Division of Neurology, National University Hospital, National University Health System, National University of Singapore, Singapore.
Parkinsonism Relat Disord. 2011 Nov;17 Suppl 1:S34-9. doi: 10.1016/j.parkreldis.2011.06.016.
Botulinum toxin (BTX), the exotoxin of the obligate anaerobe, Clostridium botulinum, is used to ameliorate pain and treat conditions associated with glandular, smooth and skeletal muscle overactivity. The benefits derived from the injection of BTX may be negated by unintended weakness of uninjected muscles. Performance of BTX injections may be facile, requiring only surface marking or clinical-localisation techniques but may be more technically demanding, necessitating the use of equipment, such as electromyography (EMG) or ultrasonography (U/S). Less often, endoscopic, fluoroscopic or computed tomographic (CT) guidance may be required. Despite evidence to support the efficacy of BTX injections in treating many conditions, there is no evidence to support the superiority of any one injection technique over needle localisation using surface anatomy. This is possibly due to the lack of well-designed controlled studies, that is, current studies are hampered by small patient numbers, lack of consistency of injection technique and the application of different rating scales. Intuitively, certain injection techniques are more suited to injection of specific muscles or conditions, for example, U/S or passive-monitoring EMG should be used to treat cervical dystonia, active-monitoring EMG applied for strabismus injections, whereas either active-monitoring EMG or endoscopy is indicated when giving BTX for spasmodic dysphonia. Finally, electrical-stimulation EMG or U/S (or a combination of both) would be most suitable when injecting the forearm muscles for spasticity or writer's cramps.
肉毒毒素（BTX）是专性厌氧菌肉毒梭菌的外毒素，用于缓解疼痛和治疗与腺体、平滑肌和骨骼肌过度活动相关的疾病。BTX 注射带来的益处可能因未注射肌肉的意外无力而被抵消。BTX 注射的操作可能很简单，只需要表面标记或临床定位技术，但也可能更具技术挑战性，需要使用设备，如肌电图（EMG）或超声（U/S）。在某些情况下，可能需要内窥镜、荧光透视或计算机断层扫描（CT）引导。尽管有证据支持 BTX 注射治疗多种疾病的疗效，但没有证据表明任何一种注射技术优于使用表面解剖学的针定位。这可能是由于缺乏精心设计的对照研究，即目前的研究受到患者数量少、注射技术缺乏一致性以及应用不同评分量表的限制。直觉上，某些注射技术更适合于特定肌肉或疾病的注射，例如，应使用 U/S 或被动监测 EMG 治疗颈部肌张力障碍，使用主动监测 EMG 治疗斜视注射，而当治疗痉挛性发音障碍时，应使用主动监测 EMG 或内窥镜。最后，在为痉挛性疾病或书写痉挛注射前臂肌肉时，电刺激 EMG 或 U/S（或两者的组合）是最合适的。
