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Journal of the Korean Academy of Rehabilitation Medicine 2002;26(2):152-160.
Electrophysiologic Responses of Neuromuscular Junction by High Dose of Botulinum Toxin A Injection: Local and Distant Effects.
Hwang, Jeonghye , Lee, Chyungki
Department of Rehabilitation Medicine, Ewha Womans University College of Medicine, Korea. chyungki@mm.ewha.ac.kr
고용량 보툴리눔 독소 A에 의한 신경근 접합부의 전기생리학적 변화
황정혜, 이청기
이화여자대학교 의과대학 재활의학교실
Abstract

Objective
The purpose of this study was to measure the local and distant effects of BTX-A of different dosage through the electrophysiologic study.


Method
Sixteen Sprague-Dawley rats were used and divided into four groups by the dosage of BTX-A (Botox®, Allergan Co.): 2, 4, 6, 8 U for each of the four rats. BTX-A was injected into tibialis anterior (TA) muscles. Slow rate (3 Hz) and fast rate (20 Hz) repetitive nerve stimulation test (RNST) was performed before and after BTX-A injection. The schedule of postinjection was as follows: 2 days after the injection, every seven days till 10 weeks postinjection, once a month for 4 months.


Results
In the fast rate RNST of the treated TA muscle, dose-dependent increments were seen on the 2nd day postin-

jection and thereafter dose-dependent decrements appeared and weakened over the course of time. In the slow rate RNST of the treated TA, dose-dependent decrements were observed through ten weeks postinjection in all groups. In the fast rate RNST of the untreated TA, incremental responses were produced in all groups in a dose-dependent manner. In the slow rate RNST of the untreated TA, there were no changes.


Conclusion
The BTX-A injection causes local paralysis in the treated muscles and presynaptic dysfunction of the neuromuscular junction in the distant untreated muscles in a dose- dependent manner. This study could not be differentiated between neuromuscular dysfunction, myopathy or neuropathy through these RNST studies. (J Korean Acad Rehab Med 2002; 26: 152-160)

Key Words: Botulinum toxin A, Repetitive nerve stimulation test, Distant effect


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