Botulinum Toxin Dilution and Endplate Targeting in Spasticity: A Double-Blind Controlled Study

被引:138
作者
Gracies, Jean-Miehel [1 ]
Lugassy, Mara [4 ]
Weisz, Donald J. [2 ]
Vecchio, Michele [5 ]
Flanagan, Steve [3 ]
Simpson, David M. [1 ]
机构
[1] Mt Sinai Med Ctr, Dept Neurol, New York, NY 10029 USA
[2] Mt Sinai Med Ctr, Dept Neurosurg, New York, NY 10029 USA
[3] Mt Sinai Med Ctr, Dept Rehabil Med, New York, NY 10029 USA
[4] Columbia Presbyterian Med Ctr, Dept Neurol, New York, NY USA
[5] Vittorio Emanuele Hosp, UO Phys Med & Rehabil, Catania, Italy
来源
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION | 2009年 / 90卷 / 01期
关键词
Botulinum toxin; Muscle spasticity; Rehabilitation; UPPER-LIMB SPASTICITY; UPPER EXTREMITY SPASTICITY; CEREBRAL-PALSY; MUSCLE PARALYSIS; STROKE PATIENTS; BRAIN-INJURY; A TOXIN; TRIAL; INJECTIONS; LOCALIZATION;
D O I
10.1016/j.apmr.2008.04.030
中图分类号
R49 [康复医学];
学科分类号
100215 ;
摘要
Objective: To determine the effects of botulinum neurotoxin type A (BTX-A) dilution and endplate-targeting in spastic elbow flexors. Design: Double blind randomized controlled trial; 4-month follow-up after a 160-unit injection of BTX-A into spastic biceps brachii (4 sites). Randomization into: group 1:100 mouse units (MU)/mL dilution, 0.4cc/site, 4-quadrant injection; group 2: 100MU/mL dilution, 0.4cc/site, 4 sites along endplate band; group 3: 20MU/mL dilution, 2cc/site, 4-quadrant injection (n=7 per group). Setting: Institutional tertiary care ambulatory clinic. Participants: Referred sample of 21 adults with spastic hemiparesis. No participant withdrew due to adverse effects. Intervention: A 160-unit injection of BTX-A of different dilutions and locations into biceps brachii. Main Outcome Measures: Primary: agonist and antagonist (cocontraction) mean rectified voltage (MRV) of elbow flexors/extensors during maximal isometric flexion/extension; secondary: maximal voluntary power of elbow flexion/extension; spasticity angle and grade in elbow flexors/extensors (Tardieu Scale); active range of elbow extension/flexion. Results: BTX-A injection overall reduced agonist flexor MRV (-47.5%, P<0.0001), antagonist flexor MRV (-12%, P=.037), antagonist extensor MRV (-19%, P<.01), flexion maximal voluntary power (-33%, P<.001), elbow flexor spasticity angle (-30%, P<.001) and grade (-17%, P=.03), and increased extension maximal voluntary power (24%, P=.037) and active range of elbow extension (5.5%, 8 degrees, P=.002). Agonist and antagonist flexor MRV reductions in group 3 (-81% and -31%) were greater than in groups 1 and 2, whereas increase in active range of elbow extension was greater in group 2 (10%) than in groups I and 3 (P<.05, analysis of covariance [ANCOVA]). Elbow flexor spasticity was significantly reduced in groups 2 and 3 only (P<.05, ANCOVA). Conclusions: In spastic biceps, high-volume or endplate-targeted BTX-A injections achieve greater neuromuscular blockade, cocontraction and spasticity reduction, and active range of elbow extension improvement, than low volume, nontargeted injections.
引用
收藏
页码:9 / 16
页数:8
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