Rha Dong-wook, Yang Eun Joo, Chung Ho Ik, Kim Hyoung Bin, Park Chang-il, Park Eun Sook
Department and Research Institute of Rehabilitation Medicine, Yonsei University of College of Medicine, Seoul, Korea.
Yonsei Med J. 2008 Aug 30;49(4):545-52. doi: 10.3349/ymj.2008.49.4.545.
The purpose of the present study was to investigate whether electrical stimulation (ES) improves the paralytic effect of botulinum toxin type A (BTX-A) and evaluate the differences between low frequency (LF) and high frequency (HF) ES in children with spastic diplegic cerebral palsy (CP).
Twenty-three children with spastic diplegia CP who had BTX-A injections into both gastrocnemius muscles were assessed. Following the toxin injection, electrical stimulation was given to 1 side of the injected muscles and a sham-stimulation to the other side for 30 min a day for 7 consecutive days [HFES (25Hz) to 11 children, LFES (4Hz) to 12 children]. The compound motor action potentials (CMAP) from the gastrocnemius muscle were assessed before injection and at 5 time points (days 3, 7, 14, 21, and 30) after injection. The clinical assessments of spasticity were performed before and 30 days after injection.
The CMAP area became significantly lower in both LFES and HFES sides from 3 days after injection compared to baseline values. In other words, the CMAP area of the sham-stimulated side showed a significant decrease at 7 or 14 days after injection. However, there were no significant differences in clinical assessment of spasticity between the stimulated and sham-stimulated sides.
Short-term ES in both LF and HF to the spastic muscles injected with BTX-A might induce earlier denervating action of BTX-A. However, it does not necessarily lead to clinical and electrophysiological benefits in terms of reduction of spasticity.
本研究旨在探讨电刺激（ES）是否能增强A型肉毒毒素（BTX-A）的麻痹效果，并评估低频（LF）和高频（HF）电刺激在痉挛型双侧瘫脑瘫（CP）患儿中的差异。
对23例双侧腓肠肌注射BTX-A的痉挛型双侧瘫CP患儿进行评估。毒素注射后，对一侧注射肌肉进行电刺激，另一侧进行假刺激，每天30分钟，连续7天[11例患儿接受高频电刺激（25Hz），12例患儿接受低频电刺激（4Hz）]。在注射前及注射后5个时间点（第3、7、14、21和30天）评估腓肠肌的复合肌肉动作电位（CMAP）。在注射前及注射后30天进行痉挛的临床评估。
与基线值相比，注射后3天起，低频电刺激和高频电刺激侧的CMAP面积均显著降低。换句话说，假刺激侧的CMAP面积在注射后7天或14天出现显著下降。然而，刺激侧和假刺激侧在痉挛的临床评估方面没有显著差异。
对注射BTX-A的痉挛肌肉进行短期的低频和高频电刺激可能会使BTX-A的去神经作用提前出现。然而，在减轻痉挛方面，这不一定会带来临床和电生理益处。
