Li Hong-Xiao, Xu Ke, Chen Shan-Lin, Wang Shu-Feng, Li Wen-Jun
EFORT Open Rev. 2025 May 5;10(5):237-249. doi: 10.1530/EOR-2024-0156.
This review highlights the role of existing spasticity treatment methods in reducing muscle tone and improving function. The surgical methods today mainly include selective dorsal rhizotomy, selective neurotomy, intrathecal baclofen treatment (ITB), etc. These techniques (except ITB) can lower patients' muscular tone in the long term and improve function to some extent. The young procedures, contralateral C7 nerve transfer and T1 neurotomy, are still under research. ITB and nonsurgical treatment methods, botulinum toxin A (BoNT-A) and extracorporeal shockwave therapy (ESWT), can reduce muscle tone in the short term, but the long-term efficacy is unsatisfactory. In addition, the effects of improving function are relatively controversial. The economic cost of these treatment methods is also heavy for patients. In addition, some studies have reported that some kinds of electrical/magnetic stimulation can improve the patients' function. They can potentially be used as an adjunctive treatment for spasticity. According to current studies and our own experience, surgery methods (except ITB) are still recommended for patients, whose spasticity has a major detrimental influence on their everyday lives, taking into account patient benefits and cost-effectiveness. There are also some problems in the current research on spasticity treatment, such as incomplete guidelines and a relative lack of high-quality studies, which is what the doctors need to strive for. Further exploration is needed to find the treatment methods that can reduce muscle tone while improving patients' function to better benefit patients.
本综述强调了现有痉挛治疗方法在降低肌张力和改善功能方面的作用。如今的手术方法主要包括选择性背根切断术、选择性神经切断术、鞘内注射巴氯芬治疗(ITB)等。这些技术(ITB除外)能长期降低患者的肌张力,并在一定程度上改善功能。较新的手术方法,如对侧C7神经移位术和T1神经切断术,仍在研究中。ITB以及非手术治疗方法,如肉毒毒素A(BoNT - A)和体外冲击波疗法(ESWT),可在短期内降低肌张力,但长期疗效并不理想。此外,在改善功能方面的效果也相对存在争议。这些治疗方法的经济成本对患者来说也很高。另外,一些研究报告称某些电/磁刺激可改善患者功能。它们有可能用作痉挛的辅助治疗。根据目前的研究以及我们自己的经验,对于痉挛对其日常生活有重大不利影响的患者,考虑到患者的受益和成本效益,仍推荐手术方法(ITB除外)。目前痉挛治疗研究中也存在一些问题,如指南不完善以及高质量研究相对缺乏,这正是医生需要努力解决的。需要进一步探索以找到既能降低肌张力又能改善患者功能从而更好地使患者受益的治疗方法。