Brin M F, Fahn S, Moskowitz C, Friedman A, Shale H M, Greene P E, Blitzer A, List T, Lange D, Lovelace R E
Dystonia Clinical Research Center, Columbia University College of Physicians and Surgeons, New York.
Mov Disord. 1987;2(4):237-54. doi: 10.1002/mds.870020402.
Medical treatment of dystonia usually results in an incomplete response and is frequently unsuccessful. Peripheral surgical therapy is available for some focal dystonias, but may only offer temporary relief and may have unacceptable complications. We have used local injections of botulinum toxin into the appropriate muscles for treatment of disabling focal or segmental dystonia in 93 patients with torticollis, blepharospasm, oromandibular dystonia (OMD), limb dystonia, lingual dystonia, and dystonia adductor dysphonia, in addition to four patients with hemifacial spasm. Significant relief of motor symptoms was seen in 69% of the patients with blepharospasm and 64% of patients with torticollis; 74% of the latter group with pain experience relief. Relief of symptoms was noted in most patients with OMD and limb dystonia, and all with lingual dystonia, dystonic adductor spastic dysphonia, and those with hemifacial spasm. Benefit averaged 2 1/2-3 months initially; however some patients experienced longer relief with subsequent injections. Adverse effects were transient, although 2 patients developed antibodies against the toxin, and we documented evidence for distant effects in others. This approach of chemically weakening contracting muscles in focal dystonia offers many advantages over pharmacotherapy and surgical therapy. Additional experience is needed to explore the proper doses, and potential for long term adverse effects.
肌张力障碍的药物治疗通常效果不完全，且常常不成功。对于某些局限性肌张力障碍，可采用外周手术治疗，但可能只能提供暂时缓解，且可能有不可接受的并发症。我们已对93例患有斜颈、眼睑痉挛、口下颌肌张力障碍（OMD）、肢体肌张力障碍、舌肌张力障碍和肌张力障碍性内收肌发音障碍的患者，以及4例面肌痉挛患者，在适当的肌肉中局部注射肉毒杆菌毒素，以治疗致残性局限性或节段性肌张力障碍。在眼睑痉挛患者中，69%的患者运动症状得到显著缓解；在斜颈患者中，64%的患者症状得到缓解；后一组中有疼痛的患者，74%疼痛得到缓解。大多数OMD和肢体肌张力障碍患者，以及所有舌肌张力障碍、肌张力障碍性内收肌痉挛性发音障碍患者和面肌痉挛患者的症状都得到了缓解。最初疗效平均持续2个半月至3个月；然而，一些患者在后续注射后缓解时间更长。不良反应是短暂的，尽管有2例患者产生了针对毒素的抗体，并且我们记录了其他患者有远处效应的证据。这种在局限性肌张力障碍中化学性削弱收缩肌肉的方法，比药物治疗和手术治疗有许多优势。需要更多经验来探索合适的剂量以及长期不良反应的可能性。
