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。     

肌电图下局部注射A型肉毒毒素治疗痉挛性斜颈临床观察

目的探讨肌电图引导下局部注射A型肉毒毒素治疗痉挛性斜颈的疗效。方法在肌电图引导下采用A型肉毒毒素局部多点注射治疗痉挛性斜颈42例,治疗前后的病情采用Tsui量表进行评分比较。结果症状基本缓解20例,占47.62%,明显缓解18例,占42.86%,部分缓解4例,占9.52%,无效0例,有效率90.48%。疗效平均持续约6月左右,最长达1~3年。复发者重复注射仍有效且剂量无增加,局部不良反应轻微短暂。结论肌电图引导下局部注射A型肉毒毒素治疗痉挛性斜颈是一种安全有效且简便易行的方法,可重复注射。     

肌电引导下A型肉毒毒素治疗痉挛性斜颈（附14例报告）

目的 :观察A型肉毒毒素 (BTX A)治疗痉挛性斜颈的疗效。方法 :在肌电图引导下用A型肉毒毒素对 14例痉挛性斜颈进行局部多点注射 ,分析其治疗疗效。结果 :14例中主要累及胸锁乳突肌、斜方肌、椎旁肌、头夹肌、肩胛提肌等。 14例中显效 3例 ,明显好转 9例 ,无效 2例 ,起效时间 7～ 10d ,疗效持续 4个月左右。结论 :肌电图引导下A型肉毒毒素治疗痉挛性斜颈是一种定位准确、安全有效的方法。     

A型肉毒毒素治疗痉挛性斜颈及Meige''''s综合征的临床研究

目的　探讨A型肉毒毒素局部注射治疗痉挛性斜颈、Meige s综合征及职业性痉挛的疗效。方法　对 2 3例痉挛性斜颈、10例完全型Meige s综合征及 1例职业性痉挛患者进行A型肉毒毒素局部注射 ,观察其治疗效果以及副作用。结果　 2 3例痉挛性斜颈患者 ,治疗后Tsui量表评分明显下降 ;10例完全型Meige s综合征 ,8例明显好转 ,2例部分缓解 ;1例职业性痉挛患者完全缓解。所有患者均未见过敏反应和严重副反应。结论　A型肉毒毒素局部肌肉注射是治疗痉挛性斜颈等肌张力障碍的有效手段。     

肌电图引导下A型肉毒毒素治疗面肌痉挛的临床观察

目的:探讨肌电图引导下A型肉毒毒素治疗面肌痉挛的临床疗效及安全性。方法:在肌电图引导下采用A型肉毒毒素治疗46例(肌电图引导组)和非肌电图引导下治疗48例(非肌电图引导组)面肌痉挛患者,对两组治疗前后的疗效及安全性进行对比。结果:肌电图引导组有效率100%(46/46例),不良反应率21.74%非肌电图引导组有效率95.83%(46/48例),不良反应率47.92%。结论:肌电图引导下A型肉毒毒素多点注射治疗面肌痉挛更安全有效,不良反应少,值得推广。     

肌电图引导局部肌肉注射A型肉毒毒素治疗痉挛性斜颈的疗效观察

目的 观察肌电图(EMG)引导局部肌肉注射A型肉毒毒素(BTX-A)治疗痉挛性斜颈(CD)的疗效.方法 应用EMG检查19例CD患者头颈部152块肌肉,针对放松状态下出现的多频群放电位的114块靶肌肉进行BTX-A局部肌肉注射;治疗前后分别采用Tsui量表对病情和疗效进行评估;随访观察疗效持续时间以及不良反应.结果 治疗后EMG发现靶肌肉5块;根据Tsui量表评分,治疗后总有效率第1周为47.3%,第2周为78.9%,第3、4周均为94.7%;随访显示疗效平均保持10个月;不良反应轻微,均在4周内自行缓解.结论 EMG引导局部肌肉注射BTX-A治疗CD安全有效.     

A型肉毒杆菌毒素治疗痉挛性斜颈的临床探讨

痉挛性斜颈是神经科较为常见且难治的一组症候群。自20世纪70年代美国Scott[1]首先应用A型肉毒杆菌毒素局部注射治疗斜视后,该方法即被神经科采用治疗痉挛性斜颈。但治疗剂量及方法不尽相同,副作用亦屡有报道[2-4]。因此,为了探讨A型肉毒杆菌毒素的合理应用剂量,使其既可产生良好疗效且又令副作用减少,笔者对我院2003年3月-2005年12月于门诊接受A型肉毒杆菌毒素局部注射治疗的32例患者的疗效进行回顾性分析。对象与方法一、对象32例痉挛性斜颈患者,男13例,女19例;年龄24～59岁,平均(40.75±11.01)岁,病程3～9年,平均(4.82±1.66)年,其中19…     

A型肉毒毒素治疗痉挛斜颈18例临床报告

<正> 痉挛性斜颈为头颈部肌肉不协调过度收缩而致的持续性头位异常,常伴有局部痛疼或压痛。我们采用A型肉毒毒素局部注射治疗痉挛性斜颈患者18例,取得了较为理想的效果,现报道如下。     

重复局部注射A型肉毒毒素治疗局限性肌张力障碍长期疗效观察

目的研究重复局部注射A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛、Meige's综合征、痉挛性斜颈的长期疗效及维持时间,有无剂量增加趋势。方法用A型肉毒毒素对241例患者重复小剂量局部多点注射,随访治疗10年,将6轮次治疗疗效以及剂量、疗效维持时间、不良反应进行比较分析。结果各轮次总有效率分别为98.7%、98.9%、99.3%、100%、100%、100%。作用持续(20±3)周,平均剂量40U,各轮间疗效、平均剂量、作用持续时间均无显著差异(P>0.05)。结论重复局部注射治疗局限性肌张力障碍长期疗效稳定,作用持续时间相似,维持疗效无需增加剂量,局部不良反应轻微短暂。     

A型肉毒毒素治疗面肌痉挛38例疗效观察

目的 :观察A型肉毒毒素治疗偏侧面肌痉挛的疗效。方法 :对 3 8例偏侧面肌痉挛进行面部肌肉多点注射A型肉毒毒素。评价其治疗效果。结果 :完全缓解 11例 ,明显缓解 2 7例 ,总有效率 10 0 %。起效时间平均 3d。局部反应轻微 ,无全身反应及过敏反应。结论 :A型肉毒毒素局部肌肉注射是治疗面肌痉挛的一种安全、有效、易行的方法。     

Treatment of sialorrhoea with ultrasound guided botulinum toxin type A injection in patients with neurological disorders

OBJECTIVES: To investigate the safety and efficacy of ultrasound guided botulinum toxin type A (BTX-A) injections into salivary glands for the treatment of sialorrhoea in patients with neurological disorders. METHODS: The parotid and submandibular glands of 10 patients were injected with BTX-A using ultrasound guidance. Before injection, the baseline rate of salivation was assessed using a visual analogue scale. Postinjection, assessments were repeated at regular intervals for up to 1 year. RESULTS: Of the 10 patients treated, nine (90%) reported a subjective reduction in salivation post-treatment and one patient (10%) found no improvement. Visual analogue scale scores showed a reduction of 55% in the mean rate of salivation for all patients and a reduction of 60.8% for the group of responders. No serious adverse events occurred and no procedure related complications were reported. CONCLUSIONS: This is the first study to report (1) the injection of BTX-A (BOTOX) into both parotid and submandibular glands, and (2) the use of ultrasound guidance during the administration of BTX-A into salivary glands. The results suggest that the technique is safe and that BTX-A injections are effective for the treatment of sialorrhoea in patients with neurological disorders.     

Ultrasound-guided versus 'blind' intraparotid injections of botulinum toxin-A for the treatment of sialorrhoea in patients with Parkinson's disease

OBJECTIVE: To investigate the efficacy and safety of intraparotid botulinum toxin-A (BTX-A) injections into parotid gland using ultrasound-guided versus nonguided techniques for the treatment of sialorrhoea in patients with Parkinson's disease (PD). METHODS: 15 patients with PD and sialorrhoea were included and divided into two groups. Group A patients (n=8) were injected with BTX-A using ultrasound guidance. Group B patients (n=7) were injected with BTX-A without ultrasound guidance. Saliva secretion was assessed quantitatively at baseline and at weeks 1, 4, and 12. Patients and/or caregivers also assessed the saliva secretion using visual analog scale (VAS). RESULTS: All patients except one reported subjective improvement in sialorrhoea at the first week. Group A patients showed significantly higher rate of saliva reduction at the first week, whereas in Group B the reduction was not statistically significant from baseline at the first week (P>0.05). Comparisons of quantitative saliva assessments at each follow-up visit also showed that ultrasound-guided injections were superior to blind injections for saliva reduction. VAS scores showed an improvement in the mean rate of saliva secretion in each group at first week (P<0.05). Two patients suffered from dry mouth in mild severity lasting 1 month. CONCLUSION: Intraparotid BTX-A injections using ultrasound guidance may be an effective, easy, and safe treatment for parkinsonian sialorrhoea.     

Botulinum toxin-A injections for spastic toe clawing

Spastic toe clawing describes extension at the metatarsophalangeal joints of the feet, flexion at the proximal interphalangeal joints and flexion at the distal interphalangeal joints that results from upper motor neuron lesions, such as stroke, intracranial hemorrhage, cervical myelopathy and brain tumors. Even though toe clawing is often asymptomatic, it can be painful. Previous studies have described the efficacy of injections of botulinum toxin type-A (BTX-A) to the long flexors of the toes, but this is often unsatisfactory as high dosages (up to 175 units) have been required, and patients often report significant residual toe clawing. We performed an open label, prospective study to assess the efficacy of BTX-A injections, targeting the long and short flexors of the toes, performed with electrical (motor point) stimulation under electromyographic guidance. Outcome measures, which included timed walking over 20m, objective assessment of toe clawing (modified Ashworth scale and a visual analog scale rating) and patient assessment of functional disability, were assessed before injections and at six-weeks' follow-up. Seven patients (five male and two female) of mean age 51 (range 38-70) were recruited. Four had spasticity from underlying intracranial hemorrhage, the remaining three from cerebral infarct, astrocytoma and post-traumatic cervical myelopathy. The total dose of BTX-A injected for toe clawing ranged from 40 to 90 units. Improvements were observed in all outcome measures except timed walking. Injecting BTX-A to the long and short flexors of the toes, with electrical stimulation under electromyographic guidance, is well tolerated and efficacious in the treatment of toe clawing from spasticity, allowing for lower dosages to be used.     

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.     

Botulinum A toxin as a treatment of detrusor- sphincter dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections

OBJECTIVES—To correlate clinical and urodynamicfindings with MRI in patients with spinal cord injury anddetrusor-sphincter dyssynergia who were consecutively treated withtransperineal injections of botulinum-A toxin (BTX-A) under EMG control.
METHODS—Six patients with spinal cord injury andupper motor neuron bladder dysfunction associated with detrusor-sphincter dyssynergia were prospectively analysed. One hundredinternational units (IU) BTX-A (Botox® in 1 ml normal saline withoutpreservative) diluted 1 to 1 with 1 ml gadopentetate were injectedtransperineally under EMG control. MRI was started immediately afterneedle withdrawal.
RESULTS—In all six patients gadopentetate waslocated in the external urethral sphincter on MRI. In no patient didtraces of gadopentetate appear in the perineal musculature located inthe vicinity of the external urethral sphincter. No patient developedresistance to BTX-A. All patients showed an (ongoing) improvement oftheir voiding function after BTX-A injections.
CONCLUSIONS—Transperineal injections of BTX-Aunder EMG control are efficient in the release or amelioration of lowerurinary tract obstruction due to detrusor sphincter dyssynergia inpatients with spinal cord injury. Despite well described methods, EMGof the external urethral sphincter is difficult and it is not possibleto definitively exclude false recordings of the surrounding perinealmusculature. By the use of MRI it was shown that both the EMGrecordings and transperineal injection method are precise.

     

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.     

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.     

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.     

A randomized trial of botulinum toxin A for treatment of drooling

The authors compared the efficacy of three different doses (18.75, 37.5, and 75 MU per parotid gland) of botulinum toxin A (BTX-A; Dysport, Ipsen Pharma, Germany) injections vs vehicle in patients with sialorrhea (n = 32) using a single-center, prospective, double-blind, placebo-controlled dose-finding study. The primary endpoint was achieved with 75 MU BTX-A without treatment-related adverse events, suggesting BTX-A is a safe and effective treatment for patients with sialorrhea.