肌电图引导下A型肉毒毒素治疗不同类型痉挛性斜颈的临床研究

目的：探讨A型肉毒毒素（BTX-A）局部注射治疗不同类型原发性痉挛性斜颈的疗效。方法：在肌电图引导下,对24例痉挛性斜颈患者行BTX-A局部肌肉注射,按其临床类型分组比较疗效及不良反应。结果：全部患者治疗后Tsui量表评分均明显下降,混合型改善程度更明显。所有患者均未见严重不良反应。结论：肌电图引导下BTX-A治疗不同类型痉挛性斜颈均有效,且安全。     

A型肉毒毒素注射联合肌肉乙醇阻滞治疗痉挛性斜颈的疗效观察

目的 观察A型肉毒毒素(BTX-A)注射联合肌肉乙醇阻滞治疗痉挛性斜颈(ST)的疗效.方法 43例ST患者随机分为联合治疗组(14例)和对照组(29例),两组均给予BTX-A注射,联合治疗组同时进行肌肉乙醇阻滞治疗.在治疗前后分别进行Tsui评分以评估疗效.结果 治疗后Tsui评分联合治疗组[(3.02±3.29)分...     

肌电图引导下A型肉毒毒素治疗痉挛性斜颈146例临床研究

目的:探讨肌电图引导下A型肉毒毒素局部肌肉注射治疗原发性痉挛性斜颈的疗效。方法:对146例痉挛性斜颈患者在肌电图引导下进行A型肉毒毒素局部肌肉注射,观察其治疗效果以及不良反应。结果:146例痉挛性斜颈患者,治疗后Tsui量表评分明显下降;重复治疗者复发症状减轻,治疗剂量下降,疗效仍良好。所有患者均未见严重不良反应。结论:肌电图引导下A型肉毒毒素局部肌肉注射是一种治疗痉挛性斜颈有效和安全的手段。     

药物性痉挛性斜颈的A型肉毒毒素治疗观察

目的 探讨药物性痉挛性斜颈的A型肉毒毒素(botulinum toxin type A,BTX-A)治疗的疗效及安全性.方法 对21例药物性痉挛性斜颈患者进行BTX-A治疗,治疗前及治疗后4周采用Tsui量表对患者颈部异常姿势程度进行客观评价,前后对照评价疗效,同时观察治疗后的起效时间、疗效持续时间及不良反应.结果 治疗前颈部姿势异常程度评分为12.85±3.32,治疗后4周颈部姿势异常程度评分为3.84±2.13.其差异具有统计学意义(P＜0.01),治疗后3～7 d起效,显效率76.2%,其中18例疗效持续(28±5)周,3例首次治疗后未见复发,2例治疗后出现颈肌无力并于4周内自然恢复,未见其他不良反应.结论 药物性痉挛性斜颈应用BTX-A治疗疗效显著,使用安全.     

肉毒毒素A配合康复治疗小儿痉挛型脑性瘫痪67例临床分析

目的观察局部肌肉注射肉毒毒素A(BTX-A)配合综合康复治疗痉挛型脑性瘫痪(CP)的疗效。方法126例痉挛型脑性瘫痪患儿随机分为治疗组和对照组,两组同时给予物理疗法(PT)、作业疗法(OT)、经络导平及药物治疗,治疗组加用BTX-A,评价两组疗效。结果经6个月治疗后评价疗效,两组运动功能、语言发育、应人能力、认人认物能力均有明显提高;但治疗组显效率及总有效率均优于对照组,(χ2分别为13·02,10·66,P均<0·01)。结论BTX-A局部肌肉注射以缓解肌肉痉挛,使CP患儿畸形改善,配合综合康复治疗可提高临床疗效。     

A型肉毒毒素治疗痉挛性斜颈的远期疗效与机理探讨

<正> 痉挛性斜颈(CD)是神经系统肌张力障碍性疾病之一,病因不甚确切。既往治疗以手术切除肌肉或切断神经及口服镇静药为主,效果不甚满意。近年来,局部肌肉注射A型肉毒毒素(BTX-A)以效果独特,颇受医患双方欢迎。作者自1996年4月至1999年5月应用BTX-A治疗CD21例,兹将远期效果报告如下。 资料和方法 对象 所有患者均为在1996年4月～1999年4月自愿接受BTX-A治疗者,其中男9例,女21例;年龄16～74岁,平均41.2岁;病程4个月～11年,平均4年。本院治疗前有针灸、理疗、药物、手术和巫术等法治疗史,均因疗效不明显或副作用而放弃。本组病例中,3例起病前有惊吓或不良精神刺激史,1     

肉毒毒素A配合康复治疗小儿痉挛型脑性瘫痪67例临床分析

目的观察局部肌肉注射肉毒毒素A（BTX-A）配合综合康复治疗痉挛型脑性瘫痪（CP）的疗效.方法 126例痉挛型脑性瘫痪患儿随机分为治疗组和对照组,两组同时给予物理疗法（PT）、作业疗法（OT）、经络导平及药物治疗,治疗组加用BTX-A,评价两组疗效.结果经6个月治疗后评价疗效,两组运动功能、语言发育、应人能力、认人认物能力均有明显提高;但治疗组显效率及总有效率均优于对照组,（χ2分别为13.02,10.66,P均〈0.01）.结论 BTX-A局部肌肉注射以缓解肌肉痉挛,使CP患儿畸形改善,配合综合康复治疗可提高临床疗效.     

A型肉毒毒素治疗小儿脑性瘫痪下肢肌张力障碍

目的研究A型肉毒毒素(BTX-A)对小儿脑性瘫痪下肢肌张力障碍的治疗效果.方法选择30例痉挛型下肢瘫脑性瘫痪患儿,用国产BTX-A进行下肢痉挛肌肉局部注射,应用PRS方法(Physician Rating Sclae)进行治疗前后的疗效评价.结果29例(96.7%)治疗后较治疗前下肢痉挛明显改善,其PRS指标治疗前后比较差异显著(P＜0.01).治疗中及治疗后无严重不良反应发生.结论BTX-A能缓解脑性瘫痪患儿下肢痉挛的肌肉,改善运动功能.小儿对该药有良好的耐受.该治疗方法是一种安全有效、简便沣易行的治疗小儿脑瘫的方法.     

A型肉毒毒素局部注射治疗面肌痉挛的临床疗效

目的探讨A型肉毒毒素(BTX-A)局部注射治疗面肌痉挛的临床疗效。方法给46例面肌痉挛患者的面部17点位皮下注射BTX-A。在治疗前和治疗后进行面肌痉挛强度评级。在注射治疗后4周,根据面肌痉挛强度评级进行疗效评定。对症状复发的患者给予重复BTX-A注射治疗。结果本组患者BTX-A注射治疗后完全缓解15例,明显缓解29例,部分缓解2例;有效率95.6%。起效时间为(2.62±1.10)d;疗效持续(19.1±2.3)周。其中注射治疗1次5例、2次23例、3次11例、≥4次7例。重复注射治疗的起效时间[(2.61±1.03)d]、疗效持续时间[(19.24±2.12)周]及有效率(100%)与初次注射治疗时的差异无统计学意义。出现注射侧局部面肌轻度麻痹6例,2~4周后自行完全恢复。结论 BTX-A局部注射是一种治疗面肌痉挛安全有效地方法,无明显不良反应;并且重复治疗的效果不减退。     

重复经颅磁刺激联合重复注射A型肉毒毒素对脑卒中后下肢肌肉痉挛状态的临床疗效和安全性研究

目的观察脑卒中后下肢肌肉痉挛患者行重复经颅磁刺激(rTMS)联合A型肉毒毒素(BTX-A)重复注射的治疗效果及安全性。方法选择2013年7月至2016年7月于本院康复科治疗的伴有下肢肌肉痉挛的脑卒中患者共96例,按照随机数字表法分为4组:A组,康复治疗;B组,rTMS+康复治疗;C组,重复注射BTX-A+康复治疗;D组,rTMS+重复注射BTX-A+康复治疗。治疗前及治疗后1、6和12个月对4组患者采用改良Ashworth痉挛量表(MAS)评定肌张力,Fugl-Meyer下肢运动功能量表(FMA)评定下肢运动功能,采用改良Barthel指数量表(MBI)评定患者日常生活能力,Berg平衡量表(BBS)评定患者平衡能力。并观察患者在治疗的过程中的不良反应情况。结果与治疗前相比,治疗后1、6、12个月,B、C、D组的MAS评分呈下降趋势,D组最为明显(P<0.05);4组患者治疗1个月后FMA评分、MBI评分、BBS评分均升高,治疗后6、12个月,A、B、C组的FMA评分、MBI评分、BBS评分有下降或回升,D组的评分都呈上升趋势,均高于其他3组(P<0.05);治疗过程中,4组均无严重不良反应情况发生。结论 rTMS联合重复注射A型肉毒毒素能够有效降低脑卒中后下肢肌肉痉挛患者的肌肉张力,提高患者的生活质量,治疗效果较为持久,无不良反应,有临床应用价值。     

Botulinum toxin-induced paralysis of frontotemporal muscles improves seizure focus localization.

BACKGROUND: Scalp EEG localization of epileptic foci may be obscured by electromyographic (EMG) artifact produced by ictal contraction of cranial muscles. Injection of botulinum toxin type A (BTX-A) into frontotemporal scalp muscles reduces EMG activity. Initial scalp video-EEG monitoring in three patients suggested partial seizures, but definitive lateralization or localization was precluded by EMG artifact. METHODS: EMG-guided BTX-A injection to bilateral frontotemporal muscles was performed. When artifact persisted, BTX-A administration was selectively repeated. Patients subsequently underwent scalp video-EEG monitoring 1 week later. RESULTS: All patients had reduction of EMG artifact during subsequent scalp video-EEG monitoring. No patient had adverse effects after BTX-A administration. All three patients had localization to either frontal or temporal lobes and definitive lateralization. Two of the three patients were able to proceed to invasive placement of frontotemporal subdural grid electrodes based on the BTX-A scalp video-EEG localization, and the third patient was determined to have a multifocal seizure disorder. CONCLUSIONS: Paralysis of frontotemporal scalp muscle after BTX-A administration reduces EMG artifact and may improve localization and lateralization of a seizure focus, providing a noninvasive technique for advancement toward epilepsy surgery.     

Reduced jaw opening from paradoxical activity of mandibular elevator muscles treated with botulinum toxin

The aim of the study was the effect of injections with botulinum toxin A (BTX-A) on reduced jaw opening, caused by paradoxical, antagonistic activity of jaw elevator muscles after brain stem lesions. The study included a male (51 years) and a female (69 years) patient. Subjective assessment, clinical recordings, muscle blocks and electromyography (EMG) were used to diagnose paradoxical activity, and to plan, guide and evaluate the treatment. The paradoxical innervation pattern was unilateral in the male and bilateral in the female. The paradoxical activity during jaw opening amounted to 24-109% of the level during maximum biting, and bursts of paradoxical activity were also present during chewing. EMG-guided blocks and later BTX-A injections of the affected muscles increased the opening by 9-23 mm from pre-treatment values of 15-18 mm, and normalized chewing. The study proved BTX-A to be an effective treatment for reduced jaw opening caused by paradoxical activity. Treatment was optimized by EMG evaluation of the current activity of the jaw elevator muscles, permitting individual treatment plans with longer intervals between BTX-A injections and lower doses than with conventional treatment for oromandibular dystonia. Thus the treatment only had to be repeated one to two times per year to maintain acceptable jaw mobility.     

Fast voluntary neck movements in patients with cervical dystonia: a kinematic study before and after therapy with botulinum toxin type A.

OBJECTIVE: To study fast voluntary neck movements in patients with cervical dystonia (CD) before and after therapy with botulinum toxin type-A (BTX-A). METHODS: A selected sample of 15 patients with CD (with prevalent torticollis) and 13 age-matched control subjects performed both right and left rotational, and flexion and extension neck movements as fast as possible. Movements were recorded with a motion analysis system (SMART, BTS). Movement time, angular amplitude, and peak angular velocity were analyzed. In patients, rotational neck movements were pooled as "pro-dystonic" (toward the dystonic side) and "anti-dystonic" (toward the non-dystonic side). Results obtained in patients before BTX-A treatment were compared with those of control subjects. The effect of BTX-A treatment was evaluated by comparing movement performance before and after treatment. RESULTS: Before receiving BTX-A, patients performed pro- and anti-dystonic movements with lower peak angular velocity than control subjects. Pro-dystonic movements had a reduced angular amplitude. Anti-dystonic movements showed an abnormally long movement time. Flexion and extension movements required longer movement times, but the other kinematic variables were normal. After BTX-A injections, pro-dystonic movement amplitude and anti-dystonic movement peak angular velocity increased, whereas flexion and extension movements remained unchanged. CONCLUSIONS: Before BTX-A injection patients with CD perform fast voluntary neck movements abnormally and BTX-A injections improved their peak velocity and amplitude. SIGNIFICANCE: Kinematic studies can detect specific neck movement disturbance in patients with CD, and can quantify both the severity of clinical picture and the effect of BTX-A injections in these patients.     

Gait analysis to assess the effects of botulinum toxin type A treatment in cerebral palsy: an open-label study in 10 children with equinus gait pattern

Botulinum toxin type A (BTX-A) injections induce a dose-related decrease in muscle tone and increased joint mobility in adults with spasticity and children with cerebral palsy. The aim of this study was to address the question of whether BTX-A-related improvements in joint mobility and muscle tone are associated with changes in instrumental gait analysis in children with cerebral palsy. Ten children with cerebral palsy and equinus gait were given a single dose of BTX-A (5 U BOTOX®/kg body weight per leg) into the gastrocnemius muscles. At follow-up (mean, 32.6 days post-injection), a significant ( P < 0.05) increase in both passive and active ankle range of motion was observed, together with a decrease in the modified Ashworth score. Instrumental gait analysis showed improvements in ankle and knee kinematics as well as in time-distance parameters, with a significant increase in step length observed ( P < 0.05). Semi-quantitative analysis of rectified electromyographic (EMG) recordings of the tibialis anterior muscle during gait showed a reduction in EMG activity during the stance phase and an increase in EMG activity during the swing phase. This study demonstrated the benefits of BTX-A treatment in improving joint mobility and ambulatory function in children with cerebral palsy, and showed that changes in tibial anterior muscle activity as a result of BTX-A injections into the gastrocnemius muscle can be measured by instrumental gait analysis.     

Factors affecting the health-related quality of life of patients with cervical dystonia and the impact of botulinum toxin type A injections

The purpose of this study was to analyze the health-related quality of life (HRQL) of patients with cervical dystonia (CD) and the impact of botulinum toxin A (BTX-A) therapy in these patients. The authors recruited 101 patients with CD, all previously treated with BTX-A. Both before and 4 weeks after injection of BTX-A the patients were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), a Visual Analogue Scale for pain (VAS: 0-100%), the Short Form 36 health survey questionnaire (SF-36), and the Montgomery-Asberg Depression Rating Scale (MADRS). A control group of 84 healthy volunteers was also evaluated. The patients? baseline SF-36 scores were worse in all the domains when compared with those of the controls. Depression was found in 47.5% of the patients. Improvements were noticed 4 weeks after the single BTX-A injections in all the SF-36 domains, and in the VAS, TWSTRS and MADRS scores. The TWSTRS results did not correlate with any of the SF-36 subscores. Stepwise backward regression analysis revealed depression as the main predictor of poor HRQL, as well as female sex, poor financial situation, and living alone. On contrary, longer treatment with BTX-A was associated with better scores. Cervical dystonia has a marked impact on HRQL and treatment with BTX-A injections has a beneficial effect, seen both in objective and in subjective measures. Depression in CD patients is a main predictor of worse HRQL.     

Efficacy of botulinum toxin type A against cervical dystonia and muscular hypertonia in persons with severe motor and intellectual disabilities with respiratory problems and/or dysphagia

We administered intramuscular injections of botulinum toxin type A (BTX-A) in 11 persons with cervical dystonia (CD) and muscular hypertonia (MH). All patients had severe motor and intellectual disabilities (SMID). Furthermore, in 10 patients, SMID was accompanied by respiratory problems and/or dysphagia. Three patients received night nasal intermittent positive pressure ventilation and 3 had undergone tracheotomy; 5 patients had upper respiratory problems. Because of these complications, BTX-A dose was gradually increased in those patients until the desired effect was obtained (mean last dose, 6.8 u/kg/dose). All patients were clinically assessed with the Tsui scale before treatment with BTX-A. At 1, 2, 4, and 8 weeks after BTX-A injections, responses to the injections were assessed with the Tsui scale repetitively in all patients. Significant or mild improvements in the Tsui scale scores were observed in 8 patients without any severe adverse effects. In addition, some improvements in respiration and body weight gain were observed. We observed a reduction in the number of oral medications in 10 cases. Administration of BTX-A for the treatment of SMID has numerous benefits, not all of which can be explained by Tsui scale scores. BTX-A is safe and has potential for use in the treatment of CD and MH with respiratory problems and/or dysphagia.     

The botulinum toxins in the treatment of cervical dystonia

The use of botulinum toxin to treat cervical dystonia (CD) has dramatically improved the quality of life of patients with this disabling, often painful disease. Two forms of toxins, botulinum toxin type A (BTX-A) and botulinum toxin type B (BTX-B), have each been studied in large multicenter trials in subjects with CD. A study of BTX-A demonstrated improvement of 5.15 to 10.65 degrees in head position using the Cervical Dystonia Severity Scale (CDSS) in those treated with BTX-A (trade name BOTOX) compared with placebo. A study in patients who continued to respond to BTX-A and a similarly designed study in patients who were resistant to BTX-A demonstrated statistical improvement in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) in those treated with BTX-B (evaluated as NeuroBloc) compared with placebo. The potential availability of both forms of toxin will allow physicians to offer further treatment options to patients with CD.