局部注射A型肉毒毒素治疗Meige综合征

目的 观察A型肉毒毒素(BTX—A)治疗Meige综合征，(眼睑痉挛-口颌肌张力障碍综合征)的疗效。方法 用A型肉毒毒素对17例Meige综合征行面部肌肉局部多点注射，分析其治疗结果。结果 17例中完全缓解者9例，明显缓解者5例，部分缓解者2例，无效1例。总有效率94％。起效时间数小时至3天，疗效持续时间3～6个月。局部副反应轻微、短暂，无全身反应及过敏反应。结论 A型肉毒毒素是治疗Meige综合征最有效的方法。     

A型肉毒毒素治疗局限性肌肉痉挛的临床研究

目的　观察A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛及Meige综合征的疗效。方法　对 40例偏侧面肌痉挛、9例眼睑痉挛、1例Meige综合征进行面部肌肉局部多点注射A型肉毒毒素 ,评价其治疗效果。结果　 40例偏侧面肌痉挛者 ,完全缓解 1 5例 (38% ) ,明显缓解2 4例 (60 % ) ,1例无效 ;9例眼睑痉挛者 ,4例完全缓解 ,4例明显缓解 ,1例无效 ;1例Meige综合征部分缓解 ,总有效率达 96 %。起效时间平均 3天 ,缓解时间平均 3 5个月。局部副反应轻微、短暂 ,无全身反应及过敏反应。结论　A型肉毒毒素局部肌肉注射是治疗局限性肌肉痉挛的一种安全、有效的治疗方法。     

A型肉毒毒素治疗面肌痉挛、眼睑痉挛疗效观察

目的观察A型肉毒毒素治疗面肌、眼睑痉挛的疗效。方法采用A型肉毒毒素局部注射治疗偏侧面肌痉挛51例、眼睑痉挛8例,并使用Cohen和Albert量表对疗效进行评估。结果31例(52.5%)症状完全缓解,22例(37.2%)明显改善,6例(10.1%)部分改善,疗效平均持续约9～33周,复发者重复注射仍有效。不良反应可出现眼睑闭合不全、面肌无力、眼睑下垂等共18例,均在4周内恢复。结论局部注射A型肉毒毒素确为一种安全有效的治疗面肌、眼睑痉挛的方法。     

A型肉毒毒素治疗痉挛性斜颈及Meige''''s综合征的临床研究

目的　探讨A型肉毒毒素局部注射治疗痉挛性斜颈、Meige s综合征及职业性痉挛的疗效。方法　对 2 3例痉挛性斜颈、10例完全型Meige s综合征及 1例职业性痉挛患者进行A型肉毒毒素局部注射 ,观察其治疗效果以及副作用。结果　 2 3例痉挛性斜颈患者 ,治疗后Tsui量表评分明显下降 ;10例完全型Meige s综合征 ,8例明显好转 ,2例部分缓解 ;1例职业性痉挛患者完全缓解。所有患者均未见过敏反应和严重副反应。结论　A型肉毒毒素局部肌肉注射是治疗痉挛性斜颈等肌张力障碍的有效手段。     

A型肉毒毒素加用抗痉挛药治疗Meige综合征的疗效观察

目的 观察A型肉毒毒素及抗痉挛药物联合治疗Meige综合征的疗效。方法 对30例Meige综合征患者应用A型肉毒毒素对痉挛肌肉多点注射，每点0．1－0.2ml(2.5-5U)，同时服用抗乙酰胆碱和苯二氮Zhuo类药物。结果 A型肉毒毒素对眼睑痉挛的治疗，4－5天症状缓解，1个星期明显缓解，2个星期疗效达最高峰。有效率100％。有效作用时间为10－24周，平均11．7周。而抗乙酰胆碱和苯二氮Zhuo类药物对口下颌肌张力障碍的治疗效果比较明显，可以有效的缓解患者的磨牙咂嘴和舌不自主伸缩等症状。结论 A型肉毒毒素和抗乙酰胆碱及苯二氮Zhuo类药物联合应用是治疗Meige综合征的一种安全、有效、简便的方法。     

A型肉毒毒素治疗面肌痉挛60例的疗效观察

目的 评估A型肉毒毒素治疗面肌痉挛的疗效,并探讨减少基其并发症的方法。方法 将60例患者随机分为A、B两组,A组对上、下睑及面肌进行多点注射A型肉毒毒素;B组仅对下睑及面肌进行多点注射。对治疗前后的病情分级及两组间的疗效、睑下垂副作用发生情况进行对比,并观察A型肉毒毒素治疗后残留的和完全缓解后部分性复发的痉挛症状应用得理多治疗的疗效。随访副作用发生情况及疗效维持时分复发性痉挛症状有效。A型肉毒毒素副作用少。结论 A型肉毒毒素治疗面肌痉挛,安全有效,简单易行,为治疗面肌痉挛的首选方法。     

A型肉毒毒素治疗眼睑及面肌痉挛的临床分析

目的观察A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛的临床疗效,探讨眼睑及面肌痉挛的病因。方法应用A型肉毒毒素对105例眼睑及偏侧面肌痉挛患者行面部肌肉局部多点注射,对治疗前后的病情分级进行对比,分析治疗效果。结果71例面肌痉挛者完全缓解35例(49.3%),明显缓解34例(47.8%),无效2例(2.8%)。34例眼睑痉挛者,22例完全缓解,12例明显缓解,总有效率达98%。起效时间数小时至7d,缓解时间3～8个月,局部不良反应轻微、短暂,无全身反应及过敏反应,其中2例引起面肌萎缩。4例MRA中3例检出有椎动脉、小脑后下动脉、小脑前下动脉变异,并造成对面神经的压迫。结论A型肉毒毒素局部肌肉多点小剂量注射,可有效控制眼睑痉挛及偏侧面肌痉挛,部分眼睑及面肌痉挛的病因为血管压迫。     

A型肉毒毒素治疗眼睑及面肌痉挛的临床分析

目的观察A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛的临床疗效，探讨眼睑及面肌痉挛的病因。方法应用A型肉毒毒素对105例眼睑及偏侧面肌痉挛患者行面部肌肉局部多点注射，对治疗前后的病情分级进行对比，分析治疗效果。结果71例面肌痉挛者完全缓解35例（49．3％），明显缓解34例（47．8％），无效2例（2．8％）。34例眼睑痉挛者，22例完全缓解，12例明显缓解，总有效率达98％。起效时间数小时至7d，缓解时间3～8个月，局部不良反应轻微、短暂，无全身反应及过敏反应，其中2例引起面肌萎缩。4例MRA中3例检出有椎动脉、小脑后下动脉、小脑前下动脉变异，并造成对面神经的压迫。结论A型肉毒毒素局部肌肉多点小剂量注射，可有效控制眼睑痉挛及偏侧面肌痉挛，部分眼睑及面肌痉挛的病因为血管压迫。     

中风与神经疾病杂志2003年第20卷文题索引

(按汉语拼音字母顺序排列 )A阿尔茨海默病阿尔茨海默病的胆碱能损害机制 ( 1 ) :89阿尔茨海默病和血管性痴呆的精神行为症状 ( 2 ) :1 1 3中国家族性 A lzheimer病的载脂蛋白 E基因型分析 ( 5) :4 0 3爱滋病爱滋病中枢神经系统机会性感染的特征 ( 4) :373A型肉毒毒素A型肉毒毒素治疗面肌、眼睑痉挛 1 56例临床观察 ( 1 ) :6 8局部注射 A型肉毒毒素治疗 Meige综合征 ( 3) :2 59鞍上池血肿鞍上池血肿 31例临床分析 ( 2 ) :1 49B卟啉病伴有神经精神症状的卟啉病 ( 732例资料分析 ) ( 3) :2 4 2C痴呆血管性痴呆患者 SPECT脑血流灌注显像特…     

A型肉毒毒素治疗111例面肌痉挛的疗效观察

目的探讨A型肉毒毒素治疗面肌痉挛的疗效及不良反应。方法对121例面肌痉挛患者进行面肌多点注射A型肉毒杆菌毒素,对治疗前后的病情分级进行比较,并随访3～12月。结果A型肉毒杆菌毒素治疗的总有效率为100％,绝大多数局部不良反应轻微、短暂,但极少数可能出现不可逆的局部面肌萎缩,偶见全身不良反应。3个月复发率为80％,药效作用时间平均为5月,重复注射仍然有效。结论局部注射A型肉毒杆菌毒素是治疗面肌痉挛的一种有效手段,准确定位、注射合适剂量是本治疗方法的关键所在,且注射剂量应遵循个体化原则。     

A型肉毒毒素对眼睑痉挛的治疗

目的　观察Ａ型肉毒毒素对原发性眼睑痉挛和Ｍｅｉｇｅ 综合征的治疗效果。方法　Ａ型肉毒毒素, 在肌电图仪的引导下对眼轮匝肌进行多点局部注射（每点２．５～５Ｕ） 治疗原发性眼睑痉挛２４ 例及Ｍｅｉｇｅ综合征１０例。结果　４～５ 天出现症状缓解, １ 个星期症状明显缓解, ２ 个星期症状缓解最明显。有效率１００％ , 原发性眼睑痉挛有效作用时间为１０～２４ 周, 平均为１５．８ 周。Ｍｅｉｇｅ 综合征平均有效作用时间为１１．７ 周。结论　Ａ型肉毒毒素局部注射是治疗眼睑痉挛和Ｍｅｉｇｅ 综合征的一种安全、有效、简便方法。     

Blefarospasmo y espasmo hemifacial: tratamiento a largo plazo con toxina botulínica

Introduction

Our purpose is to describe the demographic, clinical and therapeutic characteristics of patients with blepharospasm (BS) and hemifacial spasm (HFS) in treatment with botulinum toxin type A (BtA).

Patients and methods

Retrospective analysis of patients diagnosed with BS or HFS and treated with BtA in the Neurology Department at Complejo Asistencial de Segovia between March 1991 and December 2009.

Results

Different variables were collected from 34 patients with BS and 55 with HFS, of whom 44.1% and 32.7% respectively had been undergoing treatment with BtA for more than 10 years. Elapsed time from symptom onset to the first visit was 24 months in the BS group and 59.7 months in the HFS group. Diagnosis was given on the first visit for 76.5% of the BS patients and 90.7% of the HFS patients. Patients were referred by their primary care centres in 34.6% of the cases with BS and in 77.6% of the cases with HFS. The most commonly used BtA preparation was BOTOX^® in both groups, and there were no cases of primary or secondary resistance. The median dose of BtA was raised gradually in both groups, and the increase was statistically significant during the early years of treatment. The most common side effect was ptosis (47.1% in BS, 32.5% in HFS).

Conclusions

BS and HFS are the most common facial movement disorders. The demographic and clinical characteristics and therapeutic findings from this study show that treatment with BtA is both effective and safe over the long term.     

偏侧面肌痉挛和良性特发性眼睑痉挛的临床与治疗特点

目的 探讨偏侧面肌痉挛(HFS)和良性特发性眼睑痉挛(BEB)的临床特点、治疗现状以及对A型肉毒毒素(BTX-A)治疗的反应.方法 对2013年4~10月在武汉大学人民医院神经内科门诊就诊的HFS患者和BEB患者进行调查,其中HFS患者110例,BEB患者90例.所有的患者均接受了BTX-A局部注射治疗.注射后2周左右复诊,在每周二下午的专病门诊随访,并记录BTX-A的疗效持续时间.结果(1)入组200例患者中,BTX-A治疗起效时间0~30 d(中位数4 d),疗效持续时间2~128周(中位数16周),总有效率96.9%.HFS患者症状明显好转(完全和明显缓解)占99.3%,BEB患者占90.2%.总的来说,BEB患者的疗效持续时间[(13.6±5.5)周]与HFS患者[(20.3±10.2)周]相比较短.HFS患者所用BTX-A剂量[(53.2±15.8)U]较BEB患者[(74.8±20.2)U]少.(2)BTX-A注射(70.9%)、针灸(68.2%)和口服药(65.5%)是HFS患者曾经选择的最多的非手术治疗方法.针灸和口服药大部分效果不好而自行停用.BTX-A注射(88.9%)、口服药(86.7%)和眼轮匝肌切割术(31.1%)是BEB患者曾经选择的最多的治疗方法,但患者均反映手术无效.结论 HFS和BEB是运动障碍门诊最常见的两种疾病,BTX-A治疗HFS和BEB安全、有效,对HFS效果更好,BEB患者需要更频繁的注射,其面部肌张力障碍的治疗更具挑战性.     

Botulinum toxin treatment of hemifacial spasm and blepharospasm: objective response evaluation.

Twenty seven patients with hemifacial spasm (HFS) and sixteen patients with blepharospasm (BS) having mean Jankovic disability rating scale score of 2.56+0.58 SD and 2.81+0.54 SD, respectively, were treated with botulinum toxin A (BTX-A) injections. The total number of injection sessions were ninety one with relief response in 98.91%. The mean improvement in function scale score was 3.78+0.64 SD and 3.29+1.07 SD respectively, in HFS and BS groups. The clinical benefit induced by botulinum toxin lasted for a mean of 4.46+3.11 SD (range 2 to 13) months in HFS group and 2.66+1.37 SD (range 1 to 6) months, in BS groups. Transient ptosis was seen in 4.39% of total ninety one injection sessions. These findings show that local botulinum toxin treatment provides effective, safe and long lasting relief of spasms.     

Young onset Hemifacial Spasm in patients with Chiari type I malformation

Hemifacial spasm (HFS) resulting from Chiari type I malformation (CIM) is rare. We retrospectively evaluated five patients with CIM and HFS among a series of 103 subjects. The frequency of HFS associated to CIM was of 4.85%. The clinical profile did not differ from the classical primary cases except for young-onset development of facial spasms in patients with CIM. Three patients were treated with BTX-A injections with favorable outcome. Although rare HFS may be associated with CIM especially in young subjects with peculiar phenotypic characteristics (short neck). Moreover, BTX may be an alternative to posterior fossa decompression in selected cases.     

异常肌反应在面神经显微血管减压术中的应用

目的 探讨异常肌反应(abnormal muscle response,AMR)监测在面神经显微血管减压术(microvascular decolnpression,MVD)中鉴别责任血管、评估减压效果以及判断预后方面的作用.方法 241例典型面肌痉挛患者接受了面神经MVD术中AMR的实时监测,并在术后1周进行疗效评估,分析术中AMR变化与手术预后之问的关系.结果 所有241例患者均在术中记录到典型AMR波形,术后第1周217例(90.0%)患者症状完全缓解.AMR消失组175例,其中165例(94.3%)症状缓解;AMR未消失组66例,52例(78 8%)症状缓解.统计学分析显示AMR消失组的疗效明显好于AMR未消失组(P<0.05).结论 术中AMR监测可辅助判断责任血管,评估减压效果,对提高手术疗效具有较高的应用价值.

Abstract：

Objective Abnormal muscle response( AMR) to the electrical stimulation of a branch of facial nerve is a specific electrophysiological feature of primary hemifacial spasm ( HFS) .Although the correlation between intraoperative AMR findings and postoperative results in patients with HFS has been investigated before, the AMR monitoring has not been employed widely during the microvascular decompression (MVD) surgery.The aim of this study was to evaluate the value of AMR monitoring during MVD, and the correlation between the AMR changes and the clinical outcome.Method This study included 241 cases of MVD.Intraoperative AMR monitoring was performed for each subject.The patients were divided into two groups based on whether the AMR wave disappeared or not following decompression of the facial nerve.Results The AMR disappeared after MVD in 175 patients.Among these 175 patients, 165(94.3% ) patients were relieved from HFS 1 week after HFS.Out of the 66 patients in whom the AMR persisted after MVD, 52(78.8%) patients were relieved.The correlation between intraoperative AMR abolition and HFS relief was statistically significant ( P < 0.05 ) .Conclusions Intraoperative AMR monitoring is an effective assistant for a successful MVD for the patient with HFS.It may be helpful in predicting outcomes in short term and identifying offending vessels,so it should be monitored routinely during MVD.     

Bilateral hemifacial spasm: a series of 10 patients with literature review

Bilateral hemifacial spasm (HFS) is a rare movement disorder posing diagnostic doubt with other facial dyskinesias. In this report, we describe clinical, radiological and therapeutic features of 10 patients with bilateral HFS. The prevalence of bilateral HFS in our sample was of 2.6%. Clinical characteristics of our patients did not differ from the classic features of unilateral cases. The mean latency for contralateral facial nerve involvement was of 33.3 months. In only one case a vascular abnormality was seen. We conclude that bilateral HFS is rare and that clinical differentiation with other facial dyskinesias should be promptly made to introduce appropriate therapy.