Lippert-Gruner M, Svestkova O
University of Cologne, Germany.
Brain Inj. 2011;25(12):1266-9. doi: 10.3109/02699052.2011.613085. Epub 2011 Sep 30.
The acute management of spasticity following ABI is challenging. Contractures can occur during the acute phases of illness. The joints most affected are the shoulders and the ankles.
A case study of a 48-year-old female patient who received local chemoneurolytic anti-spasticity therapy following a severe subarachnoid haemorrhage for pes equines deformity is presented to illustrate the role of focal neurotoxin therapy.
The increasing spasticity in her legs was observed and could not be effectively treated with oral anti-spasticity agents or intensive physiotherapy. As spasticity increased (Modified Ashworth Scale 4), mobility of the right foot continued to deteriorate, leading to indication for local anti-spasticity treatment with Xeomin neurotoxin. The spastic pes equinus was injected with Xeomin® using a total dose of 150 U.
On the 6th day after injection, a gradual reduction in spasticity was observed in the injected muscle (Modified Ashworth Scale 1-2) and an increasing improvement in joint mobility.
Early local anti-spasticity treatment with Xeomin is effective treatment. The cost of the intervention would appear to be high, but if one compares it with the costs of conservative treatment, it is not more expensive.
急性脑损伤（ABI）后痉挛的急性处理具有挑战性。挛缩可能在疾病的急性期发生。受影响最严重的关节是肩部和脚踝。
本文介绍了一名48岁女性患者的病例研究，该患者在严重蛛网膜下腔出血后因马蹄足畸形接受了局部化学神经溶解抗痉挛治疗，以说明局部神经毒素治疗的作用。
观察到她腿部痉挛不断加重，口服抗痉挛药物或强化物理治疗均无法有效治疗。随着痉挛加重（改良Ashworth量表为4级），右脚活动能力持续恶化，因此决定采用Xeomin神经毒素进行局部抗痉挛治疗。向痉挛性马蹄足注射Xeomin®，总剂量为150单位。
注射后第6天，观察到注射肌肉的痉挛逐渐减轻（改良Ashworth量表为1 - 2级），关节活动能力不断改善。
早期使用Xeomin进行局部抗痉挛治疗是有效的。该干预措施的成本似乎较高，但与保守治疗的成本相比，并不更昂贵。
