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

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