Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Viale Pinto, 71100, Foggia, Italy.
"Fondazione Turati" Rehabilitation Centre, Vieste, Foggia, Italy.
Drugs. 2017 Sep;77(13):1413-1422. doi: 10.1007/s40265-017-0786-1.
Spasticity with muscle paresis and loss of dexterity is a common feature of upper motor neuron syndrome due to injuries or the pyramidal tract in several neurological conditions. Botulinum toxin type A has been considered the gold standard treatment for spasticity and movement disorders, with efficacy, reversibility, and low prevalence of complications. During the last 30 years, thousands of studies of its use have been performed, but few guidelines are available. Therefore, there is great variability in both the doses and intervals of administration and the approaches taken by clinicians with considerable experience in spasticity and movement disorder treatment. In the present review article, we provide a short overview of the benefits and risks of non-approved injection regimens and doses for botulinum toxins, focusing on the treatment of post-stroke spasticity, where there is great interest in the potential for increasing the number of treatment/years and the dose of botulinum toxin treatment for subjects with upper and lower limb spasticity. However, many doubts exist regarding antibody development and possible adverse effects.
痉挛伴肌肉无力和灵活性丧失是多种神经状况中因损伤或锥体束所致上运动神经元综合征的常见特征。肉毒毒素 A 已被认为是治疗痉挛和运动障碍的金标准，具有疗效、可逆转性和低并发症发生率。在过去 30 年中，已经进行了数千项关于其使用的研究，但很少有指南。因此，在剂量和给药间隔以及在痉挛和运动障碍治疗方面经验丰富的临床医生所采取的方法方面存在很大差异。在本文综述中，我们简要概述了未经批准的肉毒毒素注射方案和剂量的益处和风险，重点关注卒中后痉挛的治疗，对于上肢和下肢痉挛患者，增加治疗次数/年数和肉毒毒素治疗剂量的潜力引起了极大的关注。然而，对于抗体产生和可能的不良反应存在许多疑问。
