Panizza M, Castagna M, di Summa A, Saibene L, Grioni G, Nilsson J
Laboratory of Clinical Neurophysiology, Salvatore Maugeri Foundation, IRCCS, Rehabilitation Institute of Castel Goffredo, MN, Italy.
Funct Neurol. 2000 Jul-Sep;15(3):147-55.
Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks. In order to study the usefulness of botulinum toxin type A (BTX) as a therapy for spasticity, we studied 15 patients affected by spasticity secondary to stroke. Tests included: clinical evaluation of tone (Ashworth scale); active angles of extension and flexion at elbow and wrist; Hmax/Mmax ratio from flexor carpi radialis (FCR); Hreflex presynaptic inhibition from FCR during vibration; Task score; and video recording. Patients were injected with BTX into one or more muscles with total doses not exceeding 200 International Units (IU). The tests were performed immediately prior to injection and repeated 2 weeks afterwards. Furthermore, in eight patients, testing was also performed one month after BTX injection. Between two weeks and one month after BTX there were no statistically significant differences. A statistically significant difference in the Task and Ashworth scores before and after treatment emerged (p < 0.0014), but only 6 patients showed a clear improvement in motor performance. Overall, we observed an improvement in the angle of active extension and flexion at the wrist and elbow. There were no significant changes in the Hmax/Mmax ratio and the Hreflex presynaptic inhibition during vibration. All the patients reported a subjective improvement. The results suggest that subjective benefits can be gained from the use of BTX in patients affected by spasticity, and that the degree of motor improvement seems to depend on the motor recovery obtained before treatment.
痉挛是一种运动障碍，其特征为张力性牵张反射（肌张力）随速度增加，伴有腱反射亢进。为研究A型肉毒毒素（BTX）治疗痉挛的有效性，我们对15例中风继发痉挛的患者进行了研究。测试包括：肌张力的临床评估（Ashworth量表）；肘部和腕部的主动屈伸角度；桡侧腕屈肌（FCR）的Hmax/Mmax比值；振动期间FCR的Hoffmann反射（Hoffmann reflex，H反射）的突触前抑制；任务评分；以及视频记录。患者被注射BTX至一块或多块肌肉，总剂量不超过200国际单位（IU）。测试在注射前即刻进行，并在2周后重复。此外，8例患者在BTX注射后1个月也进行了测试。BTX注射后2周与1个月之间无统计学显著差异。治疗前后任务评分和Ashworth评分出现统计学显著差异（p < 0.0014），但只有6例患者的运动表现有明显改善。总体而言，我们观察到腕部和肘部的主动屈伸角度有所改善。振动期间Hmax/Mmax比值和H反射的突触前抑制无显著变化。所有患者均报告有主观改善。结果表明，对于痉挛患者，使用BTX可获得主观益处，且运动改善程度似乎取决于治疗前获得的运动恢复情况。
