Muscle Afferent Blockにみる書痙における上肢近位筋の関与(神経内科学教室竹宮敏子教授退任記念特別号)

概要

論文の詳細を見る
In the treatment of dystonia patients, we give a muscle afferent block (MAB), an intramuscular injection of lidocaine plus one tenth the volume of ethanol, to reduce abnormal hypercontraction of the relevant muscles. In this study we investigate the role of the proximal muscles in the pathophysiology of writer's cramp. Five idiopathic writer's cramp patients were studied. MAB treatment targetting the forearm muscles was unsuccessful in all cases. All patients showed more improvement when they were given extra MAB injections into the proximal muscles. Two cases in particular benefitted just after proximal injections only. Our results show proximal muscles can be responsible for writer's cramp. We assume dystonia to be an abnormality in 'motor subroutine'; in accordance with certain repeated movements some motor loops can be formed between the cerebral cortex and basal ganglia and problems within these loops can cause dystonia. Some writer's cramp patients gradually have difficulty with manual lacor other than writing resulting in incovenience when manipulating the upper limb. It is possible that the proximal muscles would take part in the 'motor subroutine' of writing.
東京女子医科大学の論文
2000-12-30