Yelnik A P, Bonan I V
Service de médecine physique et de réadaptation, GH Lariboisière-F-Widal, AP-HP, 200, rue du Faubourg-Saint-Denis, 75010 Paris, France.
Ann Readapt Med Phys. 2003 Jul;46(6):281-5. doi: 10.1016/s0168-6054(03)00111-9.
To clarify the conditions governing the use of botulinum toxin (BTX) for post-stroke lower limb spastic disorders: indications, choice of muscles, doses, and duration of efficacy.
Review of the international literature using the Medline and the Reedoc data banks.
Seven controlled studies were reviewed, including in particular 2 studies vs placebo and one vs phenol, 7 open studies or case series closely related to this topic and 4 open studies partly dedicated to it. The usefulness of BTX for the treatment of equinovarus has been demonstrated. The main muscles to be treated are the soleus, gastrocnemius and tibialis posterior. The treatment proposed for toe clawing is BTX injection into the flexor digitorum longus and flexor hallucis longus, and for great toe permanent extension, injection of the extensor hallucis longus. The quadriceps femoris, the tibialis anterior or the hamstrings have only be treated in isolated cases. When the treatment is effective, its benefit may last for more than 6 months.
A few controlled trials have demonstrated the efficacy of BTX for post stroke lower limb spasticity. The results of all the controlled and open trials argue in favor of its efficacy, but this still requires more thorough analysis.
Botulinum toxin has a place together with other local treatments for post-stroke spasticity, but a precise guide to its use, especially its dosage, and it's effectiveness compared to that of other treatments, need further study.
阐明肉毒杆菌毒素（BTX）用于中风后下肢痉挛性疾病的使用条件：适应症、肌肉选择、剂量及疗效持续时间。
使用Medline和Reedoc数据库检索国际文献。
回顾了7项对照研究，特别是2项与安慰剂对照的研究和1项与苯酚对照的研究，7项与该主题密切相关的开放性研究或病例系列，以及4项部分涉及该主题的开放性研究。已证实BTX对治疗马蹄内翻足有用。主要治疗的肌肉是比目鱼肌、腓肠肌和胫后肌。针对爪形趾提出的治疗方法是向趾长屈肌和拇长屈肌注射BTX，针对拇趾持续性背伸，则向拇长伸肌注射。股四头肌、胫前肌或腘绳肌仅在个别病例中进行过治疗。当治疗有效时，其益处可能持续超过6个月。
一些对照试验已证明BTX对中风后下肢痉挛有效。所有对照和开放试验的结果均支持其有效性，但仍需要更深入的分析。
肉毒杆菌毒素与其他局部治疗方法一样，在中风后痉挛治疗中占有一席之地，但关于其使用的精确指南，尤其是其剂量，以及与其他治疗方法相比的有效性，仍需进一步研究。
