Phadke Chetan P, Davidson Caitlin, Ismail Farooq, Boulias Chris
Upper Motorneuron Spasticity Research Program, West Park Healthcare Centre, 82 Buttonwood Ave., Toronto, Ontario, Canada M6M 2J5; Department of Physical Therapy, University of Toronto, Toronto; and Faculty of Health, York University, Toronto, Canada(∗).
Upper Motorneuron Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada(†).
PM R. 2014 May;6(5):406-11. doi: 10.1016/j.pmrj.2013.11.001. Epub 2013 Nov 7.
It is difficult to compare the dosage of botulinum toxin between different neurologic conditions because of the different methods of reported dosages. Botulinum toxin is used to manage spasticity in variety of neurologic conditions, and it is important for clinicians to know whether there are differences in the dosage injected on the basis of the etiology of spasticity.
To determine whether the type of neural lesion influences the dosage of botulinum toxin required to manage spasticity.
Retrospective chart review.
Review of patients who visited an outpatient spasticity clinic.
We assessed medical charts from 99 patients with stroke, multiple sclerosis (MS), and cerebral palsy (CP) (n = 33 for each etiology). We collected information such as age, gender, weight, time of lesion, total dosage (per person, per limb, per muscle), injection location, and injections cycles.
None.
OnabotulinumtoxinA dose - total dose in one leg was calculated as a sum of the units of the toxin injected in all the leg muscles.
Total dose of toxin injected was 161 ± 19 (mean ± standard error of mean) in patients with stroke, 175 ± 13 in patients with CP, and 225 ± 18 in patients with MS. The total dose in the legs (normalized to body weight; units/kg) was significantly different between the 3 groups (stroke, CP, MS; P = .001). Subsequent post-hoc tests revealed that total dose in the legs of patients with MS was significantly greater (88%) than patients with stroke (P = .001). Hip adductors and hamstrings were injected most commonly in MS and CP, but toe muscles were commonly injected in patients with stroke, whereas plantar flexors were evenly injected all 3 patient groups.
In our practice, we found that treating spasticity in people with MS required the greatest dose of botulinum toxin, followed by CP and then stroke.
由于肉毒杆菌毒素剂量的报告方法不同，很难在不同神经系统疾病之间比较其剂量。肉毒杆菌毒素用于治疗多种神经系统疾病中的痉挛，对于临床医生来说，了解基于痉挛病因的注射剂量是否存在差异很重要。
确定神经病变类型是否会影响治疗痉挛所需的肉毒杆菌毒素剂量。
回顾性病历审查。
对前往门诊痉挛诊所就诊的患者进行审查。
我们评估了99例中风、多发性硬化症（MS）和脑瘫（CP）患者的病历（每种病因各33例）。我们收集了年龄、性别、体重、发病时间、总剂量（每人、每肢体、每肌肉）、注射部位和注射周期等信息。
无。
计算单腿注射的A型肉毒毒素总剂量，即所有腿部肌肉注射的毒素单位总和。
中风患者注射的毒素总剂量为161±19（平均值±平均标准误差），CP患者为175±13，MS患者为225±18。三组（中风、CP、MS）腿部的总剂量（按体重标准化；单位/千克）有显著差异（P = 0.001）。随后的事后检验显示，MS患者腿部的总剂量显著高于中风患者（88%）（P = 0.001）。MS和CP患者最常注射的是髋内收肌和腘绳肌，但中风患者常注射趾肌，而三组患者中足底屈肌的注射情况相同。
在我们的实践中，我们发现治疗MS患者的痉挛需要最大剂量的肉毒杆菌毒素，其次是CP患者，然后是中风患者。
