Tater Priyanka, Pandey Sanjay
Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India.
Neurol India. 2018 Mar-Apr;66(Supplement):S79-S89. doi: 10.4103/0028-3886.226441.
Botulinum toxin has gained immense popularity since its introduction for therapeutic use. It is used in a variety of movement disorders like hemi-facial spasm, focal dystonias like blepharospasm, cervical dystonia, oromandibular dystonia, limb dystonias. It is also being used in patients with tremors, tics and for a variety of indications in Parkinson's disease as well. There are eight subtypes of toxins available, but type A and B are the ones used in movement disorder clinics. The toxin mainly acts by inhibiting the release of acetylcholine at the neuromuscular junction and causing weakness. Type B toxin has more effect over the autonomic nervous system and hence is preferred for hyper-secretory disorders. The use of electromyography and ultrasound further improve the accuracy of the procedure. It is a relatively safe therapeutic option with its effect lasting for around three months. It has very few side effects. The key is to start with the lowest possible dose and then gradually increase the dose depending upon the patient's response. Selecting the right muscles for injection is of utmost importance and is guided by the knowledge of anatomy of the muscles.
自肉毒杆菌毒素被引入用于治疗以来，它已广受欢迎。它被用于多种运动障碍，如半面痉挛、局灶性肌张力障碍，如眼睑痉挛、颈部肌张力障碍、口下颌肌张力障碍、肢体肌张力障碍。它也被用于震颤、抽搐患者以及帕金森病的多种适应症。有八种毒素亚型可供使用，但A 型和B型是运动障碍诊所使用的类型。该毒素主要通过抑制神经肌肉接头处乙酰胆碱的释放并导致肌无力起作用。B型毒素对自主神经系统有更大作用，因此更适合用于分泌过多性疾病。肌电图和超声的使用进一步提高了该操作的准确性。它是一种相对安全的治疗选择，其效果持续约三个月。它的副作用很少。关键是从尽可能低的剂量开始，然后根据患者的反应逐渐增加剂量。选择正确的注射肌肉至关重要，这由肌肉解剖学知识指导。
