Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan.
Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
Toxins (Basel). 2024 Jul 19;16(7):323. doi: 10.3390/toxins16070323.
Numerous studies have established a robust body of evidence for botulinum toxin A (BoNT-A) therapy as a treatment for upper motor neuron syndrome. These studies demonstrated improvements in spasticity, range of joint motion, and pain reduction. However, there are few studies that have focused on improvement of paralysis or functional enhancement as the primary outcome. This paper discusses the multifaceted aspects of spasticity assessment, administration, and rehabilitation with the goal of optimising the effects of BoNT-A on lower-limb spasticity and achieving functional improvement and gait reconstruction. This paper extracts studies on BoNT-A and rehabilitation for the lower limbs and provides new knowledge obtained from them. From these discussion,, key points in a walking reconstruction strategy through the combined use of BoNT-A and rehabilitation include: (1) injection techniques based on the identification of appropriate muscles through proper evaluation; (2) combined with rehabilitation; (3) effective spasticity control; (4) improvement in ankle joint range of motion; (5) promotion of a forward gait pattern; (6) adjustment of orthotics; and (7) maintenance of the effects through frequent BoNT-A administration. Based on these key points, the degree of muscle fibrosis and preintervention walking speed may serve as indicators for treatment strategies. With the accumulation of recent studies, a study focusing on walking functions is needed. As a result, it is suggested that BoNT-A treatment for lower limb spasticity should be established not just as a treatment for spasticity but also as a therapeutic strategy in the field of neurorehabilitation aimed at improving walking function.
许多研究已经为肉毒毒素 A（BoNT-A）治疗作为上运动神经元综合征的治疗方法提供了大量证据。这些研究表明痉挛、关节活动范围和疼痛减轻都得到了改善。然而，很少有研究将瘫痪或功能增强作为主要结果进行关注。本文讨论了痉挛评估、管理和康复的多方面，目的是优化 BoNT-A 对下肢痉挛的效果，并实现功能改善和步态重建。本文提取了 BoNT-A 治疗下肢的研究，并提供了从中获得的新知识。从这些讨论中，可以得出以下关于通过联合使用 BoNT-A 和康复来重建步行的策略的要点：（1）基于通过适当评估识别合适肌肉的注射技术；（2）与康复相结合；（3）有效控制痉挛；（4）改善踝关节活动范围；（5）促进前进步态模式；（6）调整矫形器；（7）通过频繁的 BoNT-A 给药来维持效果。基于这些要点，肌肉纤维化程度和干预前行走速度可能作为治疗策略的指标。随着最近研究的积累，需要对步行功能进行专门研究。因此，建议将 BoNT-A 治疗下肢痉挛不仅作为治疗痉挛的方法，而且作为神经康复领域改善步行功能的治疗策略。
