Pullman S L, Greene P, Fahn S, Pedersen S F
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, USA.
Arch Neurol. 1996 Jul;53(7):617-24. doi: 10.1001/archneur.1996.00550070055012.
To determine the dosing, response expectation, efficacy, and most rational strategy for using intramuscular injections of botulinum toxin A (BTX) for limb disorders.
Open-label prospective analysis of outcome after BTX treatment in patients with limb disorders.
Botulinum toxin A prepared from lyophilized botulinum toxin was injected into selected upper and lower limb muscles under electromyographic guidance. Booster injections were given every 10 to 14 days during the first month (if needed) until optimal effects were achieved. Clinical data and muscle strength testing were obtained before the first injections and repeated at each visit. Level of disability, global functional improvement, and relief of pain were evaluated 6 to 8 weeks after the first set of injections. Practical and meaningful BTX doses by muscle, limb, or condition according to specified levels of efficacy were developed.
Botulinum toxin A efficacy was calculated as an arithmetic combination of changes in the 3 clinical ratings before and after administration of BTX.
Botulinum toxin A injections were given to 187 patients with limb disorders during an 8-year period (136 with dystonia, 37 with parkinsonian, essential, and cerebellar tremors, and 14 with spasticity). Four overall outcomes from no effect to almost complete improvement in the use of the limb or relief of pain were found, and determined the strategy for follow-up injections. Average BTX efficacy for all patients was 65% and ranged from 83.5% for focal hand dystonia to 35.7% for parkinsonian tremor. Botulinum toxin A injections relieved pain, independent of motor function, in 82.7% of patients with painful muscle spasms.
Botulinum toxin A was found to be a safe and useful treatment of various limb conditions. Botulinum toxin A was significantly more effective when only a few muscles needing low doses were injected, and tended to be more useful in dystonia and spasticity than tremor. Candidates for BTX injection could be categorized functionally into 3 groups independent of the underlying disorders. The only significant adverse effect of BTX injection in limbs was transient weakness in injected or neighboring muscles.
确定肌肉注射A型肉毒毒素（BTX）治疗肢体疾病的剂量、预期反应、疗效及最合理策略。
对肢体疾病患者BTX治疗后的结局进行开放标签前瞻性分析。
将冻干肉毒毒素制备的A型肉毒毒素在肌电图引导下注射到选定的上肢和下肢肌肉中。在第一个月内（如有需要）每10至14天进行一次追加注射，直至达到最佳效果。在首次注射前获取临床数据和肌肉力量测试结果，并在每次就诊时重复。在第一组注射后6至8周评估残疾程度、整体功能改善情况和疼痛缓解情况。根据规定的疗效水平制定按肌肉、肢体或病情划分的实用且有意义的BTX剂量。
BTX疗效通过给药前后3项临床评分的变化进行算术组合计算。
在8年期间，对187例肢体疾病患者注射了A型肉毒毒素（136例患有肌张力障碍，37例患有帕金森病、特发性震颤和小脑性震颤，14例患有痉挛）。发现了从无效到肢体使用几乎完全改善或疼痛缓解的4种总体结局，并确定了后续注射的策略。所有患者的平均BTX疗效为65%，范围从局灶性手部肌张力障碍的83.5%到帕金森病震颤的35.7%。A型肉毒毒素注射使82.7%有疼痛性肌肉痉挛的患者的疼痛得到缓解，与运动功能无关。
发现A型肉毒毒素是治疗各种肢体疾病的安全且有效的方法。当仅注射少数需要低剂量的肌肉时，A型肉毒毒素的效果显著更好，并且在肌张力障碍和痉挛中往往比特发性震颤更有效。BTX注射的候选者可根据功能分为3组，与潜在疾病无关。BTX注射到肢体的唯一显著不良反应是注射肌肉或邻近肌肉的短暂无力。
