, J.; Garcia-Casado, J. (2021). Effect of BoNT/A in the Surface Electromyographic Characteristics of the Pelvic Floor Muscles for the Treatment of Chronic Pelvic Pain. Sensors. 21(14):1-15. https://doi.org/10.3390/s21144668S115211