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【肉毒素文献】肉毒毒素治疗阵挛的疗效 - 系统性综述

Effect of Botulinum Toxin on Clonus

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简介

【 文献重点摘要 】
 

Objective: To conduct a systematic review of the literature that examined the effectiveness of Botulinum toxin type A on clonus.

 

Data Sources: A literature search of multiple databases (Pubmed, Cochrane, Google search, EMBASE) was done to identify articles published in English, in the past 20 years.

 

Study Selection: Two reviewers independently applied the inclusion criteria, (1) Any adult patients above 18 years with upper motor lesion, (2) any location and duration of clonus, and (3) subjective and objective measurement of clonus tested at least two weeks after botulinum toxin injection.

 

Data Extraction: Two reviewers independently extracted the data and assessed the methodological quality. A consensus method was used to solve disagreements.

 

Data Synthesis: The systematic review resulted in 164 articles of which 14 met the inclusion criteria. Three were randomized control trials, one was nonrandomized, and six were case series and 3 case studies. All studies (181 subjects) showed improvement in clonus – 6 out of 14 results were statistically significant. Different scales were used for clonus measurement such as clonus score, patient diaries, clonus spasm score, and EMG duration.

 

Conclusions: Overall, there was preliminary evidence indicating improvement in clonus after botulinum injection. The major drawback with studies reviewed here was a large variation in the type of clonus assessment tools which also lacked validity, reliability, and sensitivity to small changes in clonus.

 

Keywords: Botulinum toxin; Muscle spasticity; Clonus (non-MeSH)

 

目的:对A型肉毒毒素治疗阵挛疗效的文献进行系统综述。

 

资料来源:应用计算机检索多个数据库(Pubmed、Cochrane、Google Search、EMBASE),检索近20年来英文文献。

 

资料选择:2名评价者独立采用纳入标准,(1)18岁以上有上运动障碍的成人患者,(2)阵挛的任何部位和持续时间,(3)肉毒毒素注射后至少2周进行的阵挛的主客观测量。

 

资料提炼:两名评价者独立提取数据并评估方法学质量。协商一致的方法被用来解决分歧。

 

资料综合:系统评价结果为164篇,其中14篇符合纳入标准。3个为随机对照试验,1个为非随机对照试验,6个为病例系列试验,3个为病例研究。所有研究(181名受试者)均显示阵挛改善–14项结果中有6项有统计学意义。采用不同量表测量阵挛评分、患者日记、阵挛痉挛评分、肌电图持续时间。

 

结论:总体而言,有初步证据表明肉毒杆菌注射后阵挛有所改善。这里回顾的研究的主要缺点是阵挛评估工具的类型有很大的差异,也缺乏有效性、可靠性和对阵挛微小变化的敏感度。

 

关键词:肉毒毒素;肌肉痉挛;阵挛(非网状)

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