Masakado Yoshihisa
Department of Rehabilitation Medicine, Tokai University School of Medicine.
Brain Nerve. 2014 Sep;66(9):1039-47.
Botulinum toxin (BTX) administered as an adjunct to other interventions for spasticity can act as a useful and effective therapeutic tool for treating patients disabled by spasticity. Presence of other non-reflex motor disorders (muscle stiffness, shortness, and contracture) can complicate the clinical course and disturb rehabilitative process of patients with spasticity. Treatment of spasticity using BTX can improve paralysis by correcting muscular imbalance that follows these diseases. In patients with chronic severe spasticity, we also have to address unique and difficult-to-treat clinical conditions such as abnormal posture and movement disorders. The effectiveness of BTX in treating some of these conditions is discussed. Because patients with neurological disabilities can show complex dysfunctions, specific functional limitations, goals, and expected outcomes of treatment should be evaluated and discussed with the patient, family members, and caregivers, prior to initiating BTX therapy. BTX therapy might improve not only care, passive function, but also motor functions in these patients by supplementing intensive rehabilitation with repetitive transcranial magnetic stimulation, transcranial direct-current stimulation, peripheral electrical stimulation, muscle stretching, and other rehabilitation strategies.
肉毒杆菌毒素（BTX）作为治疗痉挛的其他干预措施的辅助手段，可成为治疗因痉挛而致残患者的有用且有效的治疗工具。其他非反射性运动障碍（肌肉僵硬、挛缩和挛缩）的存在会使痉挛患者的临床病程复杂化，并干扰其康复进程。使用BTX治疗痉挛可通过纠正这些疾病后的肌肉失衡来改善瘫痪状况。对于慢性重度痉挛患者，我们还必须应对诸如异常姿势和运动障碍等独特且难以治疗的临床状况。本文讨论了BTX在治疗其中一些状况方面的有效性。由于神经功能障碍患者可能表现出复杂的功能障碍，在开始BTX治疗之前，应与患者、家庭成员和护理人员评估并讨论具体的功能限制、治疗目标和预期结果。BTX治疗不仅可以改善这些患者的护理和被动功能，还可以通过重复经颅磁刺激、经颅直流电刺激、外周电刺激、肌肉拉伸和其他康复策略来补充强化康复，从而改善其运动功能。
