U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy.
U. O. di Medicina riabilitativa e neuroriabilitazione, Ospedale Niguarda, Milan, Italy.
Neurol Sci. 2020 Jan;41(1):131-138. doi: 10.1007/s10072-019-04061-5. Epub 2019 Sep 2.
Idiopathic cervical dystonia (ICD) is a focal dystonia affecting neck muscles. Botulinum neurotoxin (BoNT) is the first-line treatment of ICD and different physical therapies (including exercise) are often proposed as adjunct treatments. However, the actual effectiveness of exercise in ICD is unclear. The aim of the current work is to assess the potential effectiveness of the Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) exercise program as adjunct therapy for ICD.
Fifteen ICD patients received BoNT injections in the neck muscles and, 12 weeks later, received BoNT a second time and SPRInt started. SPRInt consists in 18 exercise sessions in which augmented feedback of movement (including visual and acoustic feedback) is extensively used. Dystonia burden was measured by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Patients were evaluated immediately before, 6 and 12 weeks after each BoNT injection.
Six weeks after the first BoNT injection (i.e., at BoNT peak effect), TWSTRS total score was better than baseline and remained improved at 12 weeks. TWSTRS disability domain slightly improved 6 weeks after the first BoNT injection, but after 6 more weeks returned to its baseline level. Disability improved more at SPRInt end (i.e., 6 weeks after the second BoNT injection), being even lower than after toxin alone. With a single-subject analysis, 4/10 patients who did not improve disability after BoNT improved after SPRInt plus BoNT.
SPRInt plus BoNT can be more effective than BoNT alone in improving cervical dystonia patients' difficulties in the activities of daily living.
www.ClinicalTrials.gov, identifier NCT03247868 (https://register.clinicaltrials.gov).
特发性颈肌张力障碍（ICD）是一种影响颈部肌肉的局灶性肌张力障碍。肉毒毒素（BoNT）是 ICD 的一线治疗方法，通常还会提出不同的物理治疗（包括运动）作为辅助治疗。然而，运动在 ICD 中的实际效果尚不清楚。目前这项工作的目的是评估 Sensorimotor Perceptive Rehabilitation Integrated（SPRInt）运动方案作为 ICD 辅助治疗的潜在效果。
15 名 ICD 患者接受颈部肌肉 BoNT 注射，12 周后再次接受 BoNT 注射并开始 SPRInt。SPRInt 包括 18 节运动课程，其中广泛使用运动的增强反馈（包括视觉和听觉反馈）。肌张力障碍负担通过多伦多西部痉挛性斜颈评定量表（TWSTRS）进行测量。患者在每次 BoNT 注射前、注射后 6 周和 12 周进行评估。
首次 BoNT 注射后 6 周（即 BoNT 效果峰值时），TWSTRS 总分优于基线水平，12 周时仍有改善。首次 BoNT 注射后 6 周，TWSTRS 残疾域略有改善，但 6 周后又恢复到基线水平。SPRInt 结束时（即第二次 BoNT 注射后 6 周）残疾改善更多，甚至低于单独使用毒素。通过单病例分析，4/10 名在 BoNT 后残疾无改善的患者在 SPRInt 加 BoNT 后有所改善。
SPRInt 加 BoNT 比单独使用 BoNT 更能改善颈椎病患者日常生活活动的困难。
www.ClinicalTrials.gov，标识符 NCT03247868（https://register.clinicaltrials.gov）。
