使用 ESWT 作为肉毒杆菌毒素的辅助疗法治疗局灶性痉挛:文献综述

L. Verschuere, K. Oostra
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引用次数: 0

摘要

使用体外冲击波疗法(ESWT)辅助肉毒杆菌毒素治疗局灶性痉挛:文献综述 背景:痉挛是一个复杂的问题,对身体功能、活动和参与都有影响。众所周知,肉毒杆菌毒素(BTX)是治疗局灶性痉挛的一种有效而安全的疗法,但需要频繁重复使用,存在耐受性风险。体外冲击波疗法(ESWT)在单一疗法中对局灶性痉挛具有积极的临时疗效,已为人们所熟知。本文献综述希望评估 ESWT 作为肉毒杆菌毒素辅助疗法的潜力,其假设是 ESWT 可延长和增强治疗效果,因为 ESWT 可影响痉挛肌肉的流变特性,而肉毒杆菌毒素可影响痉挛的神经机制。方法:文献综述。结果:发现了 6 项研究,研究方法质量中等,肉毒杆菌毒素和 ESWT 的使用方案、结果变量报告和随访差异很大。结果变量主要包括技术检查和对身体结构和功能水平的测量(根据国际功能、残疾和健康分类(ICF))。对副作用只作了简要描述。短期效果大多是积极的。超过 3 个月的随访仍未报告。结论:ESWT 与肉毒杆菌毒素联合使用时,至少在短期内可作为一种辅助疗法。有必要开展进一步的研究,最好是开展随机、双盲对照试验,并制定明确、统一的 ESWT 和肉毒杆菌毒素治疗方案,同时进行更长时间的随访。需要报告副作用,使用符合国际功能、残疾和健康分类框架的质量评估方法,以及正确使用生物统计学方法。
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Behandeling van focale spasticiteit d.m.v. ESWT als adjuvans op Botulinetoxine: nazicht van de literatuur
Treatment of focal spasticity using Extra-corporeal Shock Wave Therapy (ESWT) as an adjuvans on Botulinum Toxin: a review of literature Background: Spasticity is a complex problem with an impact on bodily functions, activities and participation. Botulinum toxin (BTX) is commonly known as an effective and safe therapy for focal spasticity, but needs frequent repetition with risk of tolerance. Extracorporeal Shock Wave Therapy (ESWT) is a treatment already known for its positive temporary effect on focal spasticity in monotherapy. This literature review wishes to evaluate the potential of ESWT as an adjuvant therapy to Botulinum toxin based on the hypothesis that it may prolong and enhance the therapeutic effect since ESWT influences the rheological properties of the spastic muscle, where Botulinum toxin rather affects the neural mechanisms of spasticity. Methods: review of literature. Results: 6 studies were found, with a moderate methodological quality and strongly varying protocol for the use of Botulinum toxin and ESWT, reporting of outcome variables and follow-up. Outcome variables mainly consisted of technical investigations and measurements on the level of bodily structure and functions (in accordance with the International Classification of Functioning, Disability and Health (ICF)). Side effects were described only briefly. Short term effects were mostly positive. Follow-up longer than 3 months remained unreported. Conclusion: ESWT may be an adjuvant therapy when combined with Botulinum toxin, at least in the short term. Further research is necessary, preferably set up as randomised, double-blind controlled trials with a clear and uniform protocol concerning ESWT and Botulinum toxin, with a longer lasting follow-up. Reporting on side effects and usage of quality assessments that fit the ICF framework, as well as correct usage of biostatistics herein are required.
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