Эффект ботулинический нейротоксин типа А (bontà) на глутамата-вызвали височных боли в мышцах и вазомоторных ответов было исследовано у здоровых мужчин и женщин в течение 60 дневного курса. Субъекты участие в заседании предварительно bontà где свои ответы на инъекции глутамата (1 М, 0,2 мл) и солевым раствором (0,2 мл) в височных мышц оценивали. В день 1 bontà (5 U) вводили в один височной мышцы и физиологического раствора в противоположную височной мышцы, в случайном порядке. Субъекты затем получили внутримышечные инъекции глутамата (1 М, 0,2 мл) в левой и правой височных мышц на 3 ч и затем 7, 30 и 60 дней после инъекции из ботулинического токсина.
Интенсивность боли, область боли, и нейрогенного воспаления (температура кожи и кожи перфузии крови) были записаны. До начала лечения bontà, глутамат вызывали значительно более сильную боль и вазомоторные реакции (р <0,001), чем физиологический раствор. Bontà значительно снижается глутаматом вызвала интенсивность боли (р <0,05), площадь боли (р <0,01), кровоснабжение кожи (р <0,05), и температуру кожи (P <0,001). Ингибирующий эффект ботулинического токсина присутствовал на 3 ч после инъекции, достиг максимума через 7 дней и возвращались к исходным по 60 дней. Выводы из данного исследования продемонстрировали быстрое действие ботулинического токсина на глутамат-вызвала боль и нейрогенного воспаления, которое в соответствии с исследований на животных.
Цель исследования: На основании исследования особенностей состояния здоровья, образа жизни и организации медицинской помощи пациентам с неврологическими заболеваниями научно обосновать и оценить эффективность реализации медико-социальных реабилитационных мероприятий в амбулаторных условиях, среди пациентов, перенесших ишемический инсульт и страдающих 5 дорсопатиями.
Автор: Орлова О.Р., д.м.н. профессор, президент МООСБТ; Батышева Т.Т. д.м.н. профессор; Котляров В.В., к.м.н, член МООСБТ; Тимербаева С.Л., к.м.н, ведущий научный сотрудник, вице-президент МООСБТ; Хатькова С.Е., к.м.н, член МООСБТ; Фальковский И.В. к.м.н, член МООСБТ; Грибанов И.И., член МООСБТ; Куренков А.Л., д.м.н., профессор, член МООСБТ; Артеменко А.Р., д.м.н., ведущий научный сотрудник, член МООСБТ; Сойхер М.И., к.м.н, член МООСБТ; Красавина Д.А., к.м.н, член МООСБТ; Мисиков В.К., к.м.н., член МООСБТ; Костенко Е.В., к.м.н., член МООСБТ; Мингазова Л. Р., к.м.н.; Сойхер М.Г., к.м.н.; Суровых С.В., к.м.н., член МООСБТ; Коренко Л.А, к.м.н, член МООСБТ; Антипова Л.Н. к.м.н, член МООСБТ; Залялова З.А. д.м.н. профессор, член МООСБТ; Антипенко Е.А., к.м.н, член МООСБТ; Шперлинг Л.П. к.м.н, член МООСБТ
Toward an epidemiology of poststroke spasticity (ENG)
Poststroke spasticity (PSS)-related disability is emerging as a significant health issue for stroke survivors. There is a need for predictors and early identification of PSS in order to minimize complications and maladaptation from spasticity. Reviewing the literature on stroke and upper motor neuron syndrome, spasticity, contracture, and increased muscle tone measured with the Modified Ashworth Scale and the Tone Assessment Scale provided data on the dynamic time course of PSS. Prevalence estimates of PSS were highly variable, ranging from 4% to 42.6%, with the prevalence of disabling spasticity ranging from 2% to 13%. Data on phases of the PSS continuum revealed evidence of PSS in 4% to 27% of those in the early time course (1-4 weeks poststroke), 19% to 26.7% of those in the postacute phase (1-3 months poststroke), and 17% to 42.6% of those in the chronic phase (>3 months poststroke).
Автор: Jorge H. Villafañe PT, MSc, PhD, Guillermo B. Silva MSc, PhD, Alessandro Chiarotto PT , Orazio L.F. Ragusa MD
Clinical Features: A 76-year-old male patient had spastic muscles in the upper limb 10 months after an ischemic stroke.
Автор: Yu. I. Vainshenker, I. M. Ivchenko, A. D. Korotkov, G. V. Kataeva, and S. V. Medvedev
Polyfunctionality of Neurons: The Blocking of Extreme Pathological Afferentation Leads to an Improvement of the Higher Functions of the Brain (ENG)
In this paper, a possible mechanism for improving the functional state of the brain regions main taining locomotor, visual, auditory, and higher functions of the brain during the correction of the generalized spastic syndrome (botulinotherapy with Xeomin) in patients in the vegetative state (VS) is discussed. If the vegetative state is considered as a stable pathological condition (SPC) of the brain, then, in terms of the theory of the structural–functional organization of brain systems with rigid and flexible elements (N.P. Bechtereva), the therapy led to an unbalance of SPC, functional liberation of neurons, redistribution of their functions to ensure other activities, and the formation of new interneuronal connections. Taking into account the func tional variability of neurons (S.V. Medvedev), the blocking of the neuromuscular transmission in spastic mus cles reduces the abnormal afferent and efferent hyperactivity of motor and sensory neuronal circuits, which liberates the brain for other activities. Clinically, this allows considering botulinotherapy of drugresistant muscle spasticity in patients in VS and minimal consciousness not only as a symptomatic treatment but also as indirect neuroprotection.
Автор: Santamato A, Ranieri M, Panza F, Frisardi V, Micello MF, Filoni S, Fiore P.
Effectiveness of switching therapy from complexing protein-containing botulinum toxin type A to a formulation with low immunogenicity in spasticity after stroke: a case report (ENG)
We report here neurophysiological and clinical findings for a 58-year-old man treated with botulinum toxin type A for spasticity after ischaemic stroke, who became a secondary non-responder patient. Subsequent treatment with a different preparation of botulinum toxin type A had a great therapeutic effect on his spasticity. The muscles injected and the dosages were the same for each treatment, but evaluation with the Modified Ashworth Scale after treatment with the second preparation showed a reduction of approximately 2 points compared with the first examination. The clinical results were also supported by extensor digitorum brevis testing of the right muscle, which showed a reduction in compound muscle action potential, whereas it was unchanged in the non-injected muscle. No side-effects were reported, and after 1 year of treatment with this formulation clinical benefits were still evident.
Автор: Pagan FL, Harrison A.
A guide to dosing in the treatment of cervical dystonia and blepharospasm with Xeomin®: a new botulinum neurotoxin A (ENG)
Xeomin(®) (incobotulinumtoxinA; Merz Pharmaceuticals, Frankfurt am Main, Germany) was first introduced in Germany for movement disorders in 2005. In 2010, it was approved for use in the United States by the FDA for the treatment of cervical dystonia (CD) and blepharospasm. It is a unique botulinum type A formulation free of any complexing proteins and contains only the pure 150 kD neurotoxin. Thus, the formation of neutralizing antibodies is not induced even after long-term treatment. The purpose of this report is to review the safety profile and dosing schedule for Xeomin for the treatment of CD and blepharospasm. The recommended dose for patients with CD is 120 U/treatment, with administration intervals normally between 3 and 6 months. However, clinical studies have found Xeomin to be safe and effective at doses up to 400 U in both previously treated and treatment-naïve patients.
Автор: Joohi Jimenez-Shahed
A new treatment for focal dystonias: incobotulinumtoxinA (Xeomin®), a botulinum neurotoxin type A free from complexing proteins (ENG)
These studies have also suggested that incobotulinumtoxinA is associated with a lower risk for stimulating antibody formation than onabotulinumtoxinA. In phase 3 noninferiority trials, incobotulinumtoxinA demonstrated significant improvements in CD and BSP symptoms in both primary and secondary measures, compared with baseline, and met criteria for noninferiority versus onabotulinumtoxinA. In placebo-controlled trials, incobotulinumtoxinA also significantly improved the symptoms of CD and BSP, with robust outcomes in both primary and secondary measures. The use of incobotulinumtoxinA has been well tolerated in all trials, with an adverse event profile similar to that of onabotulinumtoxinA.
Автор: Santamato A, Panza F, Ranieri M, Frisardi V, Micello MF, Filoni S, Fortunato F, Intiso D, Basciani M, Logroscino G, Fiore P.
Efficacy and safety of higher doses of botulinum toxin type A NT 201 free from complexing proteins in the upper and lower limb spasticity after stroke (ENG)
Botulinum toxin type A (BTX-A) represents the gold standard therapy for focal spasticity after stroke, with low prevalence of complications, reversibility, and efficacy in reducing spastic hypertonia. Current guidelines suggest the employment of a dosage up to 600 units (U) of BTX-A to treat spasticity after stroke, to avoid important adverse effects and the development of antibodies against the neurotoxin. In recent years, NT 201, a new BTX-A free of complexing proteins, has been used for treating several movement disorders, showing safety and efficacy in upper limb spasticity. In a prospective, non-randomized, open-label study, we studied the efficacy and safety of higher doses of BTX-A NT 201 (up to 840 U) in 25 consecutive patients with upper and lower limb spasticity after stroke, evaluated at 30 and 90 days after injections. Before and after the treatment, the grade of spasticity, the disability, and spasticity-related pain were extensively measured. After 30 days of follow-up, a great reduction of spasticity and pain with improvement of disability was observed. The effects were still present at 90 days of follow-up. No major adverse events were observed.
Автор: Hesse S, Mach H, Fröhlich S, Behrend S, Werner C, Melzer I.
Stability of botulinum neurotoxin type A, devoid of complexing proteins (ENG)
Botulinum toxin type A is a complex composed of the biologically active neurotoxin, several hemagglutinins and other nontoxic proteins. After intramuscular injection these complexing proteins do not have any therapeutic effect. However, they protect the neurotoxin from harsh environmental conditions, e.g., low intragastral pH after oral ingestion. NT201, a BoNT/A drug product devoid of complexing proteins was tested in real-time and accelerated stability studies. NT201 was found to be stable without refrigeration for 48 months and even not affected by short-term temperature stress up to 60°C, demonstrating that complexing proteins are not required for the stability of BoNT/A preparations.
Автор: Maurizio Falso, Rosalba Galluso, Andrea Malvicini
Functional influence of botulinum neurotoxin type A treatment (Xeomin®) of multifocal upper and lower limb spasticity on chronic hemiparetic gait (ENG)
This report describes the modification of hemiplegic shoulder pain and walking velocity through injections of Xeomin®, a new botulinum neurotoxin type A formulation, in a 67-year-old woman with chronic residual left hemiparesis and hemiparetic gait attributable to stroke. Clinical evaluation included upper and lower limb spasticity, upper and lower limb pain, trunk control, upper and lower limb motricity index, visual gait analysis, and gait velocity. Assessments were performed before, 1 week after, and 1 month after treatment. Improvement was observed in all clinical parameters assessed. Amelioration of spasticity of the upper and lower limbs and shoulder pain was observed after 1 month. Trunk postural attitude and paraxial muscle recruitment recovered. No adverse events were observed and the patient shows significant improvement of functional impairment derived from chronic spasticity after treatment with Xeomin®. We also provide a simple and useful protocol for clinical evaluation of the treatment.