【 文献重点摘要 】
 

Despite the extensive use of botulinum toxin type A (BoNT-A) in treatments for glabellar frown lines, the dose-response effect in the glabellar muscles remains unknown. The aim of this randomized, double-blind, placebo-controlled prospective study was to characterize the neurophysiological parameters that correlate with the effect of BoNT-A in the glabellar muscles and its diffusion to surrounding ocular muscles. Sixteen healthy women were recruited and randomized to 3 different dose-groups of onabotulinumtoxin A (Vistabel®) or placebo and followed 24 weeks by neuro physiological examinations. Efficacy of treatment on corrugator supercilii muscles was measured by compound motor action potential (CMAP) and electromyography (EMG). Photographs were used to score glabellar frown lines. Diffusion of the drug to surrounding muscles was assessed by CMAP of the nasalis muscle, EMG and concentric needle electrode jitter analysis (CNE) of the orbicularis oculi muscle. CMAP reduction correlated well with intramuscular BoNT-A dose. Muscle paralysis, measured by EMG, began from 2 weeks and was not entirely reversed at 24 weeks in individuals who received high dose of onabotulinumtoxin. Limited diffusion of orbicularis oculi was detected with CNE. In conclusion, we developed a novel neurophysiological strategy for effect evaluation of BoNT-A in glabellar muscles. CMAP and EMG correlated with given BoNT-A dose and are more defined effect measures than clinical glabellar photo scales.

Keywords: botulinum toxin; glabellar muscles; compound motor action potential; electromyography.

尽管A型肉毒毒素(BoNT-A)已广泛用于治疗眉间皱纹，但其在眉间肌肉中的剂量反应效应尚不清楚。这项随机、双盲、安慰剂对照的前瞻性研究的目的是描述与BoNT-A在眉间肌肉中的作用及其扩散到周围眼肌相关的神经生理学参数。16名健康女性被随机分成3个不同剂量组，分别服用onabotulinumtoxin A(Vistabel®)或安慰剂，24周后进行神经生理检查。采用复合运动动作电位(CMAP)和肌电图(EMG)检测治疗前后皱眉肌的疗效。照片被用来划出眉间皱纹。通过鼻肌CMAP、眼轮匝肌同心针电极抖动分析(CNE)和肌电图(EMG)评价药物向周围肌肉的扩散。CMAP降低与肌注BoNT-A剂量有很好的相关性。肌电图测量的肌肉麻痹从2周开始，在24周时，接受高剂量onabotulinumtoxin的个体并没有完全恢复。CNE检测眼轮匝肌局限性弥散。综上所述，我们开发了一种新的神经生理学策略来评估BoNT-A在眉间肌肉中的效果。CMAP和EMG与给定的BoNT-A剂量相关，是比临床眉间照片量表更明确的效果指标。

关键词：肉毒毒素；眉间肌；复合运动动作电位；肌电图。