ELECTROMYOGRAPHIC FEATURES OF LEVATOR PALPEBRAE SUPERIORIS AND ORBICULARIS OCULI MUSCLES IN BLEPHAROSPASM
ELECTROMYOGRAPHIC FEATURES OF LEVATOR PALPEBRAE SUPERIORIS AND ORBICULARIS OCULI MUSCLES IN BLEPHAROSPASM
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DOI：
10.1093/brain/117.1.27
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发表时间：
1994-02-01
期刊：
影响因子：
14.5
通讯作者：
SPEELMAN, JD
中科院分区：
文献类型：
--
作者：
ARAMIDEH, M;DEVISSER, BWO;SPEELMAN, JD
对28例A型肉毒毒素治疗眼睑痉挛的患者进行了上睑提肌（LP）和眼轮匝肌（OO）同步肌电图（EMG）记录。在这项研究的时候，19名患者正在接受肉毒杆菌治疗，4名患者在EMG记录后不久接受了治疗，5名患者尚未接受治疗。根据肌电图的模式，我们能够分类五个主要的异常组。第1组（眼睑痉挛）：包括：局限于OO的张力障碍性放电，正常的LP强直活动，LP和OO之间完整的相互抑制，以及在LP强直活动恢复之前的高振幅密集动作电位爆发，即由OO短暂收缩引起的LP的“抑制后增强”。第2组（LP和OO的肌张力障碍活动联合）：7例患者属于该组。肌电图记录显示交替震颤放电LP和OO肌肉，和短的时间间隔的共同收缩，由于中度干扰的相互抑制。第3组（眼睑痉挛，LP运动不持久的组合）：在3名患者中观察到的EMG模式的特征是LP活动逐渐停止，随后是OO的短暂收缩，这有助于LP活动的恢复，导致眼睛睁开。因此，肌电图记录揭示了抑制后增强作为这种类型眼睑运动障碍的补偿机制的重要而有益的作用。肌电图模式的特点也是短或长时间的肌张力障碍放电限于OO肌肉。第4组（眼睑痉挛、不自主LP抑制的组合）：该组由4名患者组成。除了OO的肌张力障碍活动的发作，EMG还显示了LP的不自主抑制的一些时期，而没有OO的任何伴随活动。两名患者也表现出失败的OO肌肉活动的抑制，自愿收缩这肌肉。通常不会观察到抑制后增强第5组（不自主LP抑制）：由四名具有LP活动不自主抑制EMG模式的患者组成，OO时没有任何张力障碍放电。在该组中未观察到抑制后增强。第一组对肉毒杆菌毒素治疗的反应良好，第五组逐渐恶化。肉毒杆菌在OO的多个部位，特别是其跗前部分的应用，在第二组和第四组中产生了更好的治疗反应。我们的结论是，同步肌电图记录LP和OO是一个不可或缺的调查方法，以建立不同形式的眼睑运动障碍的眼睑痉挛的临床症状的患者的起源，并分析原因不满意的反应与肉毒杆菌治疗。
Electromyographic (EMG) recording war; performed synchronously from the levator palpebrae superioris (LP) and the orbicularis oculi (OO) muscles in 28 patients referred to us for treatment of blepharospasm with botulinum A toxin. At the time of this study, 19 patients were under the treatment with botulinum, four starred treatment shortly after the EMG recording and five patients had not yet been treated. Based on the EMG patterns, we were able to classify five majorgroups of abnormalities. Group 1 (blepharospasm): consisted of to patients with dystonic discharges limited to OO, normal LP tonic activity, intact reciprocal inhibition between LP and OO and dense bursts of action potentials with high amplitude preceding the return of LP tonic activity, i.e. 'postinhibition potentiation ' of LP, brought about by a brief contraction of OO. Group 2 (combined dystonic activities of LP and OO): seven patients belonged to this group. The EMG recording revealed alternating tremulous discharges in both LP and OO muscles, and short intervals of co-contractions due to moderately disturbed reciprocal inhibition. Group 3 (combination of blepharospasm, LP motor impersistence): the EMG patterns, observed in three patients, were characterized by a gradual cessation of LP activity, followed by a brief contraction of OO, which facilitated the return of LP activity, resulting in opening of the eyes. The EMG recordings, thus, revealed the crucial, beneficial role of postinhibition potentiation as a compensatory mechanism in this type of eyelid movement disorder. The EMG patterns were also characterized by short or;prolonged periods of dystonic discharges limited to the OO muscles. Group 4 (combination of blepharospasm, involuntary LP inhibition): this group consisted of four patients. In addition to episodes of dystonic activities of OO, the EMG also showed some periods of involuntary inhibition of LP without any concomitant activities of OO. Two patients also exhibited a failure of inhibition of OO muscle activity, following the voluntary contraction of this muscle. The postinhibition potentiation was often not observed Group 5 (involuntary LP inhibition): consisted of four patients with EMG patterns of involuntary inhibition of LP activity, without any dystonic discharges in OO. The postinhibition potentiation was not observed in this group. The response to the treatment with botulinum toxin was good in the first group and gradually worsened towards the fifth group. Application of botulinum into multiple sites of OO, especially its pretarsal portion, resulted in better response to the treatment in the second and fourth groups. We conclude that synchronous EMG recording of LP and OO is an indispensable investigation method to establish the origin of varying forms of eyelid movement disorders in patients with clinical symptoms of blepharospasm, and to analyse the cause of unsatisfactory response to the treatment with botulinum.