Palazón-García Ramiro, Alcobendas-Maestro Mónica, Esclarin-de Ruz Ana, Benavente-Valdepeñas Ana María
a Department of Physical Medicine and Rehabilitation , National Hospital for Paraplegics , Toledo , Spain.
b Department of Physical Medicine and Rehabilitation , Hospital Virgen de la Salud , Toledo , Spain.
J Spinal Cord Med. 2019 May;42(3):281-287. doi: 10.1080/10790268.2018.1479053. Epub 2018 Jun 5.
Spasticity is one of the most frequent complications in spinal cord injury (SCI), and is routinely managed with oral pharmacologic therapy. Botulinum toxin (BT) is not accepted as a treatment for spasticity in SCI in Spain but may be used in certain cases of focal distribution.
To report the results with BT for treatment of spasticity in SCI.
Descriptive retrospective study conducted at a specialist SCI rehabilitation center in Spain, covering patients first treated from 2012 through 2014, and successfully followed up for a minimum of 1 year. Data were collected on the following variables: demographic and SCI characteristics (level and grade); nature of spasticity, e.g. tone, distribution, spasms, articular involvement and pain; function; application of BT; tolerance and adverse reactions.
The study covered 90 patients, predominantly male with incomplete injuries. Improvement in tone as measured by the modified Ashworth scale was a mean of 1.17 points. Goniometric improvement was achieved in 65.6% and improvement in pain in 38.9% of cases. There were no adverse side-effects. Patients with focal spasticity showed a significantly greater improvement in tone (P < 0.0001). The earlier the BT injection, the greater the improvement in goniometric performance (P < 0.006) and pain (P < 0.033), with the best results being obtained within the first 6 months of clinical course. ASIA D injuries showed a greater improvement in tone (P < 0.0001).
BT can be both an effective treatment for focal spasticity in SCI and a good coadjuvant for oral treatments in generalized spasticity.
痉挛是脊髓损伤（SCI）最常见的并发症之一，通常采用口服药物治疗。在西班牙，肉毒杆菌毒素（BT）不被用作脊髓损伤痉挛的治疗方法，但在某些局灶性分布的病例中可能会使用。
报告肉毒杆菌毒素治疗脊髓损伤痉挛的结果。
在西班牙一家专业脊髓损伤康复中心进行的描述性回顾性研究，涵盖2012年至2014年首次接受治疗且成功随访至少1年的患者。收集了以下变量的数据：人口统计学和脊髓损伤特征（水平和等级）；痉挛的性质，如肌张力、分布、痉挛、关节受累和疼痛；功能；肉毒杆菌毒素的应用；耐受性和不良反应。
该研究涵盖90名患者，主要为男性，损伤不完全。通过改良Ashworth量表测量，肌张力平均改善1.17分。65.6%的病例实现了关节活动度改善，38.9%的病例疼痛得到改善。没有不良副作用。局灶性痉挛患者的肌张力改善显著更大（P < 0.0001）。肉毒杆菌毒素注射越早，关节活动度表现（P < 0.006）和疼痛（P < 0.033）改善越大，在临床病程的前6个月内效果最佳。美国脊髓损伤协会（ASIA）D级损伤的患者肌张力改善更大（P < 0.0001）。
肉毒杆菌毒素既可以是脊髓损伤局灶性痉挛的有效治疗方法，也可以是全身性痉挛口服治疗的良好辅助药物。
