Luauté J, Landrault E, Jacquin-Courtois S, Mertens P, Rode G, Boisson D
Hôpital Henry-Gabrielle, route de Vourles, BP 57, 69565 Saint-Genis-Laval cedex, France.
Ann Readapt Med Phys. 2004 Oct;47(8):555-62. doi: 10.1016/j.annrmp.2004.02.011.
It is now demonstrated that botulinum toxin can improve upper limb spasticity after stroke.
This study was designed to assess the efficacy of botulinum toxin on upper limb spasticity with an individual approach.
Prospective study on 18 patients who had disabling spasticity of upper limb after stroke. For each patient, the treatment's target was fixed preliminary to botulinum toxin injection. Evaluation of efficacy (Ashworth scale and predefined targets) was performed at 1 month and treatment continuation was decided individually.
A beneficial effect was reported by most patients when the treatment was aimed at improving comfort or quality of life. In one case, the treatment was designed to improve grasping. In that case, no effect was reported. For three patients, a neurotomy was performed in order to obtain a long lasting effect. For nine patients, repeated injections were decided. For the six other patients, no long-standing treatment was performed.
This study confirms that botulinum toxin can improve comfort of patients with upper limb spasticity. On the base of our experience, we discussed contribution of botulinum toxin to enhance and optimise strategies for the treatment of focal upper limb spasticity with emphasis on the comparison with selective neurotomy.
现已证明肉毒杆菌毒素可改善中风后的上肢痉挛。
本研究旨在采用个体化方法评估肉毒杆菌毒素治疗上肢痉挛的疗效。
对18例中风后上肢严重痉挛患者进行前瞻性研究。对于每位患者，在注射肉毒杆菌毒素前预先确定治疗目标。在1个月时进行疗效评估（Ashworth量表和预定目标），并根据个体情况决定是否继续治疗。
当治疗旨在改善舒适度或生活质量时，大多数患者报告有有益效果。在1例中，治疗旨在改善抓握能力，该病例未报告有效果。对于3例患者，进行了神经切断术以获得持久效果。对于9例患者，决定重复注射。对于其他6例患者，未进行长期治疗。
本研究证实肉毒杆菌毒素可改善上肢痉挛患者的舒适度。根据我们的经验，我们讨论了肉毒杆菌毒素在增强和优化局灶性上肢痉挛治疗策略方面的作用，重点是与选择性神经切断术的比较。
