Lanska Douglas J
Veterans Affairs Medical Center, 500 E. Veterans St., Tomah, Wisconsin, United States of America.
Tremor Other Hyperkinet Mov (N Y). 2013;3. doi: 10.7916/D89W0D6F. Epub 2013 Jan 22.
Athetosis has been controversial since it was first described by William Hammond in 1871; many aspects of Hammond's career were equally controversial.
Primary sources have been used to review treatment controversies in the 50-year period following the initial description of athetosis.
The treatments used most commonly employed available pharmaceutical agents and modalities (e.g., galvanism). Initial anecdotal reports of success were seldom confirmed with subsequent experience. Several novel invasive therapies were also developed and promoted, all of which damaged or destroyed either upper or lower motor neuron pathways, and were also often associated with high mortality rates. In general, these therapies substituted paresis for abnormal spontaneous movements. These included peripheral nerve stretching, excision of a portion of the precentral gyrus, rhizotomy, nerve "transplantation" (i.e., neurotomy and nerve-to-nerve anastomoses), and "muscle group isolation" (i.e., alcohol neurolysis). There was no agreement on the appropriateness of such high-risk procedures, particularly given the intentional generation of further neurological morbidity.
Pharmaceutical agents and modalities initially employed for athetosis had little a priori evidence-based justification and no biologically plausible theoretical framework to guide empiric treatment selection. Subsequently, all the invasive procedures employed were directed at lessening or removing the manifestations, rather than the underlying cause, of the abnormal central nervous system "irritation," usually by imposing paresis or paralysis. Factors contributing to the disparity in outcomes between favorable initial reports and the often-disappointing results of later studies included reliance on anecdotal reports or small uncontrolled case series, placebo effects, biased observation, misdiagnosis, and biased reporting.
自1871年威廉·哈蒙德首次描述手足徐动症以来，该病一直备受争议；哈蒙德职业生涯的许多方面同样存在争议。
利用原始资料回顾了自手足徐动症首次被描述后的50年里的治疗争议。
最常用的治疗方法是使用现有的药物和治疗方式（如直流电疗法）。最初关于成功的轶事报道很少能得到后续经验的证实。还开发并推广了几种新型侵入性疗法，所有这些疗法都损害或破坏了上运动神经元或下运动神经元通路，而且往往还伴有高死亡率。一般来说，这些疗法用轻瘫替代了异常的自发运动。这些疗法包括外周神经拉伸、中央前回部分切除术、神经根切断术、神经“移植”（即神经切断术和神经对神经吻合术）以及“肌群隔离”（即酒精神经溶解术）。对于这种高风险手术的适当性没有达成共识，特别是考虑到有意造成进一步的神经功能损害。
最初用于治疗手足徐动症的药物和治疗方式几乎没有先验的循证依据，也没有生物学上合理的理论框架来指导经验性治疗选择。随后，所有采用的侵入性手术都是针对减轻或消除异常中枢神经系统“刺激”的表现，而非根本原因，通常是通过造成轻瘫或瘫痪来实现。导致最初的良好报告结果与后来研究中往往令人失望的结果之间存在差异的因素包括依赖轶事报道或小型无对照病例系列、安慰剂效应、有偏差的观察、误诊以及有偏差的报告。
