Mezaki Takahiro, Hayashi Akito, Nakase Hirofumi, Hasegawa Kazuko
Department of Neurology, Sakakibara Hakuho Hospital.
Rinsho Shinkeigaku. 2005 Sep;45(9):634-42.
A questionnaire about the treatment of dystonia was sent out to 585 councilors of Societas Neurologica Japonica. One hundred and sixty-eight replies (28.7%) were collected, although some of them were excluded from the analysis because of inappropriateness. 1) The number of patients previously experienced was < 10; 37 respondents (22.7%), 10-50; 83 (50.9%), 50-100; 26 (16.0%), and > 100; 17 (10.4%). 2) Oral medication was most often the first line treatment in either of generalized dystonia, blapharospasm, cervical dystonia, and writer's cramp. Botulinum toxin injection was the first or the second line treatment in 147 (87.5%) and 116 (69.0%) respondents for blepharospasm and cervical dystonia, respectively. In these two conditions, the more experienced doctors tended to prefer botulinum toxin injection to the other treatments as the first choice (Cochran-Armitage analysis; p = 0.003 for blepharospasm and p = 0.002 for cervical dystonia). 3) Among the oral drugs, anticholinergics, especially trihexyphenidyl, were the most frequent choice in generalized dystonia, cervical dystonia, and writer's cramp. For blepharospasm, clonazepam was most favored. Sedatives, especially diazepam, were also often the drug of choice in either of these disorders. The favored drugs were not related to the respondent's experience. 4) The success rate of treatment, designated as the percentage of patients who improved through any treatment so much that the respondent was satisfied with it, was the highest in blepharospasm (65.4 +/- 24.1; mean +/- SD), followed by cervical dystonia (41.2 +/- 23.4), writer's cramp (32.9 +/- 22.5), and generalized dystonia (20.4 +/- 19.8). Only in cervical dystonia, the rate was significantly higher in more experienced respondents (regression analysis; p = 0.008). In blepharospasm (p < 0.001) and cervical dystonia (p = 0.002), regression analysis indicated that the success rate was higher in the group who preferred botulinum toxin injection to oral medication as the first line treatment. These results indicate that in Japan the treatment of choice for dystonia does not always follow the therapeutic guidelines for dystonia proposed in some foreign countries. Adopting more evidence-based rationale of treatment is encouraged, because the recent progress about the treatment of dystonia, e.g. botulinum toxin injection or the stereotaxic surgery, is reshaping dystonia from a devastating to a treatable disorder.
一份关于肌张力障碍治疗的问卷被发送给了日本神经学会的585名委员。共收集到168份回复（28.7%），不过其中一些因不合适而被排除在分析之外。1）既往治疗过的患者数量＜10例的有37名受访者（22.7%），10 - 50例的有83名（50.9%），50 - 100例的有26名（16.0%），＞100例的有17名（10.4%）。2）口服药物通常是全身型肌张力障碍、眼睑痉挛、颈部肌张力障碍和书写痉挛的一线治疗方法。肉毒毒素注射分别是147名（87.5%）眼睑痉挛受访者和116名（69.0%）颈部肌张力障碍受访者的一线或二线治疗方法。在这两种情况中，经验越丰富的医生越倾向于首选肉毒毒素注射而非其他治疗方法（ Cochr an - Armitage分析；眼睑痉挛p = 0.003，颈部肌张力障碍p = 0.002）。3）在口服药物中，抗胆碱能药物，尤其是苯海索，是全身型肌张力障碍、颈部肌张力障碍和书写痉挛中最常选用的药物。对于眼睑痉挛，氯硝西泮最受青睐。镇静剂，尤其是地西泮，在这些疾病中也常常是首选药物。所青睐的药物与受访者的经验无关。4）治疗成功率定义为通过任何治疗后病情改善到让受访者满意程度的患者百分比，在眼睑痉挛中最高（65.4±24.1；均值±标准差），其次是颈部肌张力障碍（41.2±23.4）、书写痉挛（32.9±22.5）和全身型肌张力障碍（20.4±19.8）。仅在颈部肌张力障碍中，经验更丰富的受访者的成功率显著更高（回归分析；p = 0.008）。在眼睑痉挛（p＜0.001）和颈部肌张力障碍（p = 0.002）中，回归分析表明，首选肉毒毒素注射而非口服药物作为一线治疗的组成功率更高。这些结果表明，在日本，肌张力障碍的治疗选择并不总是遵循一些国外提出的肌张力障碍治疗指南。鼓励采用更多基于证据的治疗理念，因为近期肌张力障碍治疗方面的进展，如肉毒毒素注射或立体定向手术，正在将肌张力障碍从一种严重疾病转变为可治疗的疾病。
