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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 簡國龍(Kuo-Liong Chien) | |
dc.contributor.author | Gwo-Chi Hu | en |
dc.contributor.author | 胡國琦 | zh_TW |
dc.date.accessioned | 2021-06-13T04:17:33Z | - |
dc.date.available | 2007-08-03 | |
dc.date.copyright | 2006-08-03 | |
dc.date.issued | 2006 | |
dc.date.submitted | 2006-07-24 | |
dc.identifier.citation | 參考資料
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Botulinum toxin in the treatment of cerebral palsy. Neuropediatrics 1995;26(5):249-52. 28. Sutherland DH, Kaufman KR, Wyatt MP, Chambers HG, Mubarak SJ. Double-blind study of botulinum A toxin injections into the gastrocnemius muscle in patients with cerebral palsy. Gait Posture 1999;10(1):1-9. 29. Flett PJ, Stern LM, Waddy H, Connell TM, Seeger JD, Gibson SK. Botulinum toxin A versus fixed cast stretching for dynamic calf tightness in cerebral palsy. J Paediatr Child Health 1999;35(1):71-7. 30. Love SC, Valentine JP, Blair EM, Price CJ, Cole JH, Chauvel PJ. The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia a randomized controlled trial. Eur J Neurol 2001;8 Suppl 5:50-8. 31. Koman LA, Mooney JF, 3rd, Smith B, Goodman A, Mulvaney T. Management of cerebral palsy with botulinum-A toxin: preliminary investigation. J Pediatr Orthop 1993;13(4):489-95. 32. Aoki KR. Pharmacology and immunology of botulinum toxin serotypes. J Neurol 2001;248 Suppl 1:3-10. 33. Bigalke H, Wohlfarth K, Irmer A, Dengler R. Botulinum A toxin: Dysport improvement of biological availability. Exp Neurol 2001;168(1):162-70. 34. Koman LA, Mooney JF, 3rd, Smith BP, Walker F, Leon JM. Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy: a randomized, double-blind, placebo-controlled trial. BOTOX Study Group. J Pediatr Orthop 2000;20(1):108-15. 35. Wong V. Use of botulinum toxin injection in 17 children with spastic cerebral palsy. Pediatr Neurol 1998;18(2):124-31. 36. Koman LA, Brashear A, Rosenfeld S, Chambers H, Russman B, Rang M et al. Botulinum toxin type a neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open-label clinical trial. Pediatrics 2001;108(5):1062-71. 37. Bakheit AM, Severa S, Cosgrove A, Morton R, Roussounis SH, Doderlein L et al. Safety profile and efficacy of botulinum toxin A (Dysport) in children with muscle spasticity. Dev Med Child Neurol 2001;43(4):234-8. 38. Zuber M, Sebald M, Bathien N, de Recondo J, Rondot P. Botulinum antibodies in dystonic patients treated with type A botulinum toxin: frequency and significance. Neurology 1993;43(9):1715-8. 39. Baker R, Jasinski M, Maciag-Tymecka I, Michalowska-Mrozek J, Bonikowski M, Carr L et al. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study. Dev Med Child Neurol 2002;44(10):666-75. 40. Barwood S, Baillieu C, Boyd R, Brereton K, Low J, Nattrass G et al. Analgesic effects of botulinum toxin A: a randomized, placebo-controlled clinical trial. Dev Med Child Neurol 2000;42(2):116-21. 41. Ubhi T, Bhakta BB, Ives HL, Allgar V, Roussounis SH. Randomised double blind placebo controlled trial of the effect of botulinum toxin on walking in cerebral palsy. Arch Dis Child 2000;83(6):481-7. 42. Wissel J, Heinen F, Schenkel A, Doll B, Ebersbach G, Muller J et al. Botulinum toxin A in the management of spastic gait disorders in children and young adults with cerebral palsy: a randomized, double-blind study of 'high-dose' versus 'low-dose' treatment. Neuropediatrics 1999;30(3):120-4. 43. Polak F, Morton R, Ward C, Wallace WA, Doderlein L, Siebel A. Double-blind comparison study of two doses of botulinum toxin A injected into calf muscles in children with hemiplegic cerebral palsy. Dev Med Child Neurol 2002;44(8):551-5. 44. Corry IS, Cosgrove AP, Duffy CM, McNeill S, Taylor TC, Graham HK. Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: a randomised prospective trial. J Pediatr Orthop 1998;18(3):304-11. 45. Graham HK, Aoki KR, Autti-Ramo I, Boyd RN, Delgado MR, Gaebler-Spira DJ et al. Recommendations for the use of botulinum toxin type A in the management of cerebral palsy. Gait Posture 2000;11(1):67-79. 46. Gracies J-M, Weisz DJ, Yang BY, Flanagan S, Simpson DM. Impact of botulinum toxin type A(BTX-A) dilution and endplate targeting technique in upper limb spasticity Annals of Neurology 2002;52(Suppl 1):S87. 47. Hesse S, Reiter F, Konrad M, Jahnke MT. Botulinum toxin type A and short-term electrical stimulation in the treatment of upper limb flexor spasticity after stroke: a randomized, double-blind, placebo-controlled trial. Clin Rehabil 1998;12(5):381-8. 48. Reiter F, Danni M, Lagalla G, Ceravolo G, Provinciali L. Low-dose botulinum toxin with ankle taping for the treatment of spastic equinovarus foot after stroke. Arch Phys Med Rehabil 1998;79(5):532-5. 49. Kim HS, Hwang JH, Jeong ST, Lee YT, Lee PK, Suh YL et al. Effect of muscle activity and botulinum toxin dilution volume on muscle paralysis. Dev Med Child Neurol 2003;45(3):200-6. 50. Francisco GE, Boake C, Vaughn A. Botulinum toxin in upper limb spasticity after acquired brain injury: a randomized trial comparing dilution techniques. Am J Phys Med Rehabil 2002;81(5):355-63. 51. Lee LR, Chuang YC, Yang BJ, Hsu MJ, Liu YH. Botulinum toxin for lower limb spasticity in children with cerebral palsy: a single-blinded trial comparing dilution techniques. Am J Phys Med Rehabil 2004;83(10):766-73. 52. Hsu TS, Dover JS, Arndt KA. Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol 2004;140(11):1351-4. 53. Eames NW, Baker R, Hill N, Graham K, Taylor T, Cosgrove A. The effect of botulinum toxin A on gastrocnemius length: magnitude and duration of response. Dev Med Child Neurol 1999;41(4):226-32. 54. Boyd RN, Pliatsios V, Starr R, Wolfe R, Graham HK. Biomechanical transformation of the gastroc-soleus muscle with botulinum toxin A in children with cerebral palsy. Dev Med Child Neurol 2000;42(1):32-41. 55. Tardieu C, Lacert P, Lombard M, Truscelli D, Tardieu G. H reflex and recovery cycle in spastic and normal children: intra- and inter-individual and inter-groups comparisons. Arch Phys Med Rehabil 1977;58(12):561-7. 56. Fosang AL, Galea MP, McCoy AT, Reddihough DS, Story I. Measures of muscle and joint performance in the lower limb of children with cerebral palsy. Dev Med Child Neurol 2003;45(10):664-70. 57. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987;67(2):206-7. 58. Damiano DL, Quinlivan JM, Owen BF, Payne P, Nelson KC, Abel MF. What does the Ashworth scale really measure and are instrumented measures more valid and precise? Dev Med Child Neurol 2002;44(2):112-8. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/32864 | - |
dc.description.abstract | 肉毒桿菌素已經被證明對於腦性麻痺病童的下肢痙攣是一種有效的治療方法,但是肉毒桿菌素本身是一種非常昂貴且有毒性的藥劑,所以藉由調整藥物配置方法,使用較高體積的生理食鹽水稀釋藥物,是一種提高每單位劑量的肉毒桿菌素的治療效果的方法。
本隨機對照研究的目的在比較相同劑量的肉毒桿菌素用高體積和低體積的生理食鹽水稀釋去治療腦性麻痺病童痙攣性腓腸肌的療效,20位雙側痙攣麻痺性和2位四肢痙攣麻痺性的腦性麻痺病童參與本研究,每位病童藉由隨機分配的方法決定何腳接受高體積稀釋的肉毒桿菌素注射,另一隻腳就接受低體積稀釋的肉毒桿菌素注射。在治療前和注射後一個月及二個月評估動、靜態踝關節活動角度、腓腸肌複合動作電位之面積、腓腸肌的肌肉張力,做為療效的指標。 本研究結果顯示接受高體積稀釋的肉毒桿菌素注射腳比低體積稀釋的肉毒桿菌素注射腳有顯著增加動態踝關節活動角度 (P=0.0002)、減少腓腸肌複合動作電位之面積 (P<0.0001)、降低腓腸肌的肌肉張力 (P=0.0055);兩組所有的療效指標在治療後各個時間點評估都比治療前有顯著改善;而接受高體積稀釋的肉毒桿菌素注射腳組並沒有產生更多比例的疼痛和無力的藥品不良反應。以高體積 (5毫升) 比低體積 (1毫升) 稀釋的500單位肉毒桿菌素(Dysport®) 對腦性麻痺病童下肢痙攣確實有較好的療效。 正確地使用肉毒桿菌素治療不但可以減少副作用產生的機率,同時也可以減少治療的費用,本研究的結果顯示增加稀釋肉毒桿菌素的體積會影響理想療效。 | zh_TW |
dc.description.abstract | Botulinum toxin A (BTX-A) has been shown to be an effective treatment of lower limb spasticity in children with cerebral palsy. BTX-A is an expensive and potentially toxic agent. Enhancing the efficacy of per unit dose by modifying drug preparation with higher diluent volumes is a potential options.
The object of this parallel randomized controlled study is to compare the effect of equivalent dose of BTX-A (Dysport®) in high-volume (500unit/5ml) and low-volume (500unit/1ml) injections on spastic gastrocnemius muscle in children with cerebral palsy. Twenty spastic diplegia and two spastic quadriplegia participated in the study. The children were randomized to receive high-volume preparation of BTX-A in one leg and low-volume preparation of BTX-A in the other leg. All children were assessed at baseline, four and eight weeks following injection. The analyzed parameters included dynamic and static ankle joint range of motion, area of the compound muscle action potential for gastrocnemius muscle, calf muscle tone . The legs in high-volume preparation treatment showed significant increasing dynamic ankle joint ROM (P=0.0002), improvement of modified Ashworth scale (P<0.0001), decreasing area of CMAP (P=0.0055). Both groups demonstrated significant improvement in all measurements at four and eight weeks after injection. The high-volume group did not increase side effect, such as pain and weakness. A high volume preparation with a 5-fold dilution of BTX-A does yield better results than a low-volume preparation. A judicious use of BTX-A will result in fewer side effects and significant cost reduction. This study showed that the dilution volume has implication on the desired treatment effect of BTX-A. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T04:17:33Z (GMT). No. of bitstreams: 1 ntu-95-R93846006-1.pdf: 725231 bytes, checksum: f9d087f407e9fb452bcf776395cd8520 (MD5) Previous issue date: 2006 | en |
dc.description.tableofcontents | 中文摘要 I
英文摘要 III 第一章 前言 1 第二章 文獻回顧 3 第一節 腦性麻痺兒童的相關研究: 3 第二節 痙攣型腦性麻痺病童的相關研究 4 第三節 肉毒桿菌素的相關研究: 8 第四節 肉毒桿菌素治療腦性麻痺兒童下肢痙攣的相關研究 9 第五節 如何增進肉毒桿菌素治療效果 10 第六節 使用不同體積稀釋的肉毒桿菌素治療效果的相關研究 12 第三章 研究目的與研究假說 16 第一節 研究目的 16 第二節 研究假說 16 第四章 研究方法 17 第一節 研究設計 17 第二節 研究對象 17 第三節 實驗流程 18 第四節 實驗藥物配置和注射方法 19 第五節 測量工具和方法 19 第六節 資料的分析 21 第五章 結果 23 第一節 受試者基本資料 23 第二節 注射前後踝關節動態活動角度的變化 23 第三節 注射前後踝關節靜態活動角度的變化 24 第四節 注射前後腓腸肌之複合動作電位之面積 25 第五節 注射前後腓腸肌之肌肉張力大小 25 第六節 注射後疼痛、無力及產生不良反應的比例 26 第六章 討論 27 第一節 影響肉毒桿菌素治療效果的因素 27 第二節 不同體積稀釋之肉毒桿菌素注射對踝關節動態活動角度之效應 28 第三節 不同體積稀釋之肉毒桿菌素注射對踝關節靜態活動角度之效應 29 第四節 不同體積稀釋之肉毒桿菌素注射對腓腸肌複合動作電位面積之效應 29 第五節 不同體積稀釋之肉毒桿菌素注射對腓腸肌的肌肉張力之效應 30 第六節 不同體積稀釋之肉毒桿菌素注射產生副作用的討論 30 第七節 研究限制 31 第七章 結論 32 研究收案流程圖1 38 表 1:肌肉張力評估(修正艾斯量表) 39 表 2:受試者基本資料 40 表3:受試者在基準點的評估結果(平均值±標準差) 41 表4:兩組在注射前、注射後四週與注射後八週踝關節動態活動角度之表現 42 表5:兩組在注射前、注射後四週與注射後八週踝關節靜態活動角度之表現 43 表6:兩組在注射前、注射後四週與注射後八週複合動作電位面積之表現 44 表7:兩組在注射前、注射後四週與注射後八週腓腸肌肌肉張力之表現 45 表8:兩組注射後產生疼痛或無力的比例 46 圖1:兩組踝關節動態活動角度在肉毒桿菌素注射前後變化的趨勢圖 47 圖2:所有受試者動態活動角度三次評估之個別表現趨勢圖 48 圖 3:兩組踝關節靜態活動角度在肉毒桿菌素注射前後變化的趨勢圖 49 圖4:所有受試者踝關節靜態活動角度三次評估之個別表現趨勢圖 50 圖5:兩組腓腸肌之複合動作電位之面積在肉毒桿菌素注射前後變化的趨勢圖 51 圖 6:所有受試者腓腸肌之複合動作電位之面積三次評估之個別表現趨勢圖 52 圖 7:二組肌肉張力(MAS)在肉毒桿菌素注射前後變化的長條圖 53 附錄:人體試驗委員會同意研究證明書 | |
dc.language.iso | zh-TW | |
dc.title | 肉毒桿菌素注射於腦性麻痺病童痙攣性腓腸肌之療效–比較兩種稀釋方法之隨機分派研究 | zh_TW |
dc.title | The effect of botulinum toxin type-A injection into the spastic gastrocemius muscle in children with cerebral palsy
-A randomized trial comparing two different dilute volume | en |
dc.type | Thesis | |
dc.date.schoolyear | 94-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 劉仁沛(Jen-Pei Liu) | |
dc.contributor.oralexamcommittee | 周適偉(Shih-Wei Chou),賴美淑(Mei-Shu Lai) | |
dc.subject.keyword | 腦性麻痺,痙攣,肉毒桿菌素,稀釋, | zh_TW |
dc.subject.keyword | cerebral palsy,spasticity,botulinum toxin,dilution, | en |
dc.relation.page | 54 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2006-07-25 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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