Marion M-H, Afors K, Sheehy M P
Movement disorders unit, Dept of Neurology, St George's Hospital, London, England.
Rev Neurol (Paris). 2003 Oct;159(10 Pt 1):923-7.
We studied the efficacy of botulinum toxin (BTX-A) injections in 167 patients, from a large cohort of 259 patients, presenting with writer's cramp (WC) and followed up to 10 years. The selection of the muscle was based on a careful physical examination, using up to 6 manoeuvres whilst attempting to write in order to bring out the original dystonic posture. The injection technique had to be precise, under EMG guidance, with a hollow recording needle to detect muscle or finger fascicle. The results showed a good efficacy and tolerance of this treatment in the long term with recovery of normal writing in 46 per cent, partial benefit in 10 per cent, failure in 21 per cent, and loss to follow-up after the first injection in 23 per cent. Among the responders, 27 per cent carried on the treatment every 9 months on average, with a duration of benefit of 6 months with follow-up between 3 and 9 years. Mirror dystonia had no prognostic value. Secondary dystonia, tremulous WC, long duration WC and progressive WC were associated with poor outcome.
我们研究了肉毒杆菌毒素（BTX-A）注射对167例书写痉挛（WC）患者的疗效，这167例患者来自一个259例患者的大型队列，随访时间长达10年。肌肉的选择基于仔细的体格检查，在尝试书写时使用多达6种动作，以引出最初的肌张力障碍姿势。注射技术必须精确，在肌电图引导下，使用空心记录针来检测肌肉或手指束颤。结果显示，这种治疗长期疗效良好且耐受性良好，46%的患者恢复正常书写，10%的患者部分受益，21%的患者治疗失败，23%的患者在首次注射后失访。在有反应的患者中，27%的患者平均每9个月进行一次治疗，受益持续时间为6个月，随访时间为3至9年。镜像肌张力障碍没有预后价值。继发性肌张力障碍、震颤性WC、病程长的WC和进行性WC与不良预后相关。
