局部注射A型肉毒毒素后远隔部位F波的改变

目的探讨局部注射A型肉毒毒素(BTX-A)后其远隔部位F波的改变及其可能机制。方法对19例偏侧面肌痉挛(HFS)患者、5例Meige综合征患者及2例痉挛性斜颈(TS)患者行BTX-A注射，并在注射前、注射后1周及注射后12～24周时分别检测其尺神经及胫神经F波的各项参数变化。结果①注射后1周，有3例患者共5条尺神经未引出肯定波形。②与注射前比较，尺、胫神经F波平均潜伏期以及尺神经F波时限在注射1周后显著延长，且这种改变与注射剂量无明显相关性；注射12～24周时，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是评价BTX-A远隔效应的敏感指标；BTX-A的远隔效应似与检查部位和注射部位间的距离有关，而与注射剂量无明显相关性。

The remote effect of local injection of botulinum toxin type-A:an evaluation with F-wave

Objective To evaluate the remote effect of local injection of botulinum toxin by use of the F-wave measures. Methods The F-wave responses as well as M-waves were recorded before injection, and at 1 week,12 to 24 weeks after local injection of botulinum toxin type-A (BTX-A) in 26 patients, including 19 with hemi-facial spasm (HFS),5 Meige syndrome and 2 torticollis spasmodicus (TS).The following parameters were analyzed: M-wave latency (ML) and amplitude (Mamp), F-wave minimal latency(Fmin) and average latency(Fave),amplitude (Famp), duration (Fdur), persistence (Fper) and chronodispersion (Fchr). The above parameters were obtained through the electric stimulation of ulnar and tibial nerves, and recorded from the abductor digiti minimi and extensor digitorum brevis, respectively. Results No definite F-wave was obtained by electric stimulation of ulnar nerve at 1 week after injection in 3 HFS patients (5 nerves). The Fave recorded from electric stimulation of ulnar and tibial nerves prolonged significantlyand Fdur from ulnar nerve increased significantly at 1 week after injection, but were not significantly different from those of pre-injection when recorded at 12 to 24 weeks after injection. No significant correlation of the altered F-wave parameters was found with the dosage of BTX-A. Conclusion Fdur and Fave could sensitively assess the remote effect of the local injection of BTX-A, the remote effect might be correlated with the distance between injected muscle and tested muscle, rather than the dosage of BTX-A.