A型肉毒毒素联合重复经颅磁刺激治疗眼睑痉挛合并焦虑抑郁的临床观察

目的 观察肉毒毒素联合重复经颅磁刺激治疗对眼睑痉挛合并焦虑抑郁的治疗效果。方法 纳入良性特发性眼睑痉挛(Benign essential blepharospasm,BEB)伴焦虑/抑郁患者63例,其中单纯A型肉毒毒素(Botulinum toxin A,BTX-A)注射治疗组28例,肉毒毒素联合重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)治疗组35例,随访6个月; 在治疗前后通过Cohen Albert标准分级、眨眼次数及患者满意程度评价总体疗效; 通过SDS和SAS量表评分评估患者抑郁焦虑情况; 比较2组疗效、起效时间、持续时间及焦虑抑郁量表评分。结果 单纯BTX-A治疗和联合rTMS治疗均能明显改善患者症状,有效率分别为92.86%、94.29%(P>0.05); 单纯BTX-A治疗组的疗效持续时间为(13.04±3.48)周,联合rTMS治疗组的疗效持续时间为(16.89±3.39)周(P<0.01); 单纯BTX-A治疗组及联合rTMS治疗组治疗前SDS评分分别为(62.19±5.77)、(63.50±7.97)分(P>0.05),SAS评分分别为(66.07±9.43)、(64.89±8.38)分(P>0.05); 单纯BTX-A治疗组及联合rTMS治疗组治疗2个月后SDS评分分别为(49.69±7.90)、(49.46±6.73)分(P>0.05),SAS评分分别为(53.88±7.34)、(48.79±6.62)分(P<0.05)。结论 A型肉毒毒素联合重复经颅磁刺激治疗能有效提高特发性眼睑痉挛患者的疗效,延长眼睑痉挛缓解持续的时间,明显改善抑郁焦虑,特别是对减轻患者焦虑明显优于单纯BTX-A治疗。

Efficacy evaluation of repetitive transcranial magnetic stimulation combined with botulinum toxin A for benign essential blepharospasm patients with anxiety and depression

ObjectiveTo observe the efficacy of repetitive transcranial magnetic stimulation(rTMS)on benign essential blepharospasm(BEB)with anxiety/depression.Methods 63 patients with benign essential blepharospasm(BEB)and anxiety / depression were included, of which 28 patients were only treated with botulinum toxin A(BTX-A)(alone BTX-A treatment group),while 35 patients were treated with rTMS for anxiety and depression within 1 week after receiving botulinum toxin A injection(combined with rTMS treatment group). All patients were followed up for 6 months. Overall efficacy was evaluated by Cohen Albert standard grading, number of blinks, and patient satisfaction. The depression/anxiety disorder was assessed by SDS and SAS scale. The differences in treatment efficacy, onset time, duration, and anxiety/depression scales were compared between the two groups.Results The alone BTX-A treatment and combined with rTMS treatment could significantly improve the symptoms of patients, the effective rate was 92.86%, 94.29%(P>0.05). The duration of BTX-A treatment group was(13.04±3.48)weeks, and the duration of combined with rTMS treatment group was(16.89±3.39)weeks(P<0.01). The SDS scores of alone BTX-A treatment group and combined with rTMS treatment group before treatment were(62.19±5.77)and(63.50±7.97)points(P>0.05), and SAS scores were(66.07±9.43)and(64.89±8.38)points respectively(P>0.05). The SDS scores of alone BTX-A treatment group and combined with rTMS treatment group after 2 months of treatment were(49.69±7.90)and(49.46±6.73)points(P>0.05), and SAS scores were(53.88±7.34)and(48.79±6.62)points respectively(P<0.05).Conclusion BTX-A combined with rTMS treatment could improve obviously efficacy on BEB, and prolong the duration of eyelid relief, and have more effect on anxiety disorder than alone BTX-A treatment.