PDF(Pubmed)
Abstract：
OBJECTIVE: To compare the effect of rectus femoris diagnostic motor nerve blocks (DNB) with anaesthetics and rectus femoris muscle botulinum toxin (BoNT-A) injection in multiple sclerosis patients with unilateral stiff-knee gait.
METHODS: Prospective observational study Subjects/Patients: Multiple sclerosis patients in stable condition.
METHODS: Patients underwent evaluation before and 1 hour after the anaesthetic block, and 1 month after the botulinum injection. Assessment included a 10-m walking test, a 6-minute walking test, a timed-up-and-go (TUG) test, and a Baseline Expanded Disability Status Scale (EDSS). Post-DNB and post-BoNT-A satisfaction was measured with the global assessment of efficacy scale.
RESULTS: Fourteen patients with unilateral stiff-knee gait due to multiple sclerosis underwent a DNB, among whom 13 received botulinum injections in the rectus femoris muscle after a satisfying test result. Positive post-DNB results correlated with significant functional improvements after BoNT-A. Higher EDSS and longer time from diagnosis correlated with poorer post-DNB and post-BoNT-A absolute outcomes.
CONCLUSIONS: DNB showed predictive value for BoNT-A outcomes, especially in the case of worse functional status. It effectively predicted endurance and walking speed improvement, while TUG showed greater improvement after botulinum. In cases of uncertain therapeutic benefit, nerve blocks may provide a valuable diagnostic support, particularly in patients with lower functional status.
METHODS: Prospective observational study Subjects/Patients: Multiple sclerosis patients in stable condition.
METHODS: Patients underwent evaluation before and 1 hour after the anaesthetic block, and 1 month after the botulinum injection. Assessment included a 10-m walking test, a 6-minute walking test, a timed-up-and-go (TUG) test, and a Baseline Expanded Disability Status Scale (EDSS). Post-DNB and post-BoNT-A satisfaction was measured with the global assessment of efficacy scale.
RESULTS: Fourteen patients with unilateral stiff-knee gait due to multiple sclerosis underwent a DNB, among whom 13 received botulinum injections in the rectus femoris muscle after a satisfying test result. Positive post-DNB results correlated with significant functional improvements after BoNT-A. Higher EDSS and longer time from diagnosis correlated with poorer post-DNB and post-BoNT-A absolute outcomes.
CONCLUSIONS: DNB showed predictive value for BoNT-A outcomes, especially in the case of worse functional status. It effectively predicted endurance and walking speed improvement, while TUG showed greater improvement after botulinum. In cases of uncertain therapeutic benefit, nerve blocks may provide a valuable diagnostic support, particularly in patients with lower functional status.
摘要：
目的：比较股直肌运动神经阻滞（DNB）与麻醉药和股直肌肉毒毒素（BoNT-A）注射对单侧膝关节僵硬步态多发性硬化患者的诊断效果。
方法：前瞻性观察研究受试者/患者：病情稳定的多发性硬化症患者。
方法：患者在麻醉阻滞前和麻醉阻滞后1小时接受评估，和肉毒杆菌注射后1个月。评估包括10米步行测试，6分钟的步行测试,定时启动(TUG)测试，和基线扩展残疾状态量表(EDSS)。使用全球疗效评估量表测量DNB后和BoNT-A后满意度。
结果：14例因多发性硬化症导致的单侧膝盖僵硬步态患者接受了DNB，其中13人在测试结果令人满意后接受了股直肌肉毒杆菌注射。DNB后的阳性结果与BoNT-A后的显着功能改善相关。较高的EDSS和较长的诊断时间与较差的DNB后和BoNT-A后的绝对结果相关。
结论：DNB对BoNT-A结局具有预测价值，尤其是在功能状态更差的情况下。它有效地预测了耐力和步行速度的提高，而TUG在肉毒杆菌后表现出更大的改善。在治疗益处不确定的情况下，神经阻滞可以提供有价值的诊断支持，特别是功能状态较低的患者。
方法：前瞻性观察研究受试者/患者：病情稳定的多发性硬化症患者。
方法：患者在麻醉阻滞前和麻醉阻滞后1小时接受评估，和肉毒杆菌注射后1个月。评估包括10米步行测试，6分钟的步行测试,定时启动(TUG)测试，和基线扩展残疾状态量表(EDSS)。使用全球疗效评估量表测量DNB后和BoNT-A后满意度。
结果：14例因多发性硬化症导致的单侧膝盖僵硬步态患者接受了DNB，其中13人在测试结果令人满意后接受了股直肌肉毒杆菌注射。DNB后的阳性结果与BoNT-A后的显着功能改善相关。较高的EDSS和较长的诊断时间与较差的DNB后和BoNT-A后的绝对结果相关。
结论：DNB对BoNT-A结局具有预测价值，尤其是在功能状态更差的情况下。它有效地预测了耐力和步行速度的提高，而TUG在肉毒杆菌后表现出更大的改善。在治疗益处不确定的情况下，神经阻滞可以提供有价值的诊断支持，特别是功能状态较低的患者。
