Giovannelli M, Borriello G, Castri P, Prosperini L, Pozzilli C
Multiple Sclerosis Centre, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy.
Clin Rehabil. 2007 Apr;21(4):331-7. doi: 10.1177/0269215507072772.
To determine whether additional physiotherapy increases botulinum toxin type A effects in reducing spasticity in patients with multiple sclerosis.
A single-blind, randomized, controlled pilot trial with a 12-week study period.
Thirty-eight patients with progressive multiple sclerosis affected by focal spasticity and who were observed at the Multiple Sclerosis Centre operating in the S. Andrea Hospital in Rome.
For intervention all patients received botulinum toxin type A; the treatment group also received additional physiotherapy to optimize management through passive or active exercise and stretching regimens.
To measure objective and subjective level of spasticity, patients were assessed at baseline, 2, 4 and 12 weeks post treatment by Modified Ashworth Scale and visual analogue scale.
When compared with the control group, we found a significant decrease of spasticity by Modified Ashworth Scale (P < 0.01 by t-test) in the treatment group at week 2 (2.73 versus 3.22), week 4 (2.64 versus 3.33) and week 12 (2.68 versus 3.33). The mean (%) difference in Modified Ashworth Scale score between baseline and the end of follow-up was -0.95 (26.1) in the treatment group and -0.28 (7.7) in the control group (P < 0.01). The combined treatment proved also to be more effective by visual analogue scale (P < 0.01) at week 4 (6.95 versus 5.50) and at week 12 (7.86 versus 6.56) but not at week 2 (5.18 versus 5.50; P = 0.41).
Our data suggest that physiotherapy in combination with botulinum toxin type A injection can improve overall response to botulinum toxin.
确定额外的物理治疗是否能增强A型肉毒杆菌毒素对减轻多发性硬化症患者痉挛的效果。
一项为期12周的单盲、随机、对照试验。
38例患有进行性多发性硬化症且伴有局灶性痉挛的患者，这些患者在罗马圣安德烈亚医院的多发性硬化症中心接受观察。
所有患者均接受A型肉毒杆菌毒素治疗；治疗组还通过被动或主动运动及伸展方案接受额外的物理治疗，以优化治疗管理。
为测量痉挛的客观和主观程度，在治疗前基线、治疗后2周、4周和12周时，采用改良Ashworth量表和视觉模拟量表对患者进行评估。
与对照组相比，我们发现治疗组在第2周（2.73对3.22）、第4周（2.64对3.33）和第12周（2.68对3.33）时，改良Ashworth量表显示痉挛程度显著降低（t检验，P<0.01）。治疗组改良Ashworth量表评分在基线与随访结束之间的平均（%）差异为-0.95（26.1），对照组为-0.28（7.7）（P<0.01）。在第4周（6.95对5.50）和第12周（7.86对6.56）时，联合治疗在视觉模拟量表上也显示出更显著的效果（P<0.01），但在第2周时并非如此（5.18对5.50；P=0.41）。
我们的数据表明，物理治疗联合A型肉毒杆菌毒素注射可改善对肉毒杆菌毒素的总体反应。
