Santamato Andrea, Micello Maria Francesca, Ranieri Maurizio, Valeno Giovanni, Albano Antonio, Baricich Alessio, Cisari Carlo, Intiso Domenico, Pilotto Alberto, Logroscino Giancarlo, Panza Francesco
Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy.
Physical Medicine and Rehabilitation Section-"OORR Hospital", University of Foggia, Foggia, Italy.
J Neurol Sci. 2015 Mar 15;350(1-2):1-6. doi: 10.1016/j.jns.2015.01.033. Epub 2015 Feb 7.
Spasticity is a common disabling symptom for several neurological conditions. Botulinum toxin type A injection represents the gold standard treatment for focal spasticity with efficacy, reversibility, and low prevalence of complications. Current guidelines suggest a dose up to 600 units (U) of onabotulinumtoxinA/incobotulinumtoxinA or up to 1,500 U of abobotulinumtoxinA to treat post-stroke spasticity to avoid important adverse effects. However, recently, higher doses of botulinum toxin type A were employed, especially in case of upper and lower limb severe spasticity. With searches of US National Library of Medicine databases, we identified all studies published from December 1989 to July 2014 concerning the use of higher doses of this neurotoxin for spasticity treatment with at least a dose of 600 U of onabotulinumtoxinA and incobotulinumtoxinA or 1,800 U of abobotulinumtoxinA. The cumulative body of evidence coming from the eight studies selected suggested that higher doses of botulinum toxin type A appeared to be efficacious in reducing spasticity of the upper and lower limbs after stroke, with adverse effects generally mild. However, further investigations are needed to determine the safety and reproducibility in larger case series or randomized clinical trials of higher doses of botulinum toxin type A also after repeated injections.
痉挛是几种神经系统疾病中常见的致残症状。A型肉毒毒素注射是治疗局部痉挛的金标准疗法，具有疗效好、可逆且并发症发生率低的特点。当前指南建议，使用高达600单位（U）的昂丹司琼肉毒毒素A/因卡司琼肉毒毒素A或高达1500 U的阿泊肉毒毒素A来治疗中风后痉挛，以避免严重不良反应。然而，最近人们使用了更高剂量的A型肉毒毒素，尤其是在上下肢严重痉挛的情况下。通过检索美国国立医学图书馆数据库，我们确定了1989年12月至2014年7月发表的所有关于使用更高剂量这种神经毒素治疗痉挛的研究，其中昂丹司琼肉毒毒素A和因卡司琼肉毒毒素A的剂量至少为600 U，阿泊肉毒毒素A的剂量为1800 U。从所选的八项研究中积累的证据表明，更高剂量的A型肉毒毒素似乎在减轻中风后上下肢痉挛方面有效，且不良反应通常较轻。然而，还需要进一步研究来确定更高剂量的A型肉毒毒素在更大病例系列或重复注射后的随机临床试验中的安全性和可重复性。
