慢性痉挛患者接受肉毒毒素 A（BoNT-A）治疗后行走能力有明显改善。
Meaningful improvement in walking performance after Botulinum neurotoxin A (BoNT-A) in chronic spastic patients.
机构信息
U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy Scuola di Dottorato in Scienze Cognitive, Universitá degli Studi di Siena, Siena, Italy.
U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
出版信息
NeuroRehabilitation. 2014;34(1):185-92. doi: 10.3233/NRE-131021.
BACKGROUND
Botulinum neurotoxin A (BoNT-A) may reduce lower limb spasticity but its role in improving walking ability remains to be established.
OBJECTIVE
To investigate the efficacy of simultaneous BoNT-A injections into several targeted spastic muscles of different joints on gait speed and on functional gains in gait performance in chronic stroke and MS patients.
METHODS
Twenty patients affected by stroke or multiple sclerosis were tested before, one and three months after BoNT-A administration. Gait was evaluated by the 10 Meter Walk Test; patients were stratified into functional ambulation classes accordingly. Spasticity was assessed using the modified Ashworth Scale.
RESULTS
At final assessment, spasticity was reduced in hip adductors and ankle plantar-flexors, gait speed improved and, 1/3rd of patients transitioned to a higher ambulation class. The pre-post difference in Level of Spasticity of the hips was a predictor for an increase in gait speed.
CONCLUSIONS
A meaningful improvement in walking performance can be obtained in chronic spastic patients after BoNT-A injection into several muscles, specifically the hip adductors.
背景
肉毒毒素 A（BoNT-A）可能减轻下肢痉挛，但它在改善步行能力方面的作用仍有待确定。
目的
研究同时向不同关节的多个靶向痉挛肌肉注射 BoNT-A 对慢性卒中及多发性硬化症患者的步行速度和步态表现的功能性改善的疗效。
方法
20 名卒中或多发性硬化症患者在 BoNT-A 给药前、给药后 1 个月和 3 个月接受测试。步态通过 10 米步行测试进行评估；患者根据功能步行能力分级。痉挛使用改良 Ashworth 量表评估。
结果
在最终评估时，髋关节内收肌和踝关节跖屈肌的痉挛减轻，步行速度提高，1/3 的患者过渡到更高的步行能力分级。髋关节痉挛程度的前后差值是步行速度增加的预测因素。
结论
在慢性痉挛患者中，向多个肌肉（特别是髋关节内收肌）注射 BoNT-A 后，可以获得步行表现的显著改善。
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