Mathevon L, Michel F, Decavel P, Fernandez B, Parratte B, Calmels P
Service de médecine physique et de réadaptation, laboratoire de physiologie de l'exercice, université Jean-Monnet, CHU de Saint-Étienne, Saint-Étienne, France.
Service de médecine physique et de réadaptation, université de Franche-Comté, CHU de Besançon, Besançon, France.
Ann Phys Rehabil Med. 2015 Dec;58(6):343-50. doi: 10.1016/j.rehab.2015.06.002. Epub 2015 Oct 24.
Botulinum toxin type A manages spasticity disorders in neurological central diseases. Some studies have reported that it might induce muscle changes.
We present a literature review abiding by the PRISMA statement guidelines. The purpose was to explore the structural and passive biomechanical muscle properties after botulinum toxin type A injections in healthy and spastic limb muscles, on animals and humans, as well as methods for evaluating these properties. We searched the PubMed and Cochrane Library databases using the following keywords: "Botulinum toxin" AND ("muscle structure" OR "muscle atrophy") and, "Botulinum toxin" AND "muscle elasticity".
From the 228 initially identified articles, 21 articles were included. Histological analyses were performed, especially on animals. A neurogenic atrophy systematically occurred. In humans, one year after a single injection, the histological recovery remained incomplete. Furthermore, 2D ultrasound analyses showed a reduction of the gastrocnemius thickness and pennation angle. MRI volumetric analysis evidenced muscular atrophy six months or one year after a single injection. Passive muscle stiffness depends on these structural changes. On the short term, the biomechanical analysis showed an elastic modulus increase in animals whereas no change was recorded in humans. On the short term, ultrasound elastography imaging showed a decreased elastic modulus.
To date, few data are available, but all show a structural and mechanical muscle impact post injections, specifically muscle atrophy which can linger over time. Further studies are necessary to validate this element, and the possibility of change must be taken into account particularly with repeated injections. Thus, in clinical practice, 2D ultrasound and ultrasound elastography are two non-invasive techniques that will help physicians to develop an efficient long term monitoring.
A型肉毒毒素用于治疗神经中枢疾病中的痉挛性疾病。一些研究报告称其可能会引起肌肉变化。
我们按照PRISMA声明指南进行了文献综述。目的是探讨在动物和人类的健康及痉挛肢体肌肉中注射A型肉毒毒素后肌肉的结构和被动生物力学特性，以及评估这些特性的方法。我们使用以下关键词在PubMed和Cochrane图书馆数据库中进行搜索：“肉毒毒素”与（“肌肉结构”或“肌肉萎缩”），以及“肉毒毒素”与“肌肉弹性”。
从最初识别的228篇文章中，纳入了21篇。进行了组织学分析，尤其是在动物身上。系统性地出现了神经源性萎缩。在人类中，单次注射一年后，组织学恢复仍不完全。此外，二维超声分析显示腓肠肌厚度和羽状角减小。MRI体积分析证明单次注射六个月或一年后出现肌肉萎缩。被动肌肉僵硬度取决于这些结构变化。短期内，生物力学分析显示动物的弹性模量增加，而人类未记录到变化。短期内，超声弹性成像显示弹性模量降低。
迄今为止，可用数据较少，但所有数据均显示注射后对肌肉结构和力学有影响，特别是肌肉萎缩可能会持续一段时间。需要进一步研究来验证这一因素，并且必须考虑到反复注射时变化 的可能性。因此，在临床实践中，二维超声和超声弹性成像是两种非侵入性技术，将有助于医生进行有效的长期监测。
