脑瘫患者痉挛相关疼痛的评估及使用A型伊可新治疗的疗效(文献综述)

A. L. Kurenkov, B. Bursagova, A. R. Artemenko
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摘要

30-60% 的脑瘫(CP)患者会出现疼痛。与痉挛相关的疼痛(PAS)是导致脑瘫疼痛综合征的最常见原因之一,通常会影响患儿的日常生活。最近,关于使用 A 型肉毒毒素制剂控制 PAS 的研究越来越多。这篇综述文章基于三项针对痉挛型脑瘫儿童和青少年的III期多中心前瞻性对比研究数据,对药物Xeomin(incobotulinumtoxin A)治疗PAS的镇痛效果进行了专门的汇总分析。为了评估痉挛性肢体麻痹及其对伊可菌素 A 的影响,这些研究采用了一种特殊的调查问卷(痉挛性疼痛问卷,QPS)。QPS反映的是儿童在休息和各种活动时与痉挛相关的疼痛。研究发现,在这些研究中,80%以上的下肢痉挛患儿和近70%的上肢痉挛患儿报告存在PAS。据这些儿童的父母或看护人观察,PAS 的发病率甚至更高。使用伊科保妥适 A 不仅具有明显的抗痉挛效果,还能显著降低脑瘫儿童和青少年在正常日常活动以及体育锻炼和康复治疗等剧烈活动中出现痉挛性抽搐的频率和强度。通过反复注射伊科菌素 A,PAS 持续下降,即使在体力活动变得更加困难时,也能确保疼痛减轻。如今,注射伊科保妥适 A 可被视为治疗痉挛和肌张力增高的常规治疗方法,但对于伴有 PAS 的上下肢痉挛的脑瘫患者来说,这无疑是一种有效减轻疼痛的创新方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessment of spasticity-related pain in cerebral palsy and the efficacy of its treatment with incobotulinumtoxin A (literature review)
Pain in cerebral palsy (CP) occurs in 30–60% of cases. Pain associated with spasticity (PAS) is one of the most common causes of pain syndrome in cerebral palsy, which is often associated with impairment of the child’s daily life. Recently, more studies have been published on the use of botulinum toxin type A preparations to control PAS. The review article presents the results of a special pooled analysis of data on the analgesic effect of the drug Xeomin (incobotulinumtoxin A) in the treatment of PAS based on data from three phase III multicentre prospective comparative studies in children and adolescents with spastic forms of cerebral palsy. To evaluate PAS and the effect of incobotulinumtoxin A on it, a special questionnaire (Questionnaire on Pain caused by Spasticity, QPS) was used in these studies. The QPS reflects the child's pain associated with spasticity, which can be observed at rest and during various activities of the child.It was found that the children included in these studies reported the presence of PAS in more than 80% of cases with lower limb spasticity and in almost 70% of cases with upper limb spasticity. Parents or caregivers of these children observed an even higher prevalence of PAS. The use of incobotulinumtoxin A showed not only a pronounced antispastic effect, but also a significant reduction in the frequency and intensity of PAS in children and adolescents with cerebral palsy during normal daily activities, and during strenuous activities such as physical exercise and rehabilitation treatment. With repeated injection cycles of incobotulinumtoxin A, PAS continued to decrease, ensuring a reduction in pain even when physical activity became more difficult. Nowadays, injections with incobotulinumtoxin A can be considered as a routine therapeutic approach for the treatment of spasticity and increased muscle tone, but it is certainly an innovative method for effective pain reduction in cerebral palsy patients with lower and upper limb spasticity accompanied by PAS.
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