Ward A B
University Hospital North Staffordshire, Stoke on Trent, UK.
J Neural Transm (Vienna). 2008;115(4):607-16. doi: 10.1007/s00702-007-0833-2. Epub 2008 Apr 4.
Spasticity is a physiological consequence of an insult to the brain or spinal cord, which can lead to life-threatening, disabling and costly consequences. This typically occurs following stroke, brain injury, spinal cord injury, multiple sclerosis and other disabling neurological diseases and cerebral palsy. It is but one feature of the upper motor neurone syndrome and there have been considerable developments in its management through new drugs and technology. The sole indication for treating spasticity is when it is causing harm and interferes with active or passive functioning. Successful treatment strategies have now been developed and there is good evidence of treatment effectiveness. Treatment is essentially aimed at reducing abnormal sensory inputs, which have an impact on excessive and uncontrolled alpha-motor neuron activity. Attending to the physical characteristics of muscle shortening is the basis of spasticity management. All pharmacological interventions are adjunctive to a programme of physical intervention and there is a good evidence base for this in relation to botulinum toxin treatment. Management therefore centres around the development of a formal treatment plan is important to document the intended outcomes, which should be written and agreed upon with the patient. Anti-spastic drugs treat spasticity. They do not treat contractures and they will not make hemiplegic limbs function, unless the patient's function is impeded by the spasticity. The management of spasticity is physical and all pharmacological interventions are adjunctive to that. This article therefore deals with the principles of management of spasticity and treatment with botulinum toxin. It covers treatment planning, patient assessment, goal setting and covers the range of available treatments. It also describes how botulinum toxin works, the evidence for its use in spasticity management and practical aspects of treatment, such as muscle location, the injection procedure and post-injection care. Finally, there is a word on the organisation of services. The contribution of botulinum toxin to spasticity management is now well recognised. The trick in clinical management is to use it intelligently and to know when and when not to use it. It is a useful short-term means of improving patients' function and the distressing features of spasticity following an insult to the central nervous system. This is usually against the background of a long-term condition, for which a long-term management strategy is required. Botulinum toxin provides a window of opportunity to improve the outcomes from physical management of the focal and multi-focal problems of spasticity.
痉挛是脑部或脊髓受损后的一种生理后果，可能导致危及生命、致残和高昂代价的后果。这通常发生在中风、脑损伤、脊髓损伤、多发性硬化症以及其他致残性神经疾病和脑瘫之后。它只是上运动神经元综合征的一个特征，并且通过新药和技术，其治疗方法有了相当大的进展。治疗痉挛的唯一指征是当它造成损害并干扰主动或被动功能时。现在已经制定了成功的治疗策略，并且有充分的证据证明治疗的有效性。治疗主要旨在减少异常的感觉输入，这些输入会影响过度且不受控制的α运动神经元活动。关注肌肉缩短的物理特征是痉挛管理的基础。所有药物干预都是物理干预计划的辅助手段，并且关于肉毒杆菌毒素治疗有充分的证据支持这一点。因此，管理围绕制定正式的治疗计划展开，记录预期结果很重要，这些结果应该与患者书面商定。抗痉挛药物治疗痉挛。它们不能治疗挛缩，并且除非患者的功能因痉挛而受到阻碍，否则它们不会使偏瘫肢体恢复功能。痉挛的管理是物理性的，所有药物干预都是其辅助手段。因此，本文论述了痉挛管理的原则以及肉毒杆菌毒素治疗。它涵盖治疗计划、患者评估、目标设定以及可用治疗方法的范围。它还描述了肉毒杆菌毒素的作用机制、其用于痉挛管理的证据以及治疗的实际方面，如肌肉定位、注射程序和注射后护理。最后，对服务组织进行了阐述。肉毒杆菌毒素对痉挛管理的贡献现在已得到充分认可。临床管理的诀窍是明智地使用它，并知道何时使用以及何时不使用它。它是改善中枢神经系统受损后患者功能和痉挛令人痛苦特征的一种有用的短期手段。这通常是在长期疾病的背景下进行的，对此需要长期的管理策略。肉毒杆菌毒素为改善痉挛的局部和多灶性问题的物理管理效果提供了一个机会窗口。
