Henderson J M, Ghika J A, Van Melle G, Haller E, Einstein R
Policlinique de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse.
Eur Neurol. 1996;36(1):29-35. doi: 10.1159/000117196.
The present pilot study evaluated the effect of botulinum toxin A on primarily non-dystonic tremors using accelerometry in a single-blind, placebo-controlled design. Resting, postural, intention, or head tremor were assessed before and approximately 1 month after intramuscular saline and botulinum toxin A (25-50 U) respectively. Half of the patients showed > or = 30% placebo effect. Tremor in 10 of 17 patients (60%) studied improved further after botulinum toxin A (range 30-95%), exceeding the placebo effect by > or = 30%. Nine patients demonstrated clinically significant focal weakness in the extensor muscles after botulinum toxin A which interfered with fine movements. Patients were subdivided into PD-like and ET-like tremor(s). Both groups experienced large placebo effects for resting tremor, with little or no further improvement after botulinum toxin A. The improvement in postural tremor after botulinum toxin A, of 40% in the PD-like and 57% in the ET-like groups, however, was approximately twice that of placebo. In conclusion, botulinum toxin A exerts a modest tremorlytic effect, however the dose, and its distribution over the sites injected, need to be optimised to minimise focal weakness.
本初步研究采用单盲、安慰剂对照设计，通过加速度测量法评估了A型肉毒毒素对原发性非肌张力障碍性震颤的影响。分别在肌肉注射生理盐水和A型肉毒毒素（25 - 50单位）之前及之后约1个月，对静息性、姿势性、意向性或头部震颤进行评估。半数患者显示出≥30%的安慰剂效应。在接受研究的17例患者中，10例（60%）在注射A型肉毒毒素后震颤进一步改善（改善幅度为30% - 95%），超过安慰剂效应≥30%。9例患者在注射A型肉毒毒素后出现伸肌临床上显著的局灶性无力，影响精细运动。患者被分为帕金森病样震颤组和特发性震颤样震颤组。两组在静息性震颤方面均有较大的安慰剂效应，注射A型肉毒毒素后几乎没有进一步改善。然而，在帕金森病样震颤组中，注射A型肉毒毒素后姿势性震颤改善40%，在特发性震颤样震颤组中改善57%，约为安慰剂改善幅度的两倍。总之，A型肉毒毒素有适度的震颤缓解作用，然而，需要优化剂量及其在注射部位的分布，以尽量减少局灶性无力。
