Mano Tomoo, Murakami Toshiharu, Mori Haruki, Masuda Takashi
Department of Rehabilitation, Nara Prefectural General Medical Center, Nara, Japan.
Department of Neurology, Nara Medical University, Kashihara, Japan.
Clin Med Insights Case Rep. 2025 Jan 4;18:11795476241311528. doi: 10.1177/11795476241311528. eCollection 2025.
Spasticity is an upper motor neuron syndrome that exacerbates motor paralysis and is rarely associated with pain. This report elucidates the management of drug-resistant pain attributed to an adolescent brain tumor using botulinum therapy.
A 15-year-old female patient experienced dizziness, developed muscle weakness in her upper extremities, and was diagnosed with diffuse glioblastoma of the pons. The tumor responded partially to radiation therapy. Three years later, at the time of recurrence, she had high muscle tone and pain in her extremities. On stimulation, her upper and lower extremities would bend and extend, respectively, causing excruciating pain. Despite experiencing pain-induced insomnia and restlessness, she was reluctant to use drugs, citing concerns about respiratory depression. She received botulinum therapy for her extremities 3 times (200, 300, and 500 U), with pain improvement after repeated treatments (Numerical rating scale from 7.5 to 1 and Short-form McGill Pain Questionnaire-2 score from 78 to 16). The effect lasted for more than three months after the final injection.
Thus, botulinum therapy can potentially alleviate spasticity-associated pain in advanced stages of brain tumors in adolescents.
痉挛是一种上运动神经元综合征，会加重运动麻痹，且很少与疼痛相关。本报告阐述了使用肉毒杆菌疗法治疗青少年脑肿瘤所致耐药性疼痛的情况。
一名15岁女性患者出现头晕，上肢肌肉无力，被诊断为桥脑弥漫性胶质母细胞瘤。肿瘤对放射治疗部分有反应。三年后复发时，她四肢肌张力高且疼痛。受到刺激时，她的上肢和下肢会分别弯曲和伸展，引发剧痛。尽管因疼痛导致失眠和烦躁不安，但她因担心呼吸抑制而不愿使用药物。她接受了3次四肢肉毒杆菌疗法（200、300和500单位），反复治疗后疼痛改善（数字评分量表从7.5降至1，简短麦吉尔疼痛问卷-2评分从78降至16）。最后一次注射后效果持续了三个多月。
因此，肉毒杆菌疗法可能缓解青少年脑肿瘤晚期与痉挛相关的疼痛。
