Ramirez-Castaneda Juan, Jankovic Joseph
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
Toxicon. 2014 Nov;90:344-8. doi: 10.1016/j.toxicon.2014.07.009. Epub 2014 Aug 15.
Most long-term studies of the efficacy and safety profile of botulinum toxin (BoNT) in the treatment of dystonia are limited by lack of objective assessments, relatively small sample size, or short follow-up periods. We present one of the longest follow-up studies of BoNT treatment. This is a retrospective, longitudinal study that analyzes data on 89 patients treated with BoNT for dystonia at our Movement Disorders Clinic for up to 26 years (mean follow-up period of 18.5 years). The mean ages at the time of the first and last injections were 49 and 68 years old, respectively. The most common diagnoses were cervical dystonia (N = 51), blepharospasm (N = 34), and oromandibular dystonia (N = 26). The total number of onabotulinumtoxinA units received during the first injection was 140.3 as compared to 224.5 at the last injection (p < 0.0001). The global response effect was 3.18 after the first injection session and 3.57 after the last injection (p < 0.0001). The duration of response after the initial injection session and at the last injection was 16.33 weeks versus 19.42 weeks (p 0.0037), respectively. Adverse events, typically related to injection site, were reported in 19% of the visits. This series of dystonia patients with the longest reported treatment with BoNT provide evidence that in selected patients repeated chemodenervation is associated with sustained symptomatic benefit, decreased latency effect, and prolonged duration of therapeutic response. Despite the higher requirement of mean units per visit over time, only 19% of all treatment cycles are associated with adverse, but tolerable, side effects.
大多数关于肉毒杆菌毒素（BoNT）治疗肌张力障碍的疗效和安全性的长期研究都受到缺乏客观评估、样本量相对较小或随访期较短的限制。我们展示了一项关于BoNT治疗的最长随访研究之一。这是一项回顾性纵向研究，分析了在我们的运动障碍诊所接受BoNT治疗肌张力障碍长达26年（平均随访期18.5年）的89例患者的数据。首次注射和最后一次注射时的平均年龄分别为49岁和68岁。最常见的诊断为颈部肌张力障碍（N = 51）、眼睑痉挛（N = 34）和口下颌肌张力障碍（N = 26）。首次注射时接受的A型肉毒杆菌毒素单位总数为140.3，而最后一次注射时为224.5（p < 0.0001）。首次注射后总体反应效果为3.18，最后一次注射后为3.57（p < 0.0001）。首次注射和最后一次注射后的反应持续时间分别为16.33周和19.42周（p = 0.0037）。19%的就诊报告了通常与注射部位相关的不良事件。这一系列接受BoNT治疗时间最长的肌张力障碍患者提供了证据，表明在选定的患者中，重复化学去神经支配与持续的症状改善、潜伏期效应降低和治疗反应持续时间延长相关。尽管随着时间的推移每次就诊平均所需单位量增加，但所有治疗周期中只有19%与不良但可耐受的副作用相关。
