Zusammenfassung
Einleitung: Gemäß histologischer Untersuchungen stellen axonales Aussprossen und die Restitution der neuromuskulären Synapse zwei konkurrierende Mechanismen für die Erholung der neuromuskulären Übertragung nach Injektion von Botulinumtoxin Typ A (BoNT/A) dar. Methodik: 12 gesunden Probanden, 23 - 32 Jahre alt, wurde zufällig 5, 15 oder 45 MU Dysport® in den M. extensor digitorum brevis injiziert (24 Füße, 8 Füße je Dosierung). Automatische EMG-Analyse und Neurographie erfolgten vor und 7, 19, 46, 92 und 180 Tage nach der Injektion. Ergebnisse: Die Amplitude des Muskelsummenaktionspotenzials (MSAP) und die Amplitude, Dauer, Zahl der Phasen und Turns der Potenziale motorischer Einheiten (PME) nahmen durch die Injektionen ab. Spontanaktivität war nur gering bis mäßig ausgeprägt. Die EMG-Veränderungen waren am ausgeprägtesten am Tag 19 und nahmen im Verlauf wieder ab. Die Amplitude des MSAP, Amplitude und Potenzialdauer der PME und die Amplitude bei Maximalinnervation waren bei allen drei Dosierungen nach 6 Monaten noch reduziert. Die Dosisabhängigkeit der Veränderungen war nur partiell signifikant. Diskussion: Die EMG-Veränderungen ähneln dem Bild einer Myopathie ohne Anzeichen von Aussprossungen, was für eine Dysfunktion einzelner Muskelfasern innerhalb der motorischen Einheit verursacht durch Botulinumtoxin Typ A spricht. Sprouting scheint bei der funktionellen Erholung nach Injektion von Botulinumtoxin Typ A nur eine untergeordnete Rolle zu spielen.
Abstract
Background: According to histological studies, axonal sprouting and the return of vesicle turnover are two competitive mechanisms accounting for the recovery of neuromuscular transmission after injection of botulinum toxin type A (BoNT/A). Methods: 12 healthy individuals, 23 to 32 years old, received random injections of 5, 15 or 45 MU Dysport® in the M. extensor digitorum brevis (24 feet, 8 feet each dose). Automatic quantitative EMG and neurography were done at baseline and 7, 19, 46, 92, and 180 days after the injections. Results: The amplitude of compound muscle action potentials (CMAPs) and the amplitude, duration, number of phases and of turns of the motor unit action potentials (MUAPs) were reduced by the injections. Spontaneous activity was only mild to moderate. The EMG changes were most pronounced on day 19 and subsequently return to baseline. The CMAP amplitude, the amplitude and duration of MAP, and the amplitude at maximum voluntary contraction were still reduced after 6 month for all three doses. The dose dependence of the changes were only partly significant. Conclusion: The EMG changes resemble a myopathy-like pattern without evidence of collateral sprouting suggesting that BoNT/A causes a dysfunction of single fibres within the motor units. It appears that collateral sprouting plays a minor role in the functional recovery after intramuscular injections of BoNT/A.
Key words
Botulinum toxin type A - axonal sprouting - myopathy - electromyography (EMG)
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Dr. med. M. de Groot
Klinik für Psychiatrie, Verhaltensmedizin und Psychosomatik · Klinikum Chemnitz gGmbH
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Email: m.degroot@skc.de
