Rousseaux M, Launay M J, Kozlowski O
Service de rééducation neurologique, hôpital Swynghedauw, CHU, 59037 Lille cedex, France.
Ann Readapt Med Phys. 2003 Jul;46(6):286-95. doi: 10.1016/s0168-6054(03)00112-0.
To present data about the effect of botulinum toxin injection on the upper limb of stroke patients.
We used the Medline data bank. Analysis took into account the international classification of functioning and disability. Important technical or pragmatic points were analysed separately.
Botulinum toxin reduces spasticity of the injected muscles, with a mean gain of about 1 point on the Ashworth scale in the 4 to 6 weeks post injection, but with a large variability. This is associated to an increase in the passive range of motion, especially at wrist, and at times to a facilitation of active movements, when they are still possible. Improvement in functional tests is observed when fair proximal and distal motricity persists. Reduction in the dependence in daily living activities has not been shown by group studies. Several patients have an improvement in using the hand for blocking and transporting objects, mainly in a facilitating position (pronation, partial wrist flexion). Comfort of patients and caregivers is more regularly improved. Results are partially predictable; improvement in function is observed in patients with fair distal motricity (extension) and low spasticity, and improvement in comfort in those with severe spasticity and low motricity.
Further studies are required, on one hand for better assessment of distal functional improvement, on the other hand at earlier phases of the disease.
呈现关于肉毒杆菌毒素注射对中风患者上肢影响的数据。
我们使用了医学文献数据库。分析考虑了功能与残疾的国际分类。对重要的技术或实用要点进行了单独分析。
肉毒杆菌毒素可降低注射肌肉的痉挛程度，注射后4至6周，Ashworth量表评分平均提高约1分，但存在较大变异性。这与被动活动范围增加有关，尤其是在腕部，有时还会促进主动运动（如果仍有可能的话）。当近端和远端运动功能尚可时，功能测试会有所改善。群组研究未显示出日常生活活动依赖性的降低。一些患者在使用手进行阻挡和搬运物体时有所改善，主要是在便利的姿势下（旋前、部分腕部屈曲）。患者及护理人员的舒适度更常得到改善。结果部分可预测；远端运动功能尚可（伸展）且痉挛程度低的患者功能会有所改善，而痉挛严重且运动功能低的患者舒适度会有所改善。
一方面需要进一步研究以更好地评估远端功能改善情况，另一方面需要在疾病的早期阶段进行研究。
