Zhang Tingting, Zhang Yike, Xie Jiangbo, Zhao Manli, Li Peichun
Weifang Hospital of Traditional Chinese Medicine, Shandong Second Medical University, Weifang, China.
Shandong University of Traditional Chinese Medicine, Jinan, China.
Medicine (Baltimore). 2025 Jul 11;104(28):e43136. doi: 10.1097/MD.0000000000043136.
Thalamic ataxia syndrome is a rare but severely disabling condition resulting from thalamic lesions, characterized by persistent motor incoordination that frequently fails to respond to conventional rehabilitation therapies. Given the lack of effective treatment options and the profound impact on patients' quality of life, this study aimed to evaluate the efficacy of local botulinum toxin type A (BoNT-A) injections as a potential breakthrough treatment for improving motor control and daily living activities in patients with thalamic ataxia. This investigation represents the first clinical application of BoNT-A specifically targeting thalamic ataxia, offering new hope for treatment-resistant cases.
A 59-year-old female presented with a 6-month history of debilitating left limb movement disorder, including inability to lift the left upper limb, grasp objects, or perform essential daily activities such as eating and carrying a cup. Despite 5 months of intensive rehabilitation, her symptoms showed minimal improvement, leaving her functionally dependent.
The patient was diagnosed with thalamic ataxia syndrome secondary to right thalamic hemorrhage, confirmed by cranial CT and MRI.
The patient received precisely targeted local BoNT-A injections (total 130U) into the affected upper limb muscles (deltoid, biceps brachii, flexor carpi radialis, flexor carpi ulnaris, pronator teres, extensor carpi radialis, and flexor digitorum superficialis) under dual ultrasound and electromyography guidance, ensuring optimal muscle selection and dosing accuracy.
Three weeks postinjection, the International Cooperative Ataxia Rating Scale score decreased by 8 points (from 24 to 16), with the most significant improvement in dynamic function (upper limb ataxia subscores reduced from 18 to 10). The Fugl-Meyer Assessment Upper Extremity Scale increased by 6 points (from 52 to 58), particularly in hand coordination and speed tasks. The modified Barthel index improved by 9 points (from 85 to 94), enabling independent performance of previously difficult activities like self-feeding and cup handling.
Local BoNT-A injections represent a novel and potentially transformative treatment for thalamic ataxia syndrome, particularly in cases refractory to conventional therapies. These findings challenge current rehabilitation paradigms and highlight the need for further studies with larger cohorts to validate and expand upon these findings.
丘脑性共济失调综合征是一种由丘脑病变导致的罕见但严重致残的疾病，其特征为持续性运动不协调，常规康复治疗往往对此无效。鉴于缺乏有效的治疗选择以及该疾病对患者生活质量的深远影响，本研究旨在评估局部注射A型肉毒毒素（BoNT-A）作为一种潜在的突破性治疗方法，对改善丘脑性共济失调患者运动控制和日常生活活动的疗效。本研究是BoNT-A专门针对丘脑性共济失调的首次临床应用，为难治性病例带来了新的希望。
一名59岁女性，有6个月的左侧肢体运动障碍病史，包括无法抬起左上肢、抓握物体，或进行诸如进食和端杯子等基本日常活动。尽管进行了5个月的强化康复治疗，她的症状改善甚微，功能上仍依赖他人。
经头颅CT和MRI证实，该患者被诊断为继发于右侧丘脑出血的丘脑性共济失调综合征。
在超声和肌电图双重引导下，对患者受影响的上肢肌肉（三角肌、肱二头肌、桡侧腕屈肌、尺侧腕屈肌、旋前圆肌、桡侧腕伸肌和指浅屈肌）进行精准靶向局部BoNT-A注射（总量130U），以确保最佳的肌肉选择和剂量准确性。
注射后三周，国际合作共济失调评定量表评分下降了8分（从24分降至16分），动态功能改善最为显著（上肢共济失调子评分从18分降至10分）。Fugl-Meyer上肢评定量表提高了6分（从52分升至58分），尤其是在手部协调性和速度任务方面。改良Barthel指数提高了9分（从85分升至94分），使患者能够独立完成之前困难的活动，如自行进食和端杯子。
局部BoNT-A注射是丘脑性共济失调综合征一种新颖且可能具有变革性的治疗方法，尤其适用于对传统疗法难治的病例。这些发现挑战了当前的康复模式，并强调需要进行更大样本量的进一步研究，以验证和扩展这些发现。
