In a small number of patients treated with botulinum toxin (BT) antibody (Ab) formation occurs. BT Ab can be detected by the mouse protection assay (MPA) or by the mouse diaphragm assay (MDA). Both methods, however, have major drawbacks. We tested a method for detecting BT Ab which measures the BT-induced reduction in the electromyographic amplitude of the mean maximal voluntary activation (M-EMG) of the sternocleidomastoid muscle. The M-EMG reduction was compared in 17 patients with cervical dystonia and secondary BT therapy failure to the M-EMG reduction previously measured in controls. Values more than 2 SD below the mean of controls were considered abnormal. Six patients showed BT Ab on the MPA and MDA; all of these had abnormal M-EMG reductions. Eleven patients showed no BT Ab on MPA and MDA testing; in ten of these the M-EMG reduction was normal, and in one it was pathological, but MDA testing later changed to positive under continued BT therapy. The sternocleidomastoid test is easy to perform and produces quantitative results. Since its sensitivity and specificity are at least as good as those of the MDA and the MPA, it can replace them.

译文

在少数接受肉毒杆菌毒素 (BT) 治疗的患者中,抗体 (Ab) 形成。BT Ab可以通过小鼠保护试验 (MPA) 或小鼠隔膜试验 (MDA) 检测。然而,这两种方法都有主要缺点。我们测试了一种检测BT Ab的方法,该方法测量了BT引起的胸锁乳突肌平均最大自愿激活 (m-emg) 的肌电图幅度的降低。将17例宫颈肌张力障碍和继发性BT治疗失败的患者的m-emg降低与先前在对照组中测量的m-emg降低进行了比较。低于对照组平均值超过2 SD的值被认为是异常的。六名患者在MPA和MDA上显示BT Ab; 所有这些都有异常的M-EMG降低。11例患者在MPA和MDA测试中没有显示BT Ab; 其中10例m-emg降低是正常的,其中1例是病理性的,但随后在持续的BT治疗下MDA测试变为阳性。胸锁乳突肌试验易于进行并产生定量结果。由于其敏感性和特异性至少与MDA和MPA一样好,因此可以替代它们。

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