Lagueny A, Burbaud P
Service de neurologie, hôpital Haut-Lévéque, CHRU Bordeaux, Pessoc.
Neurophysiol Clin. 1996;26(4):216-26. doi: 10.1016/s0987-7053(96)85003-9.
Botulinum toxin, the most potent of the neurotoxins, produces paralysis by blocking presynaptic release of the neurotransmitter (acetylcholine) at the neuromuscular junction, with reversible chemical denervation of the muscle fibre, thereby inducing partial paralysis and atrophy. Because chemical denervation is reversible, botulinum toxin has temporary effects, the muscle being progressively reinnervated by nerve sproutings. Type A botulinum toxin (Bix-A) is available under two dosage forms: Botox and Dysport. Although the initial clinical indication was strabismus, subsequent studies have demonstrated the efficacy of Btx-A, mainly in dystonia, hemifacial spasm and spasticity. However, botulinum toxin has been successfully used in various other clinical indications. In regard to spasticity associated with cerebral palsy, Btx-A is a promising treatment requiring a multidisciplinary approach. Btx-A injections lead to effective reduction of muscle hyperactivity with minor side-effects. They are painless, even though electromyographic guidance may be required for the injection of deep muscles. However, the production of antibodies to Btx-A may compromise the effect of long-term treatment.
肉毒杆菌毒素是毒性最强的神经毒素之一，它通过阻断神经肌肉接头处神经递质（乙酰胆碱）的突触前释放来导致麻痹，使肌纤维发生可逆性化学去神经支配，从而引起部分麻痹和萎缩。由于化学去神经支配是可逆的，肉毒杆菌毒素具有暂时的效果，肌肉会逐渐通过神经发芽重新获得神经支配。A型肉毒杆菌毒素（Btx-A）有两种剂型：保妥适（Botox）和丽舒妥（Dysport）。尽管最初的临床适应症是斜视，但随后的研究表明Btx-A的疗效，主要用于治疗肌张力障碍、半面痉挛和痉挛状态。然而，肉毒杆菌毒素已成功用于各种其他临床适应症。对于与脑瘫相关的痉挛状态，Btx-A是一种有前景的治疗方法，需要多学科方法。Btx-A注射可有效减轻肌肉活动亢进，副作用较小。它们无痛，尽管注射深部肌肉可能需要肌电图引导。然而，产生针对Btx-A的抗体可能会损害长期治疗的效果。
