Journal of Rehabilitation Medicine, Volume 42, Number 4, April 2010 , pp. 339-343(5)

Effect of shock wave stimulation on hypertonic plantar flexor muscles in patients with cerebral palsy: A placebo-controlled study

Authors: E. Amelio, P. Manganotti

Background: Extracorporeal shock wave therapy has been reported to be effective in reducing muscle hypertonia in adults.

Aim: To evaluate the effect of shock wave treatment of spastic muscles in children with cerebral palsy.

Methods: Twelve children with spastic equinus foot (6 boys, 6 girls; mean age 8 years (standard deviation (SD) 2.31)) were monitored. Clinical (Ashworth Scale, passive range of motion) and instrumental (pedobarography) examination were performed. This is an open study with one placebo treatment session, followed 6 weeks later by one active shock wave treatment session. Gastrocnemius muscles and soleus muscles were treated.

Results: After placebo stimulation no clinical or instrumental effect was seen. After a single active shock wave stimulation a significant decrease in the Ashworth Scale (from 3 to 2), an increase in the range of motion (from 20° to 50°), and an increase in the whole plantar surface area of the treated limb (from 40.3 to 80.2 cm2) were observed in all patients. This effect lasted for 4 weeks in all patients.

Conclusions: A single active shock wave stimulation produced a significant long-lasting reduction in hypertonia in the plantar flexors in children with cerebral palsy.

Rheumatology International, Springer-Verlag; 12 January 2010.

Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study

Authors: Elisa Tinazzi, Ernesto Amelio, Elettra Marangoni, Claudio Guerra, Antonio Puccetti, Orazio Michele Codella, Sara Simeoni, Elisabetta Cavalieri, Martina Montagnana, Roberto Adani, Roberto Corrocher, Claudio Lunardi

Vasculopathy, immunological abnormalities, and excessive tissue fibrosis are key elements in the pathogenesis of progressive systemic sclerosis (SSc). Extracorporeal shock waves (ESW) have anti-inflammatory and regenerative effects on different tissues. We hypothesized that ESW can reduce endothelial cell damage and skin fibrosis in patients with SSc. We enrolled 30 patients affected by SSc, 29 females and 1 male. Rodnan Skin Score (RSS) and Visuo-Analogical Scale (VAS) for skin wellness were performed before and immediately after ESW therapy (ESWT) and at 7, 30, 60, and 90 days after the treatment. Sonographic examination of the patients' arms was performed before and 7, 30, 60, 90 days after treatment. Blood samples were obtained before and 30 and 60 days after treatment to measure serological levels of von Willebrand factor, vascular endothelial growth factor, intracellular adhesion molecule-1, monocyte chemotactic protein-1. The number of endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) were determined at the same time points. After ESWT we observed a rapid and persistent reduction of RSS and decrease of VAS. There was no difference in skin thickness before and after ESWT; however, we observed a more regular skin structure and an improvement in skin vascularization 90 days after treatment. EPCs and CECs increased 60 and 90 days after treatment, while serological biomarkers showed no variation before and after therapy. In conclusion, ESWT resulted in an improvement of VAS, RSS, and of skin vascular score, and in an increase of CECs and EPCs.

7th International Symposium on Experimental Spinal Cord Repair and Regeneration
February 19.21, 2009, Brescia University School of Medicine

Effect of Extracorporeal Shock Wave Therapy on Spastic Hypertonia

Autors: Ernesto Amelio MD and Paolo Manganotti MD PhD

Background and purpose: Spasticity is a disabling complication of stroke. Different not invasive treatments are used in order to reduce the muscle hypertonia. Shock waves are defined as a sequence of single sonic pulses characteristics by high peak pressure (100 MPa), fast pressure rise (<10 ns) and short duration (10 µs). Shock waves are largely used in the treatment of bone and tendon diseases and on muscular contractures. Our purpose is to investigate the long term effect of extracorporeal shock wave therapy (ESWT) on the muscle hypertonia of the hand and the wrist.

European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies 2009;16(4):517-21.

External shock waves therapy in dystonia: preliminary results

Authors: Trompetto C; Avanzino L; Bove M; Marinelli L; Molfetta L; Trentini R; Abbruzzese G

Background and purpose: Extracorporeal shock wave therapy (ESWT) has been shown to reduce hypertonia in patients with upper motor neuron syndrome without any side effect. The aim of the present study is to investigate whether ESWT could be useful also in patients with dystonia. Methods: We evaluated three patients with secondary dystonia and three patients with idiopathic writer's cramp. Placebo treatment was performed in each patient. ESWT was administered during four sessions (once weekly) to the target muscles of hand and forearm using an electromagnetic lithotripter (Modulith SLK - Storz Medical). Clinical evaluation was performed using the Unified Dystonia Rating Scale in patients with secondary dystonia and the Arm Dystonia Disability Scale in patients with writer's cramp. Results: After treatment, the three patients with secondary dystonia showed a marked improvement which lasted at least until 1 month after the last session. In the patients with writer's cramp, the improvement after ESWT was less consistent being effective only in two subjects. There were no associated adverse effects. Conclusions: Extracorporeal shock wave therapy is probably an effective and safe treatment for upper limb dystonia, particularly for the secondary forms. Larger randomized studies are needed to confirm these preliminary results.

Circulation - Journal of the American Heart Association - December 19, 2006

Low-Energy Shock Wave for Enhancing Recruitment of Endothelial Progenitor Cells- A New Modality to Increase Efficacy of Cell Therapy in Chronic Hind Limb Ischemia

Authors: Alexandra Aicher, MD; Christopher Heeschen, MD; Ken-ichiro Sasaki, MD; Carmen Urbich, PhD; Andreas M. Zeiher, MD; Stefanie Dimmerler, PhD

Hind limb adductor muscles of nude rats were treated with 500, 1000 and 2000 impulses of focused low-energy SW (flux density level: 0.05 mJ/mm2). Twenty-four hours, mRNA expression of the chemoattractant stromal cell-derived factor 1 was significantly increased with 1000 impulses (stromal cell-derived factor 1/GAPDH: 0.95±0.09) and 2000 impulses (stromal cell-derived factor 1/GAPDH: 1.17±0.24)....

International Journal of Cardiology - August 3, 2006

Extracorporeal cardiac shock wave therapy: First experience in the everyday practice for treatment of chronic refractory angina pectoris

Authors: Ahmed A. Khattab, Broder Brodersen, Daniela Schuermann-Kuchenbrandt, Hans Beurich, Ralph Tölg, Volker Geist, Torsten Schäfer, Gert Richardt

Several aternative therapies have emerged for treating patients with chronic refractory angina pectoris, yet only a few have given rise to sufficiently published data regarding safety and effectiveness. It is imperative to establish an effective and preferbly non-invasive therapy for this expanding patient cohort....

Journal of Neurology - Springer Volume 253 - Supplement 2 - May 2006
Sixteenth Meeting of the European Neurological Society

Extracorporeal shock waves in the rehabilitation of children with cerebral palsy

Authors: H. Lohse-Busch, M. Kraemer, U. Reime

After the informed consent of children and parents the treatments were performed 5 times during 2 weeks with a modified Minilith SL lithotriptor (Storz Medical) producing diverging ESW of 0.012mJ/mm2 - 0.024 mJ/mm2 energy flux density. This is about 10% of what is considered in physical medicine as "low energy extracorporeal shock waves (ESW)". We performed 2 different investigations.

Journal of Neurology - Springer Volume 253 - Supplement 2 - May 2006
Sixteenth Meeting of the European Neurological Society

Effect of shock-wave therapy on spastic equinus foot in patients affected by cerebral palsy

Authors: E. Amelio, P. Manganotti (University Verona, I)

Different non-invasive treatments are used to reduce muscle hypertonia.Shock wave(ESW) are defined as a sequence of single sonic pulses largely used for bone, tendon diseases and muscular contractures. In our previous study we have documented the significant decrease of spastic hypertonia in the affected hand of patients with stroke after treatment by ESWT (Stroke vol. 36, n°9,September 2005 1967-1971). The aim of this study is to examine the effect of shock wave treatment in spastic equinus foot in a group of children with cerebral palsy.

JBJS - December 12, 2005, pag. 2380-2387

Treatment for Osteonecrosis of the Femoral Head: Comparison of Extracorporeal Shock Waves with Core Decompression and Bone-Grafting

Authors: Ching-Jen Wang, Feng-Sheng Wang, Chung-Cheng Huang, Kuender D. Yang, Lin-Hsiu Weng and Hsuan-Ying Huang

Patients with stage-I, II or III esteonecrosis were randomly assigned to be treated either with shock waves or with core decompression and nonvascularized fibular grafting. The shock-wave group consisted of twenty-three patients (twenty-nine hips),and the surgical group consisted of twenty-five patients (twenty-eight hips). The patients in the two groups had similar demographic characteristics, duration and stage disease, and duration of follow-up. The patients in the shock-wave group....

FEBS Letters 579 (2005) 6839-6845

Nitric Oxide mediates anti-inflammatory action of extracorporeal shock waves

Authors: Anna R. Ciampa, Alessandra Carcereri de Prati, Ernesto Amelio, Elisabetta Cavalieri, Tiziana Persichini, Marco Colasanti, Giovanni Musci, Ernst Marlinghaus, Hisanori Suzuki, Sofia Mariotto.

Here, we show that extracorporeal shock waves (ESW), at a low energy density value, quickly increase neuronal nitric oxide (nNOS) activity and basal nitric oxide (NO) production in the rat glioma cell line C6. In addition, the treatment of C6 cells with ESW reverts the decrease of nNOS activity and NO production induced by a mixture of lipopolysacharides (LPS), interferon-gamma (IFN-gamma) plus tumour necrosis factor-alpha (TNF-alpha). Finally, ESW treatment efficiently downregulates NF-kB activation and NF-kB-dependent gene expression, including inducible NOS and TNF-alpha. The present report suggests a possible molecular mechanism of the anti-inflammatory action of ESW treatment.

Stroke - Journal of the American Heart Association
Volume 36, Number 9, September 2005 ISSN 0039-2499

Long-Term Effect of Shock Wave Therapy on Upper Limb Hypertonia in Patients Affected by Stroke

Authors: P. Manganotti, MD, PhD; E. Amelio, MD

Spasticity is a disabling complication of stroke and different noninvasive treatments are used to reduce muscle hypertonia. Shock waves are defined as a sequence of single sonic pulses largely used in the treatment of diseases involving bone and tendon as well as muscular contractures. The effect and duration of extracorporeal shock wave therapy (ESWT) was investigated on muscle hypertonia of the hand and wrist....

Burns 31 (2005) 921-922

Shock wave therapy: An innovative treatment method for partial thickness burns

Authors: R. Meirer, F.S. Kamelger, H. Piza-Katzer

Deep partial thickness burns are characterized by the fact that they take over 21 days to heal and scarring may be sever. As differentiation from full thickness burns is often difficult the majority of cases are skin grafted with early excision beginning within less than 72h as it is said to be beneficial especially in children and young adults less than 30 years old....

Nitric Oxide 12 (2005) - pag.89-96

Extracorporeal shock waves: From lithotripsy to anti-inflammatory action by NO production

Authors: Sofia Mariotto, Elisabetta Cavalieri, Ernesto Amelio, Anna Rosa Ciampa, Alessandra Carcereri de Prati, Ernst Marlinghaus, Sergio Russo, Hisanori Suzuki

At low energy density (0.03mJ/mm²), extracorporeal shock waves (ESW), originally developed for clinical lithotripsy, have successfully been used for anti-inflammatory treatment of soft tissues. Since nitric oxide plays a critical role in inflammation, we hypothesized for ESW to increase NO production in cells. Using human umbilical vein endothelial cells as a model system, we observed that ESW, at low energy density, rapidly induced an enhancement of eNOS activity...

Circulation - November 9, 2004 - pag.3055-3061

Extracorporeal Cardiac Shock Wave Therapy Markedly Ameliorates Ischemia-Induced Myocardial Dysfunction in Pigs in Vivo

Authors: Takahiro Nishida, MD; Hiroaki Shimokawa, et al.

Prognosis of ischemic cardiomyopathy still remains poor because of the lack of effective treatments. To develop a noninvasive therapy for the disorder, we examined the in vitro effects of extracorporeal shock wave (SW) that could enhance angiogenesis...

Effect of Shock Wave Therapy in Patients Affected by Stroke with Upper Limb Spasticity: Neurophysiologic and Clinical Study

Authors: E. Amelio and P. Manganotti

Reprinted from 9th Congress of the International Federation of Societies for Surgery the Hand
Editor Antal Renner - Medimond International Proceedings

Aim of the study is to investigate the effect and the duration of extracorporeal shock wave therapy (ESWT) on the muscle spasticity of the hand and the wrist.
We studied 15 patients affected by stroke associated to severe spasticity in upper limb.
Clinical examination, neurological scales (NIH scale and Ashworth scales) and a video were performed before and immediately after the placebo and real stimulation. The placebo stimulation was performed before the real stimulation in each stimulation. The patients were monitored after one, four, twelve weeks from the real treatment. After four weeks needle EMG was studied...

Journal of Hand Surgery - Volume 28 - Supplement 1 - February 2003
Neurophysiologic Study on Shock Wave Therapy in Upper Limb Spasticity

Authors: E. Amelio, P. Manganotti, O. Galasso and L. Cugola

The authors report an in-vivo prospective preliminary study to assess the effectiveness of shock waves in the treatment of upper limb spastic muscles in adult patients suffering from central spasticity. In all patients an increase of velocity in the angular movement of the forearm was noted. Video score, acceleration, muscle activation timing were measured. Patients have been subjected to extracoporeal shock waves by means of electromagnetic coil lithotriptor; 1500 shots for flexor carpi ulnaris, 1500 for extensor digitorum comunis, 1500 for biceps and triceps muscles each were used, the energy was 0.030 mJ/mm2. In all patients video polyEMG was recorded. Video polygraphy system for movement analysis was used (Micromed System EEG-EMG, Sampling 1024Hz). Surface EMG were recorded form flexor carpi ulnaris, extensor digitorum comunis, biceps and triceps muscles. Surface electrodes with bipolar montage were used. An accelerometer was positioned over the forearm. Video score, acceleration, muscle activation timing were measured before and after extracorporeal shock wave treatments. Follow ups were scheduled at 1, 2 and 3 months. In all patients an increase of velocity was noted in the angular movement of the forearm. Less index of co-contraction was observed from distal and proximal muscles.

Effect of Shock Wave on the Catalytic Activity of
Endothelial Nitric Oxide Synthase in Human Umbilical Vein Endothelial Cells.

Authors: H.Suzuki, E.Amelio, E.Cavalieri, S.Mariotto, O.Galasso, S.Russo

Abstract form 6th Congress of the International Society of Musculoskeletal Shockwave Therapy - Orlando (Florida) 10-13 febbraio 2003

Recent clinical observation indicates the beneficial effect of shock wave on inflammatory region of soft tissues. Although the molecular mechanism of this effect is poorly understood, shock wave treatment seems to locally trigger immediate vasodilation and successive angiogenesis...

FEBS Letters 520 (2002) 153-155

Short-time non-enzymatic nitric oxide synthesis from L-arginine and hydrogen peroxide induced by shock waves treatment

Authors: G. Gotte, E. Amelio, S. Russo, E. Marlinghaus, G. Musci, H. Suzuki;

The evidence that nitric oxide (NO) production is possible by a non-enzymatic pathway has already been shown under restrictive experimental conditions. Here we show that NO can non-enzymatically be formed with short-time kinetics (min), by ‘bombing’ with shockwaves a solution containing 1 mM hydrogen peroxide and 10 mM L-arginine. This procedure is widening its medical application with surprisingly positive effects in tissue regeneration and our finding could be one of the first steps for the understanding of the biochemical responsible for these therapeutical effects...