传统的药物治疗痉挛状态。第一部分:局部治疗。

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格里斯JM, Elovic E, McGuire J,辛普森DM

传统的药物治疗痉挛状态。第一部分:局部治疗。

肌肉神经生理1997;6:s61 - 91。

PubMed ID

9826983 (在PubMed

]

文摘

痉挛状态是一个数值增加拉伸反射活动。它是一种形式的肌肉过度活跃,可能影响患者损害中枢神经系统。痉挛状态监控相关函数因为痉挛状态的程度可能反映了其他禁用的强度类型的肌肉过度活跃,如不必要的敌对co-contractions、永久肌肉活动没有任何伸展或意志的命令(痉挛性肌张力障碍),或者不恰当的对皮肤的营养输入。此外,痉挛状态,像其他肌肉过度活跃,可以导致肌肉缩短,这是另一个残疾的重要来源。最后,痉挛状态是唯一形式的肌肉过度活跃在床边容易量化。药理治疗痉挛状态的名义,我们理解的使用代理旨在减少所有类型的肌肉过度活跃,通过减少兴奋性的运动路径,在中枢神经系统,神经或肌肉。药物治疗应辅助肌肉延长和拮抗剂的培训。局部肌肉过度活跃的特定肌肉群通常被认为在许多常见的疾病,包括中风和创伤性脑损伤。在这些情况下,我们倾向于使用当地的治疗在过度活跃的肌肉最禁用,通过肌肉注射(神经肌肉块)或接近神经提供肌肉(围神经的块)。有两种类型的本地代理除了新出现的肉毒杆菌毒素:局部麻醉剂(利多卡因和副产品),与一个完全可逆作用时间短,和醇(乙醇和苯酚),长期的行动。 Local anesthetics block both afferent and efferent messages. The onset of action is within minutes and duration of action varies between one and several hours according to the agent used. Their use requires resuscitation equipment available close by. When a long-lasting blocking agent is being considered, we favor the use of transient blocks with local anesthetics for therapeutic tests or diagnostic procedures to answer the following questions: Can function be improved by the block? What are the roles played by overactivity and contracture in the impairment of function? Which muscle is contributing to pathologic posturing? What is the true level of performance of antagonistic muscles? A short-acting anesthetic can also serve as preparation to casting or as an analgesic for intramuscular injections of other antispastic treatment. Alcohol and phenol provide long-term chemical neurolysis through destruction of peripheral nerve. Experience with ethanol is more developed in children using intramuscular injection, while experience with phenol is greater in adults with perineural injection. In both cases, there are anecdotal reports of efficacy but studies have rarely been controlled. Side effects are numerous and include pain during injection, chronic dysesthesia and chronic pain, and episodes of local or regional vascular complications by vessel toxicity. In the absence of controlled studies, a theoretical comparison of neurolytic agents with botulinum toxin is proposed. Neurolytic agents may be preferred to botulinum toxin on a number of grounds, including earlier onset, potentially longer duration of effect, lower cost, and easier storage. Conversely, pain during injection, tissue destruction with chronic sensory side effects, and lack of selectivity on motor function with neurolytic agents may favor the use of botulinum toxin. Neurolytic agents and botulinum toxin may be used in combination, the former for larger proximal muscles and the latter for selective injection into distal muscles. In the future, neurolytic agents may prove more appropriate in very severely affected patients for whom the purposes of the block are comfort and hygiene. (ABSTRACT TRUNCATED)

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药物

苯酚