ボツリヌス治療で十分な治療効果が得られない局所性・分節性ジストニア—第一選択のボツリヌスが有効でないが，どうする

Focal or Segmental Dystonia Resistant to Botulinum Toxin: How Do You Treat Patients in Whom Botulinum Toxin Treatment Has No Effect?

本邦では，局所性ジストニアは眼瞼痙攣，痙性斜頸，上肢ジストニアの順に多い。ボツリヌス治療が第一選択だが，治療効果が得られずに難渋することもある。ボツリヌス治療の欠点としては，治療効果が一過性で短期間であり，治療無効なことや，費用が高価なことである。ボツリヌス治療が無効例では内服，リハビリテーションなどを行う。しかし，これらの治療はエビデンスレベルが低いため，症例ごとに対応せざるを得ない。

Abstract

Botulinum toxin treatment is most commonly used for blepharospasm, spastic torticollis, upper limb dystonia, and local dystonia in Japan. Botulinum toxin treatment is the first choice in these conditions. However, it has the disadvantages that the therapeutic effect is transient, that there are cases in whom the treatment is ineffective, and a high cost. In ineffective cases, botulinum toxin treatment involves medication and rehabilitation. Various medications have been used for the treatment of focal dystonia mainly in open trials. As these treatments have low evidence levels, each case should be dealt with individually. Operative treatment should be considered for severe cases.