背景與目的：排尿週期包括了填充期與排尿期，且由自主神經系統,陰部神經以及橋腦排尿中樞來協同控制。脊髓的疾病將會影響這複雜的神經協同支配系統，例如脊柱損傷或脊柱膨出。這些情況將會導致膀胱逼尿肌與外括約肌協同不良或是骨盆底肌肉高張的現象。先前的研究顯示尿道外括約肌肉毒桿菌素注射對這情況是有療效的。本研究提出對肌電圖訊號的分析方法來評估患者接受肉毒桿菌素注射前後的骨盆底肌肉的活動變化。
材料與方法：本研究包括兩位患有脊柱膨出症的青少年。他們在接受肉毒桿菌素注射前後均接受完整的尿流速，膀胱壓力圖與骨盆底肌肉肌電圖的檢查。肌電圖訊號將依照排尿週期分成八段並加以分析。包括以傅立葉轉換後求得正中頻率，能量頻譜密度的正中頻率與平均功率，以及振幅的均方根。每次回診也將填寫症狀評估問卷。
結果與結論：正中頻率與正中能量頻率均往低頻飄移。平均功率與振幅均方根會減低而最大尿流速有明顯的改善。外尿道括約肌肉毒桿菌素的注射不只會改善尿流速，減少餘尿量，根據肌電圖的變化，更發現可以改變排尿的模式。本研究所使用的肌電圖分析方式不只可以用來評估骨盆底肌肉的活動，也可以用來預測接受第二次肉毒桿菌素注射的時機。

Background and Purpose: The micturition cycle which includes filling phase and voiding phase is controlled by autonomic nerve systems, pudendal nerve and pontine micturition center. Spinal diseases such as spinal cord injury or meningomyelocele will interrupt the synchronized control of the complex nervous systems. These conditions may lead to detrusor sphincter dyssynergia or pelvic floor hypertonicity. Previous studies show that the Botulinum toxin injection in the external urethral sphincter is effective. We introduce the analysis of the electromyography (EMG) to interpret the changes of pelvic floor muscle activities before and after the botulinum toxin injection.
Material and Methods: Two teenagers with meningomyelocele were included. They received the uroflow study, cystometry and electromyography of pelvic floor before and after Botulinum toxin injection. The EMG signals were segmented into 8 stages and were analyzed. The median frequency of signals after Fourier’s transformation, the median power frequency and the mean power of the power spectral density, and the root mean square of the EMG signals were calculated. Symptom questionnaires were taken at each visit.
Results and Conclusions: The median frequency and median power frequency shift to lower aspect. The average power and amplitude decreased and the maximum flow rate improved significantly. The injection of Botulinum toxin not only improves the urinary flow rate, the residual urine amount, but also alters the voiding pattern according to the EMG studies. The EMG analysis introduced by this study is useful not only in interpreting the pelvic floor muscle activities but also in predicting a further shot of Botulinum toxin injection.

1. Walter JS, Wheeler JS, Jr. and Dunn RB: Dynamic bulbocavernosus reflex: dyssynergia evaluation following SCI. J Am Paraplegia Soc. 17: 140-5, 1994.
2. Kinder MV, Bastiaanssen EH, Janknegt RA and Marani E: The neuronal control of the lower urinary tract: A model of architecture and control mechanisms. Arch Physiol Biochem. 107: 203-22, 1999.
3. Cotran RS KV, Robbins SL: Robbins Pathologic Basis of Disease. Philadelphia, W.B. Saunders, 1994, pp 1301.
4. Nath M, Wheeler JS, Jr. and Walter JS: Urologic aspects of traumatic central cord syndrome. J Am Paraplegia Soc. 16: 160-4, 1993.
5. Ukkonen M, Elovaara I, Dastidar P and Tammela TL: Urodynamic findings in primary progressive multiple sclerosis are associated with increased volumes of plaques and atrophy in the central nervous system. Acta Neurol Scand. 109: 100-5, 2004.
6. Sahai A, Khan M, Fowler CJ and Dasgupta P: Botulinum toxin for the treatment of lower urinary tract symptoms: a review. Neurourol Urodyn. 24: 2-12, 2005.
7. Dykstra DD, Sidi AA, Scott AB, Pagel JM and Goldish GD: Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol. 139: 919-22, 1988.
8. Dykstra DD and Sidi AA: Treatment of detrusor-sphincter dyssynergia with botulinum A toxin: a double-blind study. Arch Phys Med Rehabil. 71: 24-6, 1990.
9. Schurch B, Hauri D, Rodic B, Curt A, Meyer M and Rossier AB: Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients. J Urol. 155: 1023-9, 1996.
10. Phelan MW, Franks M, Somogyi GT, Yokoyama T, Fraser MO, Lavelle JP, Yoshimura N and Chancellor MB: Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol. 165: 1107-10, 2001.
11. de Seze M, Petit H, Gallien P, de Seze MP, Joseph PA, Mazaux JM and Barat M: Botulinum a toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur Urol. 42: 56-62, 2002.
12. Kuo HC: Botulinum A toxin urethral injection for the treatment of lower urinary tract dysfunction. J Urol. 170: 1908-12, 2003.
13. Leippold T, Reitz A and Schurch B: Botulinum toxin as a new therapy option for voiding disorders: current state of the art. Eur Urol. 44: 165-74, 2003.
14. Cruz F and Silva C: Botulinum toxin in the management of lower urinary tract dysfunction: contemporary update. Curr Opin Urol. 14: 329-34, 2004.
15. Kuo HC: Urodynamic evidence of effectiveness of botulinum A toxin injection in treatment of detrusor overactivity refractory to anticholinergic agents. Urology. 63: 868-72, 2004.
16. Smith CP and Chancellor MB: Emerging role of botulinum toxin in the management of voiding dysfunction. J Urol. 171: 2128-37, 2004.
17. Kuo HC: Effectiveness of urethral injection of botulinum A toxin in the treatment of voiding dysfunction after radical hysterectomy. Urol Int. 75: 247-51, 2005.
18. Finsterer J: EMG-interference pattern analysis. J Electromyogr Kinesiol. 11: 231-46, 2001.
19. Fuglsang-Frederiksen A: The utility of interference pattern analysis. Muscle Nerve. 23: 18-36, 2000.
20. Toffola ED, Sparpaglione D, Pistorio A and Buonocore M: Myoelectric manifestations of muscle changes in stroke patients. Arch Phys Med Rehabil. 82: 661-5, 2001.
21. Jost WH and Naumann M: Botulinum toxin in neuro-urological disorders. Mov Disord. 19 Suppl 8: S142-5, 2004.
22. Scott AB: Botulinum toxin injection of eye muscles to correct strabismus. Trans Am Ophthalmol Soc. 79: 734-70, 1981.
23. Scott AB: Development of botulinum toxin therapy. Dermatol Clin. 22: 131-3, v, 2004.
24. Dressler D and Adib Saberi F: Botulinum toxin: mechanisms of action. Eur Neurol. 53: 3-9, 2005.
25. Pistolesi D, Selli C, Rossi B and Stampacchia G: Botulinum toxin type B for type A resistant bladder spasticity. J Urol. 171: 802-3, 2004.
26. Reitz A and Schurch B: Botulinum toxin type B injection for management of type A resistant neurogenic detrusor overactivity. J Urol. 171: 804; discussion 804-5, 2004.