Esquenazi A, Mayer N
MossRehab Gait and Motion Analysis Laboratory, 1200 West Tabor Road, Philadelphia, PA 19141, USA.
Curr Atheroscler Rep. 2001 Jul;3(4):295-8. doi: 10.1007/s11883-001-0022-y.
Stroke is a major cause of disability involving the arm and leg. This disability results from the upper motoneuron syndrome (UMN) evident after stroke. It is commonly associated with spasticity and muscle overactivity, which can lead to abnormal limb posturing that interferes with active and passive function. The origin of limb deformity in patients with UMN is based on the concept of unbalanced agonist and antagonist muscle forces acting across joints. In the past decade, botulinum toxin A (BTX-A) a new medication that modifies muscle force and, hence, can treat muscle imbalance, has become available and has renewed interest in the management of muscle overactivity and spasticity after stroke. A reduction in muscle tone, painful spasms, and improved functionality can be obtained. Research and clinical reports support the concept that chemodenervation with BTX-A is an excellent intervention for treating focal muscle overactivity and spasticity secondary to stroke. Many muscles differing in size, shape, and location have been injected, and clinical effectiveness is particularly notable in elbow flexors, ankle plantar flexors, and smaller limb muscles, such as intrinsics of the hand and wrist. Smaller muscles are readily accessible for injection and require smaller amounts of toxin.
中风是导致手臂和腿部残疾的主要原因。这种残疾是由中风后明显的上运动神经元综合征（UMN）引起的。它通常与痉挛和肌肉过度活动有关，这可能导致异常的肢体姿势，从而干扰主动和被动功能。UMN患者肢体畸形的根源基于跨越关节的主动肌和拮抗肌力量不平衡的概念。在过去十年中，肉毒杆菌毒素A（BTX-A）作为一种能够改变肌肉力量、进而可治疗肌肉失衡的新药已可供使用，并重新引发了人们对中风后肌肉过度活动和痉挛管理的兴趣。它可以降低肌张力、缓解疼痛性痉挛并改善功能。研究和临床报告支持这样的观点，即使用BTX-A进行化学去神经支配是治疗中风继发的局灶性肌肉过度活动和痉挛的一种出色干预措施。许多大小、形状和位置各异的肌肉都已接受注射，并且临床疗效在肘部屈肌、踝部跖屈肌以及手部和腕部的固有肌等较小的肢体肌肉中尤为显著。较小的肌肉便于注射，且所需毒素量较少。
