A型肉毒毒素注射治疗痉挛型脑瘫患儿的观察护理

目的:探讨痉挛型脑瘫患儿肌内注射A型肉毒素(BTX-A)的护理特点。方法:应用BTX—A局部多点注射痉挛型脑瘫患儿痉挛肌肉共103例,并对患儿注射前进行护理评估,注射中积极配合医师,严格执行无菌操作,注射后密切观察患儿的不良反应及对家长进行健康教育,做好各阶段家长及患儿的心理护理。结果:103例患儿均顺利完成注射治疗,无1例出现皮下血肿、感染等并发症,家长的配合程度增加,加强康复训练后均有不同程度的疗效。结论:提出护理工作在BTX—A注射治疗过程中的重要性,做好注射治疗前、中、后的配合与护理,将大大提高BTX—A注射治疗的成功率,缩短患儿康复治疗时间,降低家长心理压力。     

肌电定位注射A型肉毒毒素治疗脑瘫的电流相关性分析

目的探讨肌电定位注射A型肉毒毒素（BTX—A）定位刺激电流强度与疗效之间的关系。方法15例痉挛型脑瘫患儿接受肌电定位下BTX．A阻滞术治疗，根据患儿体重和修改的Ashworth评分确定BTX—A剂量。对疗效持续时间与诱发肌肉收缩的最小电刺激强度的关系进行分析。结果电流强度与BTX-A的疗效持续时间呈负相关（r=-0．769，P=O．01）。结论在应用绝缘针注射BTX-A时，应该在所需电流强度较小的部位注射。     

A型肉毒毒素改善脑性瘫痪儿童下肢痉挛状态的效果评价

目的：评估A型肉毒毒素（botulinum toxin A,BTX-A)在下肢痉挛性脑性瘫痪（CP）患儿的治疗作用。方法：11例痉挛性CP患儿，采用BTX－A 3－6IU／kg注射下肢痉挛肌肉，依照马氏等制定的疗效与评估标准和修订的Ashworth量表评估注射前与注射后72h、1、2、4、8周不同时期的运动功能，痉挛状态及肌张力的变化。结果：运动功能恢复和肌肉痉挛状态改善，注射后较注射前比较差异有显著或非常显著性意义（P＜0．05，P＜0．01）。结论：BTX－A注射疗法有较好的改善运动功能和降低下肢肌肉痉挛状态。     

A型肉毒毒素治疗痉挛型脑瘫的观察与护理

【摘要】目的 探讨A型肉毒毒素（BTX—A或衡力）改善痉挛型脑瘫患儿肌张力的治疗疗效及肉毒毒素注射的护理要点。 方法 接受A型肉毒毒素治疗的692例痉挛型脑瘫患儿,结合运动训练、针灸推拿等综合康复治疗及以家庭为中心的护理,治疗前后进行关节活动度测量和粗大运动功能评定（GMFM—88）。 结果 患儿经过3-6个月治疗和精心护理后,四肢肌张力明显改善,运动功能进步明显,未发生护理并发症 。结论A型肉毒毒素注射结合综合康复治疗,可明显改善痉挛型脑瘫患儿的肌张力,对于患儿的站立和步行功能的建立有良好的作用。配合以家庭为中心的护理和护理干预,可提高药物疗效,减少药物并发症的发生。     

A型肉毒素治疗痉挛型脑瘫临床观察

目的:探讨肉毒毒素A(BTXA)注射配合康复训练对痉挛型脑瘫患儿运动功能及日常生活活动能力(activities of daily living,ADL )的影响.方法:选择例100例双下肢痉挛型脑瘫儿童随机分为BTX-A组和对照组各50例,2组均采用常规康复训练,A 型肉毒毒(botulinumtoxin A ,BTX2A)组加用兰州产BTX-A 干粉制剂,(于-20～ -5 ℃避光保存,以生理盐水稀释后立即使用),运用"反向牵拉指压法"进行下肢痉挛肌局部注射,注射后次日开始进行痉挛肌牵伸及功能训练.观察两组患儿的肌张力与ADL变化.结果:治疗1个月和3个月后,治疗组患儿的肌张力、ADL改善情况明显优于对照组(P＜0.01).结论:康复训练仍是有效的脑瘫治疗手段, BTX-A注射配合康复训练可明显改善痉挛型脑瘫患儿运动功能和日常生活能力.两者结合可明显缩短疗程、提高疗效.     

A型肉毒毒素配合踝关节支具治疗痉挛性脑性瘫痪动力性尖足畸形的临床价值

目的：探讨A型肉毒毒素（BTX－A）配合踝关节具对痉挛性脑瘫的动力性尖足畸形治疗的临床价值。方法：28位儿童采用BTX－A注射治疗肌痉挛，BTX－A注射的起始剂量为3－5IU／kg，注射后1周配带踝关节支具。结果：采用BTX－A注射小腿三头肌同时配带AFO支具的肌张力有明显降低，关节活动度有一定程度的提高，改善了患的运动功能。结论：BTX－A提供安全有效的治疗痉挛性脑瘫的动力性尖足畸形。     

A型肉毒素治疗痉挛型脑瘫临床观察

目的:探讨肉毒毒素A(BTXA)注射配合康复训练对痉挛型脑瘫患儿运动功能及日常生活活动能力(activities of daily living,ADL)的影响。方法:选择例100例双下肢痉挛型脑瘫儿童随机分为BTX-A组和对照组各50例,2组均采用常规康复训练,A型肉毒毒(botulinumtoxin A,BTX2A)组加用兰州产BTX-A干粉制剂,(于-20~-5℃避光保存,以生理盐水稀释后立即使用),运用“反向牵拉指压法“进行下肢痉挛肌局部注射,注射后次日开始进行痉挛肌牵伸及功能训练。观察两组患儿的肌张力与ADL变化。结果:治疗1个月和3个月后,治疗组患儿的肌张力、ADL改善情况明显优于对照组(P<0.01)。结论:康复训练仍是有效的脑瘫治疗手段,BTX-A注射配合康复训练可明显改善痉挛型脑瘫患儿运动功能和日常生活能力。两者结合可明显缩短疗程、提高疗效。     

A型肉毒毒素局部注射治疗面肌痉挛的护理进展

面肌痉挛（Hemifacial spasm ,HFS）是面神经受激惹而产生的功能紊乱症状群,属运动障碍性疾病,临床表现为身体同侧面神经所支配的面部肌群不自主的、不规则的、无痛性的强直或阵挛性收缩为特征的慢性疾病［1］。 HFS 患者神经系统检查无其他阳性体征;肌电图显示肌纤维震颤和肌束震颤波,脑电图无阳性发现［2］。 HFS 最主要的影响是引起社交、心理障碍和视野受损,使患者生活质量下降［3］。目前,原发性 HFS 最佳治疗方法是采用 A型肉毒杆菌毒素（Botulinum toxin type A ,BTX‐A ）局部注射［4］。BTX‐A又称A型肉毒毒素,是毒性最强毒物之一,严重中毒者可危及生命,因此在治疗过程中,护士应熟悉BTX‐A疗法并制定相应的护理措施,应用针对性的心理护理措施应对 H FS常见的社交回避,个人形象受损,生活质量减低等合并症,以期最大限度地发挥治疗作用。     

肉毒毒素A对肌肉痉挛患者功能康复的作用

目的：探讨A型肉毒毒素（botulinum toxin type A，BTX—A）对上运动神经元损伤后肢体肌肉痉挛的治疗价值及其剂量影响。方法：选择48例上运动神经元损伤患者采用肉毒毒素A电刺激引导下局部肌肉注射治疗肌痉挛，其中把小腿三头肌、肱二头肌、屈指肌随机分成高低两个剂量组，观察剂量不同对疗效的影响，同时对所有患者制订注射后的目标，观察其达标情况。结果：肉毒毒素A注射后肌肉张力明显降低（P〈0．05），但在小腿三头肌、肱二头肌及屈指肌群中均未发现明显的量效关系，各配对大小剂量组肌张力评分差异无显著性意义（P〉0．05）；患者功能显著改善，康复目标总达标率为70．4％，肉毒毒素对上肢的粗大运动及下肢的步行功能的改善效果明显，而对手的精细活动功能的恢复效果欠佳。结论：肉毒毒素A对缓解上运动神经元损伤后的肢体肌肉痉挛，提高其生活自理能力及运动功能疗效显著，肉毒毒素作用的量效关系尚有待确认.     

书写痉挛症发病机制与治疗

书写痉挛症是由于职业因素长期从事手部精细动 ,导致手部肌肉痉挛 ,出现以书写功能障碍为主的一种症状群 ,表现为患者在持笔时或开始写字时困难。系统阐述书写痉挛症流行病学、发病机制 (脊髓水平、基底节和丘脑水平、大脑皮层水平 )和治疗 (包括口服药物治疗、肉毒毒素注射治疗和外科治疗 )。     

Restoring balance in focal limb dystonia with botulinum toxin

Focal task-specific dystonia of the hand is rare in the general population, where it usually manifests as writer's cramp, but seems relatively common among musicians. The disability may be so severe as to prevent writing altogether or to end a professional musician's career. The cause is usually unknown but it is thought to be primarily a basal ganglia disorder with dysfunction of cortical-striatothalamic-cortical circuits. Abnormalities have been found in cortical movement preparation, intracortical inhibition, sensory and motor maps, and patterns of cortical activation during movement. Much evidence supports disordered processing of sensory information with disturbed sensorimotor integration. Underlying this may be maladaptive neural plasticity mechanisms. Treatment is difficult. Oral medications are generally ineffective and have troublesome side-effects. Intensive rehabilitation techniques based on neural plasticity theory show promise but are rarely available and are time-intensive. Botulinum toxin injections appear to be effective in writer's cramp and musician's dystonia, at least initially; long-term benefit is less common. Despite definite improvement, some patients abandon treatment because the gain is insufficient for meaningful function: this is particularly so for musicians. Much of the benefit from botulinum toxin injection comes from simply reducing muscle overactivity through muscle paralysis, restoring balance to motor control. However, some evidence suggests that botulinum toxin injections can produce transient improvement in some of the various cortical abnormalities described, probably through alteration of sensory input from the periphery, by direct and indirect means. These changes in cortical function might be usefully combined with those brought about by sensorimotor retraining programs, but such studies are awaited.     

Focal dystonia, with special reference to writer's cramp

If focal dystonia affects the hand muscles writer's cramp will result, but also other types of activity when the task involves repetitive movements such as typing and playing the piano. Writer's cramp is described, both simple and dystonic, and also the possibility of genetic causes, especially in the latter group. The characteristics of the electromyogram in this condition are discussed. The possible causes of focal dystonia and writer's cramp are reviewed: both the role of excitatory and inhibitory mechanisms and how these may influence treatment. Various treatments have been tried, and the most effective seems to be the use of botulinum toxin. However, if this does not relieve the symptoms, operations such as stereotactic lesions of the basal ganglia may be justified.     

规范化A型肉毒毒素治疗肌痉挛性疾病

目的：探讨如何规范化应用A型肉毒毒素(BTX—A)局部注射治疗面肌痉挛、各型头颈部的肌张力障碍，以提高其临床疗效和安全性。方法：在肌电图监测下对59例肌痉挛性疾病患者采用BTX—A局部多点注射痉挛肌肉，并治疗前后对照。结果：面肌痉挛36例，睑痉挛13例，Meige综合征(睑痉挛—口下颌肌张力不全综合征)3例，痉挛性斜颈7例，治疗3—5d起效，肌痉挛症状缓解时间平均3—4个月。总有效率93．2％。结论：该疗法安全、有效，副作用轻微且可逆，可作为面肌痉挛及各型头颈部肌张力障碍的首选治疗，但一定要规范化。     

Treatment of focal dystonia with botulinum toxin A

Local injections with Botulinum toxin A (BtxA) are safe and effective in the treatment of focal dystonia. In cervical dystonia and blepharospasm, BtxA injections have become the treatment of choice. However, good results have also been reported with oromandibular dystonia, spasmodic dysphonia and writer's cramp. In cervical dystonia, muscles for injection are selected by clinical presentation or in complex forms with EMG guidance. Several studies have shown that 500 units Dysport are safe and effective in the treatment of cervical dystonia. In blepharospasm, injections are performed in the periorbital part of the orbicularis oculi muscle with good results for 12-14 weeks. The most frequently employed starting dose is 120 units Dysport per eye, divided in three periorbital injection sites. In case of levator inhibition, the pretarsal part of the orbicularis oculi muscle should be injected in a lower dose. EMG guidance is not necessary. By contrast, BtxA treatment of spasmodic dysphonia and writer's cramp require EMG-guided injections in order to avoid side-effects. Dose recommendations for the various types of dystonia are given in the text. In up to 5% of patients with dystonia, the development of neutralising antibodies is reported following repetitive injections with BtxA. Patients with antibodies had a shorter interval between injections, more "boosters", a higher dose per 3-month interval, and a higher total dose injected. In case of neutralizing antibodies against the A toxin, the treatment with Botulinum toxin B (Neurobloc) is a possible alternative.     

Electroencephalographic spectral power in writer's cramp patients: evidence for motor cortex malfunctioning during the cramp

We investigated cortical activation as reflected in task-related spectral power (TRPow) changes in 8 writer's cramp patients during writing on a digital board and during isometric contraction and compared them to those of 8 age-matched healthy subjects. Scalp EEG was recorded over the contralateral primary sensorimotor area (SM1(c)), and from the ipsilateral sensorimotor area (SM1(i)). The electromyogram (EMG) was recorded from the Extensor Digitorum Communis (Extensor), Flexor Digitorum Superficialis (Flexor), and First Dorsal Interosseous (FDI) muscles. We analyzed (1) handwriting performance, (2) changes in the TRPow confined to alpha and beta band, and (3) the EMG spectral power during both tasks, writing and isometric contraction. During writing, all patients developed writer's cramp. The handwriting in writer's cramp patients was associated with significantly less reduction of the beta-range TRPow and lower frequency of the TRPow reduction compared to controls. No significant differences between patients and controls for the alpha band TRPow reduction during handwriting were observed. During writing, the patients showed higher EMG spectral power than the controls but this difference was at the border of significance. The present results indicate disorder in the motor execution system, in writer's cramp patients, associated with impaired functional beta-network state of the contra- and ipsilateral sensorimotor cortices, most probably due to inadequate modulation of the intracortical inhibition associated with writing.     

Task-specific plasticity of somatosensory cortex in patients with writer's cramp

Focal dystonias such as writer's cramp are characterized by muscular cramps that accompany the execution of specific motor tasks. Until now, the pathophysiology of focal dystonia remains incompletely understood. Recent studies suggest that the development of writer's cramp is related to abnormal organization of primary somatosensory cortex (SI), which in turn leads to impaired motor function. To explore contributions of SI on mechanisms of task specificity in focal dystonia, we investigated dynamic alterations in the functional organization of SI as well as sensory-motor gating for rest, left- and right-handed writing and brushing in writer's cramp patients and healthy controls. The functional organization of somatosensory cortex was assessed by neuromagnetic source imaging (151 channel whole-head MEG). In accordance with previous reports, distances between cortical representations of thumb and little finger of the affected hand were smaller in patients compared to healthy subjects. However, similar to healthy controls, patients showed normal modulation of the functional organization of SI as induced by the execution of different motor tasks. Both in the control subjects and patients, cortical distances between representations of thumb and little finger increased when writing and brushing compared to the resting condition. Although, cramps only occured during writing, no differences in the organization of SI were seen among motor tasks. Our data suggest that despite alterations in the organization of primary somatosensory cortex in writer's cramp, the capability of SI to adapt dynamically to different tasks is not impaired.     

Botulinum toxin type A in the treatment plan for cerebral palsy

Over the past decade a number of placebo-controlled studies have confirmed that intramuscular injections of botulinum toxin A (BTX A) has antispastic effects. Cerebral palsy is among the most frequent disorders of the growing locomotor apparatus during childhood. Weakness as well as spasticity due to lack of selective neuronal control causes functional impairment and additional mechanisms of compensation, retardation of motor development, secondary deformities of muscles and soft tissues due to a failure of muscle growth, subluxation/dislocation of joints, early osteoarthritis, and pain. Prevention of this vicious circle has to be the main goal of caring for children with spasticity. Quality of life in children with cerebral palsy can be improved by support of their daily living motor activities. Increased muscle tone can be reduced by physical exercises, by individually adapted orthoses, walkers, and wheelchairs, by manual therapy, serial casting and in certain cases by systemic drugs or by multiple-stage surgical procedures. BTX A can be used to enable these treatment possibilities or to increase their effect. In our clinical study (BTX A in 114 patients in 19952/2000) we found no major side effects. Weakness, pain or swelling occurred temporarily. Indications for the use of BTX A are pain, functional impairment, severe cosmetic problems, as well as prevention of secondary contractures, deformities, and dislocations caused by increased muscle tone. We consider the selection of patients for the use of BTX A and the development of a goal-orientated treatment plan by multidisciplinary team approach as the most important steps. Prerequisites are exact statomotoric and dynamic physical examinations, and standardised movement analysis. 3-D-gait analysis and dynamic electromyography is used in cases where functional improvement of gait is the goal of BTX A-treatment.     

Application of botulinum toxin to clinical therapy: advances and cautions

The therapeutic use of botulinum toxin Type A has followed a novel and unanticipated pathway of applications, from its initial application by Scott to paralyze the extraocular muscles of the eyes to correct strabismus. In the late 1970s, Scott formed a company, called Oculinum Inc, to make botulinum toxin Type A available for this ophthalmic application. From this modest and limited beginning, it has found use for treatment of a plethora of cosmetic, neuromuscular, and skeletal disabilities, including cervical dystonia, blepharospasm, and temporary improvement in the appearance of moderate to severe glabellar lines. Botulinum toxin Type A is now being used as therapy in voiding disorders, migraine and tension-type headache, writer's cramp, and laryngeal muscle hyperactivity syndromes. It has reduced the spasm and pain associated with perianal fissures. It has found application in the reduction of glandular function in severe primary axillary hyperhidrosis and sialorrhea. Additional applications are being studied in the area of pain management based on its apparent ability to inhibit neuropeptide release from nociceptors.     

Botulinum toxin therapy for neurologic disorders.

In the last 20 years, the therapeutic uses of botulinum toxin, a potent neurotoxin, have been investigated. The agent produces chemical denervation of muscle, thereby causing atrophy and weakness. Studies have shown that injection of this agent is an effective therapy for focal dystonias, particularly blepharospasm, hemifacial spasm, and torticollis. Investigation continues into the role of botulinum toxin in the treatment of anismus, detrusor-sphincter dyssynergia, writers' cramp, and other disorders in which focal weakening of selected muscles could be useful.     

Restoring balance in focal limb dystonia with botulinum toxin

Focal task-specific dystonia of the hand is rare in the general population, where it usually manifests as writer's cramp, but seems relatively common among musicians. The disability may be so severe as to prevent writing altogether or to end a professional musician's career. The cause is usually unknown but it is thought to be primarily a basal ganglia disorder with dysfunction of cortical-striatothalamic-cortical circuits. Abnormalities have been found in cortical movement preparation, intracortical inhibition, sensory and motor maps, and patterns of cortical activation during movement. Much evidence supports disordered processing of sensory information with disturbed sensorimotor integration. Underlying this may be maladaptive neural plasticity mechanisms. Treatment is difficult. Oral medications are generally ineffective and have troublesome side-effects. Intensive rehabilitation techniques based on neural plasticity theory show promise but are rarely available and are time-intensive. Botulinum toxin injections appear to be effective in writer's cramp and musician's dystonia, at least initially; long-term benefit is less common. Despite definite improvement, some patients abandon treatment because the gain is insufficient for meaningful function: this is particularly so for musicians. Much of the benefit from botulinum toxin injection comes from simply reducing muscle overactivity through muscle paralysis, restoring balance to motor control. However, some evidence suggests that botulinum toxin injections can produce transient improvement in some of the various cortical abnormalities described, probably through alteration of sensory input from the periphery, by direct and indirect means. These changes in cortical function might be usefully combined with those brought about by sensorimotor retraining programs, but such studies are awaited.