Saez-Calveras Nil, Bryarly Meredith, Salinas Meagen
University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ther Adv Neurol Disord. 2023 Mar 24;16:17562864221150317. doi: 10.1177/17562864221150317. eCollection 2023.
We describe a case of limb myorhythmia successfully palliated with botulinum toxin injections. The patient is a 30-year-old male evaluated for abnormal movements of the left lower foot that began after an ankle injury for which the patient underwent Achilles tendon scar tissue debridement without improvement. On examination, he had near-constant involuntary, slow, rhythmic flexion/extension tremor of toes 2-4 that was diminished during active movement. Needle electromyography (EMG) revealed a rhythmic, 2-3 Hz tremor isolated to the flexor digitorum brevis. After failure of medical management with muscle relaxants, gabapentin, and levodopa trials, the patient underwent two EMG-guided chemodenervation procedures with incobotulinum toxin A injections of the left flexor digitorum brevis. At 3-month follow-up, he had achieved a sustained 50% reduction in the intensity of the movements and improved quality of life. Myorhythmia is a rare condition characterized by a repetitive, rhythmic, slow frequency (1-4 Hz) movement affecting the cranial and limb muscles. The most common causes include stroke, demyelinating disorders, drug or toxin intake, trauma, and infections. The management of this condition is very limited with pharmacologic agents such as anticholinergics, antispasmodics, anticonvulsants, or dopaminergic agents showing limited efficacy. The use of botulinum toxin chemodenervation aided by EMG muscle targeting can be a useful therapeutic intervention in cases of medication-refractory regionally distributed myorhythmia involving accessible muscles.
我们描述了一例通过肉毒毒素注射成功缓解的肢体肌节律障碍病例。患者为一名30岁男性，因左足下部异常运动前来就诊，该症状始于一次脚踝损伤后，患者为此接受了跟腱瘢痕组织清创术，但症状并未改善。检查发现，他的第2至4趾存在近乎持续的、不自主的、缓慢的节律性屈伸震颤，在主动运动时震颤减弱。针极肌电图（EMG）显示，仅趾短屈肌存在节律性的2 - 3Hz震颤。在使用肌肉松弛剂、加巴喷丁和左旋多巴进行药物治疗均失败后，患者接受了两次EMG引导下的化学去神经支配手术，向左侧趾短屈肌注射了incobotulinum毒素A。在3个月的随访中，他的运动强度持续降低了50%，生活质量得到改善。肌节律障碍是一种罕见病症，其特征为影响颅部和肢体肌肉的重复性、节律性、低频（1 - 4Hz）运动。最常见的病因包括中风、脱髓鞘疾病、药物或毒素摄入、创伤和感染。使用抗胆碱能药、抗痉挛药、抗惊厥药或多巴胺能药等药物治疗这种病症的效果非常有限。在药物难治性、累及可触及肌肉的局灶性分布肌节律障碍病例中，借助EMG肌肉靶向注射肉毒毒素进行化学去神经支配可能是一种有效的治疗干预手段。
