Mezaki T, Kaji R, Hamano T, Nagamine T, Shibasaki H, Shimizu T, Kimura J
Department of Neurology, Kyoto University School of Medicine, Japan.
J Neurol Neurosurg Psychiatry. 1994 Dec;57(12):1535-7. doi: 10.1136/jnnp.57.12.1535.
Twenty two patients with cervical and axial dystonias were treated with Japanese type A botulinum toxin. Injections were given repeatedly at intervals of 28-30 days to carefully chosen muscles with increased activities, with a maximum dose per session of 300 units. The maximum improvements in subjective and objective ratings were obtained only after repeated injections. No anti-toxin antibodies were detected; nor did any muscle fail to respond to the toxin. During the treatment, previously "silent" muscles were activated to reproduce the original abnormal posture, as if driven by a central motor programme. This resistance to treatment was overcome by injecting the toxin into newly activated muscles. Repeated injections are thus required to override central mechanisms in dystonias or to maximise drug delivery to large muscles. Antibody development may be controlled by the use of a less immunogenic toxin.
22例颈部和轴性肌张力障碍患者接受了日本A型肉毒杆菌毒素治疗。每隔28 - 30天对精心挑选的活动增强的肌肉重复进行注射，每次最大剂量为300单位。只有在重复注射后才获得主观和客观评分的最大改善。未检测到抗毒素抗体；也没有任何肌肉对毒素无反应。在治疗过程中，先前“静止”的肌肉被激活，重现原来的异常姿势，就好像是由中枢运动程序驱动的一样。通过将毒素注射到新激活的肌肉中克服了这种治疗抵抗。因此，需要重复注射以克服肌张力障碍的中枢机制或使药物最大程度地输送到大型肌肉。通过使用免疫原性较低的毒素可以控制抗体的产生。
