Safarpour Yasaman, Mousavi Tahereh, Jabbari Bahman
University of California, Irvine (UCI), Irvine, CA, 92697, USA.
, Toronto, Canada.
Curr Treat Options Neurol. 2017 Aug 17;19(10):33. doi: 10.1007/s11940-017-0470-5.
Purpose of review The purpose of this review is to provide updated information on the role of botulinum neurotoxin (BoNT) therapy in multiple sclerosis (MS). This review aims to answer which symptoms of multiple sclerosis may be amenable to BoNT therapy. Recent findings We searched the literature on the efficacy of BoNTs for treatment of MS symptoms up to April 1st 2017 via the Yale University Library's search engine including but not limited to Pub Med and Ovis SP. The level of efficacy was defined according to the assessment's criteria set forth by the Subcommittee on Guideline Development of the American Academy of Neurology. Significant efficacy was found for two indications based on the available blinded studies (class I and II) and has been suggested for several others through open-label clinical trials. Summary There is level A evidence (effective- two or more class I) that injection of BoNT-A into the bladder's detrusor muscle improves MS-related neurogenic detrusor overactivity (NDO) and MS-related overactive (OA) bladder. There is level B evidence (probably effective- two class II studies) for utility of intramuscular BoNT-A injections for spasticity of multiple sclerosis. Emerging data based on retrospective class IV studies demonstrates that intramuscular injection of BoNTs may help other symptoms of MS such as focal tonic spasms, focal myokymia, spastic dysphagia, and double vision in internuclear ophthalmoplegia. There is no data on MS-related trigeminal neuralgia and sialorrhea, two conditions which have been shown to respond to BoNT therapy in non-MS population.
综述目的 本综述旨在提供关于肉毒杆菌神经毒素（BoNT）疗法在多发性硬化症（MS）中作用的最新信息。本综述旨在回答多发性硬化症的哪些症状可能适合BoNT疗法。 最新发现 我们通过耶鲁大学图书馆的搜索引擎，检索了截至2017年4月1日关于BoNTs治疗MS症状疗效的文献，包括但不限于PubMed和Ovis SP。疗效水平根据美国神经病学学会指南制定小组委员会规定的评估标准来定义。基于现有的双盲研究（I类和II类），发现两种适应症有显著疗效，并且通过开放标签临床试验也提示了其他几种适应症的疗效。 总结 有A级证据（有效——两项或更多I类研究）表明，将BoNT-A注射到膀胱逼尿肌可改善MS相关的神经源性逼尿肌过度活动（NDO）和MS相关的膀胱过度活动（OA）。对于肌肉注射BoNT-A治疗多发性硬化症痉挛的效用，有B级证据（可能有效——两项II类研究）。基于回顾性IV类研究的新数据表明，肌肉注射BoNTs可能有助于MS的其他症状，如局灶性强直性痉挛、局灶性肌纤维颤搐、痉挛性吞咽困难和核间性眼肌麻痹中的复视。对于MS相关的三叉神经痛和流涎症，尚无数据，而在非MS人群中已证明这两种情况对BoNT疗法有反应。
