Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, B-5530 Yvoir, Belgium.
Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, NMSK, avenue Mounier 53, B-1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, service de médecine physique et réadaptation, avenue Hippocrate 10, B-1200 Brussels, Belgium.
Ann Phys Rehabil Med. 2019 Jul;62(4):220-224. doi: 10.1016/j.rehab.2018.07.008. Epub 2018 Aug 11.
To discuss the effectiveness, indications, limitations and side effects of botulinum toxin type A and selective neurotomy for treating focal spastic muscle overactivity to help clinicians choose the most appropriate treatment.
Expert opinion based on scientific evidence and personal experience.
Botulinum toxin type A can decrease muscle tone in different types of spastic muscle overactivity, which allows for treating a large variety of spastic patterns with several etiologies. The toxin effect is sometimes insufficient to improve functional outcome and is transient, thereby requiring repeated injections. Selective neurotomy is a permanent surgical treatment of the reflex component of the spastic muscle overactivity (spasticity) that is effective for spastic equinovarus foot. The neurotomy provides a greater and more constant reduction in spasticity. However, the long-lasting effect on the non-reflex muscle overactivity, especially dystonia, is doubted. The effectiveness, clinical indications, advantages, side effects and limitations of both techniques are discussed.
Botulinum toxin type A has the highest level of evidence and the largest range of indications. However, the botulinum toxin effect is reversible and seems less effective, which supports a permanent surgical treatment such as selective neurotomy, especially for the spastic foot. Further research is needed to compare the effect of botulinum toxin type A and selective neurotomy for the different types of spastic muscle overactivity and clinical patterns.
讨论 A 型肉毒毒素和选择性神经切断术治疗局灶性痉挛性肌肉过度活动的疗效、适应证、局限性和副作用，以帮助临床医生选择最合适的治疗方法。
基于科学证据和个人经验的专家意见。
A 型肉毒毒素可降低不同类型痉挛性肌肉过度活动的肌肉张力，可治疗多种病因引起的多种痉挛模式。毒素的作用有时不足以改善功能结果，且作用是暂时的，因此需要重复注射。选择性神经切断术是痉挛性肌肉过度活动（痉挛）反射成分的永久性手术治疗方法，对痉挛性马蹄内翻足有效。神经切断术可更显著、更持久地降低痉挛程度。然而，对于非反射性肌肉过度活动（特别是肌张力障碍）的持久效果存在疑问。讨论了这两种技术的疗效、临床适应证、优点、副作用和局限性。
A 型肉毒毒素具有最高的证据水平和最广泛的适应证。然而，肉毒毒素的作用是可逆的，效果似乎较差，这支持进行永久性手术治疗，如选择性神经切断术，特别是治疗痉挛性马蹄内翻足。需要进一步研究比较 A 型肉毒毒素和选择性神经切断术治疗不同类型的痉挛性肌肉过度活动和临床模式的效果。
