TONIC VIBRATION REFLEX AND MUSCLE AFFERENT BLOCK IN WRITERS CRAMP
TONIC VIBRATION REFLEX AND MUSCLE AFFERENT BLOCK IN WRITERS CRAMP
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DOI：
10.1002/ana.410380206
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发表时间：
1995-08-01
影响因子：
11.2
通讯作者：
KIMURA, J
中科院分区：
文献类型：
--
作者：
KAJI, R;ROTHWELL, JC;KIMURA, J
局灶性肌张力障碍患者利用某些皮肤或本体感觉输入来缓解症状（“感觉技巧”）。我们观察了强直振动反射运动增加肌纺锤体活动和肌内注射利多卡因降低肌纺锤体活动的效果。在15名作家痉挛患者和15名年龄匹配的正常受试者的手掌或前臂肌肉肌腱上施加振动。在11例患者中，振动诱发了书写过程中典型的肌张力障碍姿势或运动。正常受试者要么对振动没有反应，要么仅在手腕和手指屈肌中出现逐渐发展的强直性振动反射，其产生的可见运动潜伏期（12.5 +/- 6.7秒[平均+/-标准差]）明显长于患者（2.7 +/- 2.5秒，p < 0.0001）。局部注射利多卡因（0.5%，5-40 ml/肌肉）可减弱肌腱反射，对M反应影响相对较小。在13例患者中，向活动增加的肌肉注射可显著减少肌张力障碍运动，并显著改善临床效果，而向其他肌肉注射则没有效果。注射后临床获益持续1 ~ 24小时。在13例额外注射10%乙醇的患者中，作用持续时间延长至5至21天，乙醇阻断钠通道的时间比利多卡因长。这些发现表明，引起肌张力障碍运动的肌肉在静止时对振动有异常的敏感性，肌肉传入神经可能在产生肌张力障碍运动中起关键作用。局部注射利多卡因或乙醇可降低肌梭形神经传入的有效性，并可提供一种治疗作家痉挛的方法，而不会引起不必要的虚弱。
Patients with focal dystonia take advantage of certain cutaneous or proprioceptive sensory inputs to alleviate their symptoms (''sensory trick''). We examined the effects of increasing muscle spindle activity by the tonic vibration reflex maneuver and decreasing it by intramuscular injection of lidocaine. The vibration was applied to the palm or the tendon of forearm muscles in 15 patients with writer's cramp and 15 age-matched normal subjects. In 11 patients, the vibration induced dystonic postures or movements typical of those seen during writing. Normal subjects showed either no response to the vibration or a gradually developing tonic vibration reflex only in the wrist and finger flexors, which produced visible movements with a significantly longer latency (12.5 +/- 6.7 seconds [mean +/- standard deviation]) than what was observed in the patients (2.7 +/- 2.5 seconds, p < 0.0001). Local injection of lidocaine (0.5%, 5-40 ml/muscle) attenuated the tendon reflex with relatively little effect on the M response. Injection into muscles with increased activity produced marked reduction of dystonic movements and significant clinical improvement in 13 patients, whereas injection into the other muscles had no effect. The clinical benefit lasted for 1 to 24 hours after injection. In 13 patients who had additional injections of 10% ethanol, which blocks sodium channels for a longer period than does lidocaine, the duration of action was prolonged to 5 to 21 days. These findings suggest that muscles causing dystonic movements have abnormal sensitivities to vibration at rest and that muscle afferents may play a pivotal role in producing dystonic movements. Local injection of lidocaine or ethanol reduces the effectiveness of muscle spindle afferent and may provide a means of treating patients with writer's cramp without causing unwanted weakness.