Department of Neurology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacký University Olomouc, 779 00 Olomouc, Czech Republic.
Toxins (Basel). 2021 Feb 17;13(2):155. doi: 10.3390/toxins13020155.
In dystonic and spastic movement disorders, however different in their pathophysiological mechanisms, a similar impairment of sensorimotor control with special emphasis on afferentation is assumed. Peripheral intervention on afferent inputs evokes plastic changes within the central sensorimotor system. Intramuscular application of botulinum toxin type A (BoNT-A) is a standard evidence-based treatment for both conditions. Apart from its peripheral action on muscle spindles, a growing body of evidence suggests that BoNT-A effects could also be mediated by changes at the central level including cerebral cortex. We review recent studies employing electrophysiology and neuroimaging to investigate how intramuscular application of BoNT-A influences cortical reorganization. Based on such data, BoNT-A becomes gradually accepted as a promising tool to correct the maladaptive plastic changes within the sensorimotor cortex. In summary, electrophysiology and especially neuroimaging studies with BoNT-A further our understanding of pathophysiology underlying dystonic and spastic movement disorders and may consequently help develop novel treatment strategies based on neural plasticity.
然而，在肌张力障碍和痉挛性运动障碍中，尽管其病理生理机制不同，但人们认为它们的感觉运动控制都存在类似的损伤，特别强调传入神经的影响。外周对传入输入的干预会引起中枢感觉运动系统内的可塑性变化。A型肉毒毒素（BoNT-A）的肌肉内应用是这两种疾病的标准循证治疗方法。除了对肌梭的外周作用外，越来越多的证据表明 BoNT-A 的作用也可以通过中枢水平的变化来介导，包括大脑皮层。我们回顾了最近使用电生理学和神经影像学研究的研究，以探讨肌肉内应用 BoNT-A 如何影响皮质重组。基于这些数据，BoNT-A 逐渐被接受为一种有前途的工具，可以纠正感觉运动皮层内的适应性不良的可塑性变化。总之，电生理学，特别是 BoNT-A 的神经影像学研究，加深了我们对肌张力障碍和痉挛性运动障碍的病理生理学的理解，因此可能有助于基于神经可塑性开发新的治疗策略。
