O'Brien Christopher F
Elan Pharmaceuticals, San Diego, California 92121, USA.
Clin J Pain. 2002 Nov-Dec;18(6 Suppl):S182-90. doi: 10.1097/00002508-200211001-00011.
Spasticity is an abnormal increase in muscle contraction often caused by damage to central motor pathways that control voluntary movement. During clinical examination, spasticity manifests as an increase in stretch reflexes, producing tendon jerks and resistance appearing as muscle tone. There are many causes of spasticity, including demyelination from multiple sclerosis, congenital damage from diseases such as cerebral palsy, trauma to the brain or spinal cord, hemorrhage or infarction, and other pathologic conditions that interrupt neural pathways. Effects of spasticity range from mild muscle stiffness to severe, painful muscle contractures and repetitive spasms that reduce mobility and substantially impede normal activities of daily living. Botulinum toxin therapy reduces spasticity and pain associated with several disorders. Local treatment with botulinum toxins can be used as adjunctive therapy, along with oral antispasticity medications, or alone to provide localized decrease in symptoms of spasticity and pain. Botulinum toxin therapy may be particularly useful for patients with spasticity due to stroke, whose treatment can be tailored based on recovery of function over time. In addition, botulinum toxin therapy is safe for pediatric patients, including children with cerebral palsy, who may not be able to tolerate the cognitive side effects of oral medications. Results of studies evaluating botulinum toxin for the treatment of spasticity due to various causes are presented here.
痉挛是肌肉收缩异常增加，通常由控制自主运动的中枢运动通路受损引起。在临床检查中，痉挛表现为牵张反射增强，产生腱反射亢进，且阻力以肌张力的形式出现。痉挛有多种病因，包括多发性硬化导致的脱髓鞘、脑瘫等疾病引起的先天性损伤、脑或脊髓外伤、出血或梗死，以及其他中断神经通路的病理状况。痉挛的影响范围从轻度肌肉僵硬到严重的、疼痛性肌肉挛缩以及重复性痉挛，这些会降低活动能力并严重妨碍正常的日常生活活动。肉毒毒素疗法可减轻与多种疾病相关的痉挛和疼痛。肉毒毒素局部治疗可作为辅助疗法，与口服抗痉挛药物联合使用，或单独使用以局部减轻痉挛和疼痛症状。肉毒毒素疗法对因中风导致痉挛的患者可能特别有用，其治疗可根据功能随时间的恢复情况进行调整。此外，肉毒毒素疗法对儿科患者是安全的，包括患有脑瘫的儿童，他们可能无法耐受口服药物的认知副作用。本文介绍了评估肉毒毒素治疗各种病因所致痉挛的研究结果。
