Olney R K, Aminoff M J, Gelb D J, Lowenstein D H
Department of Neurology, University of California, San Francisco 94143.
Neurology. 1988 Nov;38(11):1780-3. doi: 10.1212/wnl.38.11.1780.
We assessed the severity and temporal profile of distant neuromuscular effects from a single dose (280 units) of botulinum neurotoxin injected into neck muscles for torticollis. We performed single-fiber EMG studies on the biceps brachii of six patients to measure jitter (20 pairs) and fiber density on the initial treatment day and then again, at least once more, after 2 to 12 weeks. No patient developed weakness beyond the neck muscles or decrement of the biceps response to repetitive 3-Hz nerve stimulation. Between the baseline and the last follow-up study, the average of mean MCD increased from 29 microseconds to 38 microseconds (31%). Mean fiber density increased concurrently or earlier from 1.35 to 1.79 (33%). There were no electrophysiologic signs of presynaptic blockade, even at 2 and 4 weeks. The effects we observed are compatible with stimulation of terminal sprouting by the neurotoxin, without significant presynaptic inhibition of acetylcholine release. We therefore believe that higher dosages of the neurotoxin may be used if clinically indicated.
我们评估了向颈部肌肉注射单剂量（280单位）肉毒杆菌神经毒素治疗斜颈后远处神经肌肉效应的严重程度和时间变化情况。我们对6例患者的肱二头肌进行了单纤维肌电图研究，以测量初始治疗日的颤抖（20对）和纤维密度，然后在2至12周后至少再次测量一次。没有患者出现颈部肌肉以外的肌无力，也没有肱二头肌对3赫兹重复神经刺激反应的衰减。在基线和最后一次随访研究之间，平均最小可分辨时限的平均值从29微秒增加到38微秒（增加了31%）。平均纤维密度同时或更早从1.35增加到1.79（增加了33%）。即使在2周和4周时，也没有突触前阻滞的电生理迹象。我们观察到的效应与神经毒素刺激终末发芽一致，而没有对乙酰胆碱释放产生明显的突触前抑制。因此，我们认为如果有临床指征，可以使用更高剂量的神经毒素。
