重复局部注射A型肉毒毒素治疗局限性肌张力障碍长期疗效观察

目的研究重复局部注射A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛、Meige's综合征、痉挛性斜颈的长期疗效及维持时间,有无剂量增加趋势。方法用A型肉毒毒素对241例患者重复小剂量局部多点注射,随访治疗10年,将6轮次治疗疗效以及剂量、疗效维持时间、不良反应进行比较分析。结果各轮次总有效率分别为98.7%、98.9%、99.3%、100%、100%、100%。作用持续(20±3)周,平均剂量40U,各轮间疗效、平均剂量、作用持续时间均无显著差异(P>0.05)。结论重复局部注射治疗局限性肌张力障碍长期疗效稳定,作用持续时间相似,维持疗效无需增加剂量,局部不良反应轻微短暂。     

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。     

Eyelid movements before and after botulinum therapy in patients with lid spasm

Quantitative analysis of lid motility is presented for 4 individuals with hemifacial spasm and 1 with Meige's syndrome. The data were obtained, by means of a magnetic search coil technique, prior to and 1 week after injection of botulinum toxin into the orbicularis oculi muscle. Before treatment, the peak velocity of blink-related lid lowering and lid raising was slower than normal, yet lid saccades were normal. After botulinum treatment, significant decreases occurred in (1) the amplitude of blinks and lid saccades, and (2) the peak velocity of the blink down-phase. Botulinum treatment significantly alters blink lid-lowering kinematics, while saccadic lid-lowering kinematics are normal, providing further evidence that the orbicularis oculi muscle does not play a primary role in downward lid saccades.     

Responsiveness of idiopathic spasmodic torticollis to botulinum A toxin injection. A critical evaluation of five cases

Five patients with Idiopathic Spasmodic Torticollis (IST), one associated with Meige's disease, have been cured by local injection of purified botulinum "A" toxin (BT). The therapeutic effect on the different subjects treated proved to be variable, and often the effect varied as well on the same subject from session to session. The response was only partly related to the dose of BT injected, and appeared inversely proportional to the number of hyperactive muscles. Transient dysphagia was the major untoward effect of the treatment. The inconstant response to BT makes us consider BT worth to be used selectively in the so-called "agonistic" cases of IST.     

Laryngeal dystonia--personal experience with botulin toxin treatment

Laryngeal dystonia is a focal dystonia occurring more often than it is diagnosed. Adductor type dystonia was described in 5 patients. In 3 cases it manifested itself as blepharospasm, which later developed into Meige's syndrome. The patients were treated with botulinum toxin A injections under EMG control administering 10 i.m. into laryngeal muscles on both sides with good and very good results. There were no serious side effects.     

Meige's disease misdiagnosed as anxiety disorder.

A woman in her late 40s with a 5 year history of anxiety was treated with relaxation training and cognitive restructuring. Her anxiety was manifested by facial twitching, hand fidgeting, vocal tremor, loss of self-esteem, and depression. Therapy seemed to reduce motor symptoms and improve her self-esteem, confidence, and mood. Six months after the start of therapy the client was found to have Meige's Disease. Following treatment with botulinum toxin, motor symptoms disappeared. This case highlights the need for psychotherapists to be more aware of neurological and medical problems which may mimic psychological ones.     

Botulinum toxin type A in primary palmar hyperhidrosis: randomized, single-blind, two-dose study.

BACKGROUND: Primary palmar hyperhidrosis is characterized by excessive sweating due to increased sympathetic cholinergic sudomotor nerve traffic to the palmar surface of the hands. Clinical studies suggest that intradermal injections of botulinum toxin are effective in the treatment of palmar hyperhidrosis. OBJECTIVES: To establish the effectiveness of intradermal botulinum toxin in reducing hyperhidrosis, to determine the most effective dose of toxin, and to examine its effect on muscle strength. METHODS: In a prospective, single blind, randomized trial, 24 patients with severe palmar hyperhidrosis received either a low (50 U) or a high dose (100 U) of botulinum toxin type A (Botox, Allergan) injected intradermally in 20 sites in each palm. RESULTS: Following injection with either dose, iodine starch test revealed a significant decrease in sweating within the first month. Six months after injection, the anhidrotic effect was still evident in two thirds of the patients in both groups. Handgrip strength was not affected with either dose but finger pinch strength, 2 weeks after the injection, decreased 23 +/- 27% with 50 U (p < 0.05) and 40 +/- 21% with 100 U (p < 0.001). Pinch strength improved gradually but 6 months after treatment it was still 7-11% lower than at baseline. CONCLUSIONS: Both 50 and 100 U of botulinum toxin type A, injected intradermally in each hand, decreased sweating in patients with primary hyperhidrosis for at least 2 months in all the patients, and 6 months in most patients. Weakness in the intrinsic muscles of the hand was observed.     

Crocodile tears syndrome: botulinum toxin treatment under EMG guidance

Crocodile tears syndrome is one of the rare complications of facial paralysis. There have been several reports of cases in which botulinum toxin was found to be useful in the treatment of crocodile tears syndrome. The adverse effects, due to the paralytic action of botulinum toxin, have been reported to involve the palpebral muscle, lateral rectus and superior rectus. Therefore, we considered that it might be more appropriate to carry out the injection procedure under electromyographic guidance in order to inject botulinum toxin selectively into the lacrimal gland and protect the above-mentioned muscles. In conclusion, we recommend EMG guidance in the treatment of crocodile tears syndrome with botulinum toxin.     

Meige's syndrome: clinical, pharmacological and radiological observations

The clinical pharmacological, and neuroradiological observations in six patients with spontaneous blepharospasm-oromandibular dystonia (Meige's) syndrome are recorded. This group consisted of five males and one female, mean age at onset being 50.3 years. The duration of symptoms ranged from three months to 12 years, three patients having had symptoms for over four years. The dyskinesia was arrhythmic and asymmetrical in the orbicularis oculi and masseter muscles electrophysiologically. Pharmacological studies evinced no consistent response to parenteral physostigmine, no response to oral levodopa and no significant improvement in the dyskinesia following oral haloperidol. Lumbar air encephalogram was done in five patients, and showed frontal cortical atrophy without ventricular dilation in three. It is concluded that Meige's syndrome is a distinct nosological entity, and that physostigmine test is unlikely to be helpful in the differential diagnosis from neuroleptic-induced tardive dyskinesia. Neurotransmitter imbalance in the basal ganglia in this disorder remains to be established, and at present there is no satisfactory drug treatment for this progressively disabling movement disorder.     

Acrylamide inhibits nerve sprouting induced by botulinum toxin type A

Botulinum toxin type A is a potent muscle relaxant that blocks the transmission and release of acetylcholine at the neuromuscular junction. Intramuscular injection of botulinum toxin type A has served as an effective and safe therapy for strabismus and focal dystonia. However, muscular weakness is temporary and after 3–4 months, muscle strength usually recovers because functional recovery is mediated by nerve sprouting and reconstruction of the neuromuscular junction. Acrylamide may produce neurotoxic substances that cause retrograde necrotizing neuropathy and inhibit nerve sprouting caused by botulinum toxin type A. This study investigated whether acrylamide inhibits nerve sprouting after intramuscular injection of botulinum toxin type A. A tibial nerve sprouting model was established through local injection of botulinum toxin type A into the right gastrocnemius muscle of Sprague-Dawley rats. Following intramuscular injection, rats were given intraperitoneal injection of 3% acrylamide every 3 days for 21 days. Nerve sprouting appeared 2 weeks after intramuscular injection of botulinum toxin type A and single-fiber electromyography revealed abnormal conduction at the neuromuscular junction 1 week after intramuscular injection of botulinum toxin type A. Following intraperitoneal injection of acrylamide, the peak muscle fiber density decreased. Electromyography jitter value were restored to normal levels 6 weeks after injection. This indicates that the maximal decrease in fiber density and the time at which functional conduction of neuromuscular junction was restored were delayed. Additionally, the increase in tibial nerve fibers was reduced. Acrylamide inhibits nerve sprouting caused by botulinum toxin type A and may be used to prolong the clinical dosage of botulinum toxin type A.