Hesse S, Krajnik J, Luecke D, Jahnke M T, Gregoric M, Mauritz K H
Klinik Berlin, Department of Neurological Rehabilitation, Free University Berlin (Germany).
Stroke. 1996 Mar;27(3):455-60. doi: 10.1161/01.str.27.3.455.
Recent studies have been made of the novel treatment of lower limb spasticity after stroke with botulinum toxin A, and the results were based mostly on the clinical assessment made before and after treatment. This study investigated the effects of toxin on ankle muscle activity during gait in patients with severe extensor spasticity. The questions posed were whether the toxin particularly diminishes the so-called premature muscle activity as a major cause of equinovarus deformity and whether different types of altered motor control allow a prediction of the outcome of the treatment.
In 12 chronic hemiparetic outpatients with pronounced lower limb spasticity, we injected 400 U botulinum toxin A into the soleus and tibialis posterior muscles and both heads of the gastrocnemius muscles. Ankle spasticity and complex gait analysis including kinematic electromyography (EMG) of the soleus and tibialis muscles were assessed before treatment and 4 weeks after the injection.
Nine patients profited with a reduction of spasticity, improved gait ability, and a more normal temporal pattern of muscle activity with a prominent reduction of the premature activity of the plantar flexors. Eight patients exhibited a qualitative pattern (type I) corresponding to an increased stretch-reflex excitability. Three patients did not profit; their muscle tone, gait ability, and muscle activation remained stable or even deteriorated.
This study further supports the beneficial effects of botulinum toxin in the treatment of lower limb extensor spasticity. A correlation was observed between the clinical reduction of muscle tone, functional gait parameters, and a more normal EMG pattern with a predominant reduction of the premature activity of the plantar flexors. The qualitative type of EMG pattern corresponding to an increased stretch-reflex excitability (type I) was a positive predictor for the outcome.
近期已有关于肉毒杆菌毒素A治疗中风后下肢痉挛的新研究，其结果大多基于治疗前后的临床评估。本研究调查了毒素对严重伸肌痉挛患者步态期间踝关节肌肉活动的影响。提出的问题是，毒素是否特别减少了作为马蹄内翻畸形主要原因的所谓过早肌肉活动，以及不同类型的运动控制改变是否能预测治疗结果。
在12名患有明显下肢痉挛的慢性偏瘫门诊患者中，我们将400单位肉毒杆菌毒素A注射到比目鱼肌、胫骨后肌以及腓肠肌的两个头中。在治疗前和注射后4周评估踝关节痉挛情况以及包括比目鱼肌和胫骨肌的运动肌电图（EMG）在内的复杂步态分析。
9名患者受益，痉挛减轻，步态能力改善，肌肉活动的时间模式更正常，跖屈肌的过早活动明显减少。8名患者表现出一种定性模式（I型），对应于牵张反射兴奋性增加。3名患者未受益；他们的肌张力、步态能力和肌肉激活保持稳定甚至恶化。
本研究进一步支持肉毒杆菌毒素在治疗下肢伸肌痉挛方面的有益效果。观察到肌张力的临床降低、功能性步态参数与更正常的肌电图模式之间存在相关性，其中跖屈肌的过早活动明显减少。对应于牵张反射兴奋性增加的定性肌电图模式类型（I型）是治疗结果的一个积极预测指标。
