Ross M H, Charness M E, Sudarsky L, Logigian E L
Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Muscle Nerve. 1997 May;20(5):593-8. doi: 10.1002/(sici)1097-4598(199705)20:5<593::aid-mus8>3.0.co;2-4.
Over a 5-year period, 40 patients, 11 with musician's and 29 with writer's cramp, were treated with botulinum toxin A using a precise injection technique in which the hollow-bore electromyography (EMG) needle was positioned by both standard EMG and by muscle twitch evoked by stimulating current passed through it. Moderate to complete improvement in dystonia occurred in 28 patients (70%) after the first injection and in 34 patients (85%) after the second injection with better outcome in nonmusicians than in musicians. Of note, weakness of uninjected muscles, immediately adjacent to those injected, was found in 25/40 patients (63%). The most common patterns of toxin spread were from flexor digitorum sublimis to profundus, extensor carpi radialis to extensor digitorum communis, and extensor indicis proprius to extensor pollicis brevis. Spread to, and weakness of, adjacent uninjected muscles was a major factor contributing to suboptimal outcome in 6/39 (15%) such patients.
在5年期间，40例患者接受了A型肉毒毒素治疗，其中11例患有音乐家型痉挛，29例患有书写痉挛，采用精确注射技术，即通过标准肌电图和经空心针电极肌电图（EMG）针施加刺激电流诱发肌肉抽搐来定位针的位置。首次注射后，28例患者（70%）肌张力障碍出现中度至完全改善，第二次注射后，34例患者（85%）出现改善，非音乐家患者的效果优于音乐家患者。值得注意的是，在40例患者中有25例（63%）发现，紧邻注射肌肉的未注射肌肉出现无力。毒素最常见的扩散模式是从指浅屈肌扩散到指深屈肌、桡侧腕伸肌扩散到指总伸肌、示指固有伸肌扩散到拇短伸肌。在39例此类患者中，有6例（15%）出现相邻未注射肌肉的扩散和无力，这是导致治疗效果欠佳的主要因素。
