Bloorview Research Institute, Bloorview Kids Rehab, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
Eur J Neurol. 2010 Aug;17 Suppl 2:38-56. doi: 10.1111/j.1468-1331.2010.03127.x.
The primary objective of this paper was to evaluate the published evidence of efficacy and safety of botulinum neurotoxin (BoNT) injections in paediatric upper limb hypertonia (PULH). Secondary objectives included the provision of clinical context, based on evidence and expert opinion, in the areas of assessment, child and muscle selection, dosing, and adjunctive treatment. A multidisciplinary panel of authors systematically reviewed, abstracted, and classified relevant literature. Recommendations were based on the American Academy of Neurology (AAN) evidence classification. Following a literature search, 186 potential articles were screened for inclusion, and 15 of these met the criteria and were reviewed. Grade A evidence was found to support the use of BoNT to reach individualized therapeutic goals for PULH. There is grade B evidence (probably effective) for tone reduction following BoNT injections and grade U evidence (inconclusive) for improvement in upper limb (UL) activity and function. BoNT injections were generally found to be safe and well tolerated with the most common side effect identified as a transient decrease in grip strength.
本文的主要目的是评估已发表的关于肉毒毒素（BoNT）注射治疗儿童上肢痉挛（PULH）的疗效和安全性证据。次要目标包括根据证据和专家意见，在评估、儿童和肌肉选择、剂量和辅助治疗等方面提供临床背景。一个多学科的作者小组系统地审查、提取和分类了相关文献。建议基于美国神经病学学会（AAN）的证据分类。在进行文献检索后，筛选了 186 篇潜在的文章以纳入，其中 15 篇符合标准并进行了综述。A级证据支持使用 BoNT 来实现针对 PULH 的个体化治疗目标。BoNT 注射后降低肌张力有 B 级证据（可能有效），而改善上肢活动和功能的证据为 U 级（无定论）。BoNT 注射通常被认为是安全的，具有良好的耐受性，最常见的副作用是握力短暂下降。
