Bhakta B B, Cozens J A, Bamford J M, Chamberlain M A
Rheumatology and Rehabilitation Research Unit, University of Leeds, UK.
J Neurol Neurosurg Psychiatry. 1996 Jul;61(1):30-5. doi: 10.1136/jnnp.61.1.30.
Spasticity can contribute to poor recovery of upper limb function after stroke. This is a preliminary evaluation of the impact of botulinum toxin treatment on disability caused by upper limb spasticity after stroke.
Seventeen patients with severe spasticity and a non-functioning arm were treated with intramuscular botulinum A neurotoxin (median age at treatment 54.5 years; median time between onset of stroke and treatment 1.5 years). Baseline and assessments two weeks after treatment were compared to assess efficacy. The duration of improvement in disability was documented. Outcome measures used were; passive range of movement at the shoulder, elbow, wrist, and fingers; modified Ashworth scale to assess spasticity of biceps and forearm finger flexors; an eight point scale to assess the degree of difficulty experienced by the patient or carer for each functional problem defined before treatment; the presence of upper limb pain. The biceps, forearm finger flexors, and flexor carpiulnaris were treated with intramuscular botulinum toxin. Up to a total dose of 400-1000 mouse units (MU) of Dysport (Speywood) or 100-200 MU of BOTOX (Allergan) was used in each patient.
Functional problems reported by the patients before treatment were difficulty with cleaning the palm, cutting fingernails, putting the arm through a sleeve, standing and walking balance, putting on gloves, and rolling over in bed. Hand hygiene improved in 14 of 17 patients; difficulty with sleeves improved in four of 16; standing and walking balance improved in one of four; shoulder pain improved in six of nine; wrist pain improved in five of six. Passive range of movement at shoulder, elbow, and wrist improved after treatment. Benefit was noted within two weeks and lasted one to 11 months. No adverse effects occurred.
This preliminary study suggests that intramuscular botulinum toxin is a safe and effective treatment for reducing disability in patients with severe upper limb spasticity.
痉挛可能导致中风后上肢功能恢复不佳。这是一项关于肉毒杆菌毒素治疗对中风后上肢痉挛所致残疾影响的初步评估。
17例患有严重痉挛且患侧上肢无功能的患者接受了肌肉注射A型肉毒杆菌神经毒素治疗（治疗时的中位年龄为54.5岁；中风发作至治疗的中位时间为1.5年）。比较治疗前的基线情况与治疗后两周的评估结果以评估疗效。记录残疾改善的持续时间。使用的结果指标包括：肩部、肘部、腕部和手指的被动活动范围；改良Ashworth量表以评估肱二头肌和前臂指屈肌的痉挛程度；一个八点量表以评估患者或护理人员在治疗前定义的每个功能问题上所经历的困难程度；上肢疼痛情况。对肱二头肌、前臂指屈肌和尺侧腕屈肌进行肌肉注射肉毒杆菌毒素治疗。每位患者使用的Dysport（斯皮伍德）总剂量最高达400 - 1000鼠单位（MU）或BOTOX（艾尔建）100 - 200 MU。
患者治疗前报告的功能问题包括清洁手掌困难、剪指甲困难、穿袖子困难、站立和行走平衡问题、戴手套困难以及在床上翻身困难。17例患者中有14例手部卫生情况改善；16例中有4例穿袖子困难情况改善；4例中有1例站立和行走平衡改善；9例中有6例肩部疼痛改善；6例中有5例腕部疼痛改善。治疗后肩部、肘部和腕部的被动活动范围得到改善。在两周内出现益处，并持续1至11个月。未发生不良反应。
这项初步研究表明，肌肉注射肉毒杆菌毒素是一种安全有效的治疗方法，可减少严重上肢痉挛患者的残疾情况。
