Contarino Maria Fiorella, Van Den Dool Joost, Balash Yacov, Bhatia Kailash, Giladi Nir, Koelman Johannes H, Lokkegaard Annemette, Marti Maria J, Postma Miranda, Relja Maja, Skorvanek Matej, Speelman Johannes D, Zoons Evelien, Ferreira Joaquim J, Vidailhet Marie, Albanese Alberto, Tijssen Marina A J
Department of Neurology, Haga Teaching Hospital, The Hague, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.
Department of Neurology AB 51, University Medical Centre Groningen, Groningen, Netherlands; ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.
Front Neurol. 2017 Feb 24;8:35. doi: 10.3389/fneur.2017.00035. eCollection 2017.
Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.
颈部肌张力障碍（CD）是局限性肌张力障碍最常见的形式。其症状常导致疼痛和功能障碍。局部注射肉毒杆菌神经毒素是目前治疗CD的首选方法。尽管这种治疗方法已被证明有效且在全球广泛应用，但临床实践中仍存在许多问题。我们基于问题导向的方法对肉毒杆菌毒素治疗CD的文献进行了系统综述，旨在为临床治疗医生提供实用建议。探讨了临床实践中的关键问题。结果表明，虽然肉毒杆菌毒素治疗对CD不同方面的有益效果已得到充分证实，但在一些实际问题上仍缺乏有力证据，如不同制剂之间的剂量等效性、最佳治疗间隔、治疗方法以及包括肌电图或超声在内的支持技术的使用。预防或管理常见副作用（包括过度肌肉无力、注射部位疼痛、吞咽困难）以及该治疗潜在禁忌症（妊娠和哺乳期、使用抗凝剂、神经合并症）的既定策略也应进一步探索。
