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背景:注射A型肉毒毒素后,不仅影响注射局部神经肌肉接头的功能,也可导致远隔部位的改变;F波由运动神经元逆向兴奋引起,故有可能间接评价运动神经元的功能状态。目的:探讨局部注射A型肉毒毒素后远隔部位F波改变及其可能机制。设计:以运动障碍性疾病患者为研究对象的自身对照观察性研究。单位:一所大学医院神经科门诊。对象:2002-09/2003-07就诊于武汉大学人民医院神经科门诊的未接受过A型肉毒毒素局部注射治疗的运动障碍性疾病患者26例,其中19例为偏侧面肌痉挛、5例为Meige综合征、2例为痉挛性斜颈。干预:对26例患者行A型肉毒毒素注射,并在注射前、注射后1周及注射后12～24周,分别检测其尺神经及胫神经F波。主要观察指标:注射A型肉毒毒素前、后F波最短潜伏期、平均潜伏期、负峰波幅、时限、出现率和弥散时值;M波潜伏期及波幅变化。结果:注射1周后3例共5条尺神经未引出肯定波形。与注射前比较,尺、胫神经F波平均潜伏期及尺神经F波时限在注射后1周显著延长,且这种改变与注射剂量无关;注射后12～24周上述两参数与注射前比较,差异均无显著性意义。结论:F波平均潜伏期和时限为评价A型肉毒毒素远隔效应的敏感指标;A型肉毒毒素的远隔效应似与注射部位的距离有关,而与注射剂量无关。
Background: Injection of botulinum toxin type A not only affects the function of local neuromuscular injection, but also leads to the change of distant site. F wave is caused by reverse excitability of motor neurons, so it is possible to indirectly evaluate the functional status of motor neurons . OBJECTIVE: To investigate the changes of F-waves in distal septal site after botulinum toxin A injection and its possible mechanism. Design: A self-controlled observational study of patients with dyskinesia. Unit: a University Hospital neurology clinic. PARTICIPANTS: From September 2002 to July 2003, 26 patients with dyskinesia who did not receive localized injection of botulinum toxin type A were enrolled in the department of neurology of People’s Hospital of Wuhan University. Of the patients, 19 were hemifacial spasm and 5 Meige syndrome, 2 cases of spasmodic torticollis. INTERVENTION: Botulinum toxin type A injection was given to 26 patients. F-wave of ulnar nerve and tibial nerve were detected before injection, 1 week after injection and 12-24 weeks after injection. MAIN OUTCOME MEASURES: Before and after injection of botulinum toxin type A, the shortest incubation period, average latency, negative peak amplitude, time limit, incidence and time of F wave were observed; M wave latency and amplitude changes. Results: A total of 5 ulnar nerves in 3 cases did not lead to positive waveform after 1 week of injection. Compared with that before injection, the average latency of F wave and the F wave of ulnar nerve in the ulnar and tibial nerve were significantly prolonged at 1 week after injection, and the change was not related to the injection dose. Compared with the pre-injection, There was no significant difference between the two groups. CONCLUSION: The average latency and time-limit of F-wave are sensitive indicators for evaluating the remote effect of botulinum toxin type A. The distant effect of botulinum toxin A may be related to the distance of injection site, but not to the injected dose.