Schramm Axel, Bäumer Tobias, Fietzek Urban, Heitmann Susanne, Walter Uwe, Jost Wolfgang H
Department of Neurology, University of Erlangen, Erlangen, Germany.
Department of Movement Disorders and Neuropsychiatry, University of Lübeck, Lübeck, Germany.
J Neural Transm (Vienna). 2015 Oct;122(10):1457-63. doi: 10.1007/s00702-014-1356-2. Epub 2014 Dec 30.
Botulinum neurotoxin A (BoNT A) is the first-line treatment for cervical dystonia. However, although BoNT A has a favorable safety profile and is effective in the majority of patients, in some cases the treatment outcome is disappointing or side effects occur when higher doses are used. It is likely that in such cases either the target muscles were not injected accurately or unintended weakness of non-target muscles occurred. It has been demonstrated in clinical trials for spastic movement disorders that sonography-guided BoNT A injections could improve treatment outcome. As the published evidence for a benefit of sonography-guided BoNT injection in patients with cervical dystonia is scarce, it is the aim of this review to discuss the relevance of sonography in this indication and provide a statement from clinical experts for its use. The clear advantage of sonography-guided injections is non-invasive, real-time visualization of the targeted muscle, thus improving the precision of injections and potentially the treatment outcomes as well as avoiding adverse effects. Other imaging techniques are of limited value due to high costs, radiation exposure or non-availability in clinical routine. In the hands of a trained injector, sonography is a quick and non-invasive imaging technique. Novel treatment concepts of cervical dystonia considering the differential contributions of distinct cranial and cervical muscles can reliably be implemented only by use of imaging-guided injection protocols.
肉毒杆菌神经毒素A（BoNT A）是治疗颈部肌张力障碍的一线药物。然而，尽管BoNT A具有良好的安全性，且对大多数患者有效，但在某些情况下，治疗效果令人失望，或在使用较高剂量时会出现副作用。在这些病例中，可能是靶肌肉注射不准确，或者出现了非靶肌肉意外无力的情况。在痉挛性运动障碍的临床试验中已证明，超声引导下的BoNT A注射可改善治疗效果。由于关于超声引导下BoNT注射对颈部肌张力障碍患者有益的已发表证据很少，本综述的目的是讨论超声在该适应症中的相关性，并提供临床专家对其使用的声明。超声引导注射的明显优势是对靶肌肉进行无创、实时可视化，从而提高注射精度，可能改善治疗效果，并避免不良反应。由于成本高、辐射暴露或临床常规中无法使用，其他成像技术价值有限。在训练有素的注射者手中，超声是一种快速且无创的成像技术。只有通过使用成像引导注射方案，才能可靠地实施考虑不同颅部和颈部肌肉不同作用的颈部肌张力障碍新治疗概念。
