Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan,
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
Eur Neurol. 2019;81(1-2):30-36. doi: 10.1159/000499907. Epub 2019 Apr 23.
Treatment with Botulinum toxin A (BoNT-A) is effective in decreasing upper limb spasticity.
This study aimed to determine the differences in the outcome based on the upper limb motor function before BoNT-A treatment.
The subjects were 61 patients who underwent BoNT-A treatment for upper limb spasticity. Limb function was evaluated using the Fugl-Meyer Assessment upper extremity (FMA-UE), modified Ashworth scale, passive range of motion and disability assessment scale before treatment as well as 2, 6, and 12 weeks after treatment. We divided the total and each subscale of FMA-UE before BoNT-A administration into beyond-the-mean-score group (higher score group) and below-the-mean-score group (lower score group).
In both the higher and lower score groups of the FMA-UE total and modified Ashworth scale scores improved significantly after treatment. In FMA-UE, the higher score group of subscale A improved significantly, but subscale C decreased significantly at 2 and 6 weeks after the administration. The lower score group of total, subscale A, and B improved significantly. In the disability assessment scale, the self-dressing capability at 6 weeks and limb position at 2, 6 and 12 weeks after the administration improved significantly in the higher score group. In the lower score group, the hygiene capability at 2 weeks as well as the dressing capability and limb position improved significantly at 2, 6 and 12 weeks after administration.
The time course after administration of BoNT-A differed based on upper limb motor function before injection. When administering BoNT-A into the finger flexor muscles of a patient, we should carefully judge the indications for administration.
肉毒毒素 A（BoNT-A）治疗可有效降低上肢痉挛程度。
本研究旨在根据 BoNT-A 治疗前上肢运动功能确定治疗效果的差异。
本研究共纳入 61 例行 BoNT-A 治疗上肢痉挛的患者。治疗前及治疗后 2、6、12 周，采用 Fugl-Meyer 上肢评估量表（FMA-UE）、改良 Ashworth 量表、被动关节活动度和残疾评估量表评估肢体功能。我们将 BoNT-A 治疗前 FMA-UE 总分和各亚量表分为高于平均分组（高分组）和低于平均分组（低分组）。
FMA-UE 总分和改良 Ashworth 量表评分在治疗后两组均显著改善。FMA-UE 中，亚量表 A 高分组治疗后显著改善，但 2、6 周时亚量表 C 显著降低。FMA-UE 总分和亚量表 A、B 低分组显著改善。残疾评估量表中，治疗后 6 周时自我穿衣能力，以及治疗后 2、6、12 周时肢体位置显著改善。FMA-UE 总分和亚量表 A、B 低分组中，治疗后 2 周时自理能力，治疗后 2、6、12 周时穿衣能力和肢体位置显著改善。
BoNT-A 治疗后的时间进程与注射前上肢运动功能不同。在给手指屈肌注射 BoNT-A 时，我们应仔细判断注射适应证。
