Pribitkin E A, Greco T M, Goode R L, Keane W M
Department of Otolaryngology-Head & Neck Surgery, Jefferson Medical College, Philadelphia, Pa, USA.
Arch Otolaryngol Head Neck Surg. 1997 Mar;123(3):321-6. doi: 10.1001/archotol.1997.01900030103013.
To determine the dose-response characteristics and side-effects profile of Clostridium botulinum type A exotoxin (Botox) used to treat glabellar wrinkles and develop guidelines for patient selection based on the nature and severity of the treated wrinkles.
Prospective, nonrandomized pilot and electromyogram (EMG)-guided studies.
Two ambulatory care clinics at university hospitals.
For the pilot study, volunteer samples of 23 patients with glabellar wrinkles; for the EMG-guided study, volunteer samples of 57 patients with glabellar wrinkles.
For the pilot study, 23 patients were serially injected with up to 10.0 mouse units (MU) of Botox into each corrugator muscle; for the EMG-guided study, 57 patients were injected under EMG guidance with an initial dose of 10.0 MU of Botox into each corrugator muscle. Eleven patients with persistent corrugator activity were reinjected with 10.0 MU of Botox.
For the pilot study, slide photographs were obtained before and 2 weeks after injection; for the EMG-guided study, slide photographs were obtained before and at 2 weeks and at 2 months after injection. Patients were asked to evaluate results numerically.
For the pilot study, injection of up to 10.0 MU of Botox into each corrugator muscle produced a satisfactory improvement in 12 patients; for the EMG-guided study, 43 patients were satisfied with improvement after full abolition of corrugator or accessory lateral brow muscle activity. Women were more likely to achieve satisfactory results than were men (80% [40/50] vs 43% [3/7]; P < or = .03). Improvement was not age related. No significant side effects or complications were observed.
Glabellar wrinkles may be satisfactorily treated with Botox injection into the corrugator supercilii muscles. Improvement is temporary, dose dependent, and may not be seen in some patients even with successful denervation of the treated muscles. Clinicians may begin treatment with a dose of 10.0 MU of Botox into each corrugator muscle, and may select candidates for injection by determining the type of wrinkle to be treated and its spreadability (glabellar spread test).
确定用于治疗眉间皱纹的A型肉毒杆菌毒素（保妥适）的剂量反应特征和副作用情况，并根据所治疗皱纹的性质和严重程度制定患者选择指南。
前瞻性、非随机的试点研究和肌电图（EMG）引导研究。
大学医院的两家门诊护理诊所。
试点研究中，23例有眉间皱纹的患者作为志愿者样本；EMG引导研究中，57例有眉间皱纹的患者作为志愿者样本。
试点研究中，23例患者每侧皱眉肌依次注射高达10.0鼠单位（MU）的保妥适；EMG引导研究中，57例患者在EMG引导下，每侧皱眉肌初始注射10.0 MU的保妥适。11例皱眉肌持续活动的患者再次注射10.0 MU的保妥适。
试点研究中，在注射前和注射后2周获取幻灯片照片；EMG引导研究中，在注射前、注射后2周和2个月获取幻灯片照片。要求患者对结果进行数值评估。
试点研究中，每侧皱眉肌注射高达10.0 MU的保妥适使12例患者有满意的改善；EMG引导研究中，43例患者在皱眉肌或外侧眉辅助肌活动完全消除后对改善情况满意。女性比男性更有可能获得满意结果（80%[40/50]对43%[3/7]；P≤0.03）。改善与年龄无关。未观察到明显的副作用或并发症。
通过向皱眉肌注射保妥适可令人满意地治疗眉间皱纹。改善是暂时的、剂量依赖性的，即使治疗肌肉成功去神经支配，一些患者可能也看不到改善效果。临床医生可开始每侧皱眉肌注射10.0 MU的保妥适进行治疗，并可通过确定待治疗皱纹的类型及其扩展性（眉间扩展试验）来选择注射对象。
