A型肉毒毒素治疗紧张性头痛的血流动力学研究

目的观察A型肉毒毒素治疗紧张性头痛的临床疗效和血流动力学研究。方法选取42例紧张性头痛患者,应用A型肉毒毒素进行颅周肌内注射治疗。对比紧张性头痛患者治疗前、后3个月紧张性头痛发作频率、持续时间、严重程度及观察不良反应,并对患者治疗前后进行TCD检测。结果患者进行A型肉毒毒素治疗后,紧张性头痛发作频率、发作持续时间、疼痛程度均较治疗前明显下降(P<0.05),疗效至少可维持3个月,且不良反应轻微、短暂。TCD显示A型肉毒毒素治疗后可有效调节患者的脑供血状态。结论 A型肉毒毒素颅周肌内注射治疗紧张性头痛具有一定疗效,其可能为通过改善颅脑血管的供血状态发挥作用。     

A型肉毒毒素在头痛治疗中的研究进展

肉毒毒素是肉毒杆菌产生的一种强效的神经毒素,可阻断神经肌肉接头处的乙酰胆碱释放,造成可逆性化学去神经支配效应,从而导致肌肉迟缓性麻痹.近些年来,肉毒毒素治疗头痛已成为相关研究和临床领域的热点之一.本文就肉毒毒素的作用机制和药理学,尤其是A型肉毒毒素治疗偏头痛、紧张型头痛和丛集性头痛等疾患的新近研究进展作一综述.     

A型肉毒毒素重复治疗偏头痛的临床疗效

目的 探讨A型肉毒毒素重复注射治疗偏头痛的疗效与安全性。方法 对30例偏头痛患者均进行2次A型内毒毒素注射治疗,两次均采用颅周固定位点注射,初次治疗间隔6个月以上后进行第2次治疗,2次治疗后分别于第1,2,3个月评定头痛发作天数、头痛发作次数、疼痛程度、偏头痛残疾程度及不良反应。结果 二次A型肉毒毒素注射治疗后偏头痛发作天数、发作次数、疼痛程度、残疾程度均较治疗前缓解（F分别为3．86,5．23,9．37,5．67;P〈0．05）,但两次治疗后各观察点评定指标比较差异无统计学意义（P〉0．05）。结论 A型肉毒毒素重复治疗偏头痛有效、安全,较初次治疗无差异．     

A型肉毒毒素治疗抽动障碍

目的 探讨A型肉毒毒素治疗抽动障碍患者运动性抽动症状的疗效.方法 25例抽动障碍患者(男性20例,女性5例)接受国产A型肉毒毒素注射,治疗主要针对患者最突出的运动性抽动的表现.治疗前进行耶鲁综合抽动严重程度量表(YGTSS)基线评分,治疗1、4周和1年内分别进行YGTSS和Jankovic评分,并记录疗效的潜伏期、持续时间、副作用、患者的主观感觉和感觉先兆的变化以及再次注射情况.结果 在25例患者总共29人次的治疗中,肉毒毒素疗效平均潜伏期5.0 d,平均总体疗效持续4.6个月,平均最佳疗效Jankovic评分3.4分,根据YGTSS减分率统计62.1%(18/29)明显有效,34.5%(10/29)好转,3.4%(1/29)无效.85.7%(18/21)的患者感觉先兆减轻,平均改善72.4%(20%～100%).主要副作用为注射部位短暂而轻微的无力和皮疹.症状复发者再次注射仍然有效.结论 A型肉毒毒素对于控制抽动障碍的运动性抽动症状安全有效.     

A型肉毒毒素注射联合红外偏振光治疗慢性偏头痛的疗效

目的对A型肉毒毒素注射联合红外偏振光在慢性偏头痛中的临床治疗效果予以探讨。方法随机选取我院收治的慢性偏头痛患者56例,将其均分为对照组与观察组,对照组应用A型肉毒毒素注射治疗;观察组应用A型肉毒毒素注射联合红外偏振光治疗,均治疗50~60d,并进行6个月的持续随访,对每个偏头痛患者治疗前3个月及治疗后1个月、3个月、6个月的头痛发作情况进行记录分析,并对患者开展生活质量评价量表评分及偏头痛残疾程度评估问卷评分;对2组的不良反应发生情况、慢性偏头痛恢复状况、止痛药物的应用情况、慢性偏头痛的发作频率、严重程度、发作持续时间等予以对比分析。结果治疗后,2组慢性偏头痛的发作频率、严重程度、持续时间等与治疗前相比差异有统计学意义(P0.05);观察组偏头痛残疾程度评分明显低于对照组,生活质量评分明显高于对照组,差异均有统计学意义(P0.05);观察组止痛药物的应用情况、慢性偏头痛的发作频率、严重程度、发作持续时间等与对照组相比差异具有统计学意义(P0.05);2组不良反应发生率无明显差异。结论将A型肉毒毒素注射联合红外偏振光应用于慢性偏头痛患者的治疗中,具有良好的临床治疗效果,并且具有较好的安全性,值得临床应用中。     

A型肉毒杆菌毒素治疗Meige综合征

<正> 1、一般资料 本组12例中男4,女8。年龄46～67岁,平均56.5岁。病程半年至4年。 2、临床表现 12例病人表现为双眼睑发作性紧闭、睁眼困难,并进行性加重,发作间隙逐渐缩短,闭眼时持续时间延长。每次持续数秒至数分钟不等。情绪紧张、劳累、光线刺激时加重,发作时尚伴有眼干、酸胀、流泪及视物不清,5例严重者功能性失明。3例发作时张口厥嘴、抬眉蹙额,1例伴咽喉发紧、张口困     

国产A型肉毒毒素治疗脑卒中后上肢痉挛的疗效

目的探讨国产A型肉毒毒素(CBTX-A)肌肉注射治疗脑卒中后上肢痉挛的疗效和安全性。方法选取43例脑卒中患者为研究对象。根据随机数字表将患者分为两组:CBTX-A +康复治疗组(治疗组)和单纯康复治疗组(对照组)。治疗组患者除康复训练外,肱二头肌肌肉注射CBTX- A。分别于治疗前及治疗后2、4、8、12周对患者上肢功能进行评价。评价内容包括改良的Ashworth计分(MAS)、关节活动度(ROM)、上肢的Fugl-Meyer(FMA-上肢)计分和上肢的FIM运动能力(mot- FIM-上肢)。结果治疗组CBTX-A局部注射治疗后,85.7%(18/21)的患者有效。两组在MAS、ROM、FMA-上肢计分和mot-FIM-上肢方面,治疗后比治疗前均有显著改善。治疗后2、4、8周MAS计分治疗组分别为1.74±0.41,1.62±0.35,1.60±0.41,对照组分别为2.50±0.51,2.27±0.53, 2.18±0.55,各期两组间差异有统计学意义(P<0.01)。但是在治疗后12周时,两组间差异无统计学意义(P>0.05)。治疗后4-12周,ROM计分治疗组分别为57.81±57.60,66.43±64.38,68.14±65.99,对照组分别为27.91±30.13,30.73±34.03,33.73±34.50,各期治疗组比对照组均有显著性增加,差异有统计学意义(P<0.05)。治疗组治疗后FMA-上肢计分和mot-FIM-上肢计分与对照组相比均无统计学意义(P>0.05)。结论通过实验可以得出CBTX-A肌肉注射结合康复治疗可以达到提前缓解局部肌张力,扩大关节活动度,减轻疼痛,改善肢体功能的目的,这种治疗方法安全有效,具有良好的耐受性。     

A型肉毒杆菌毒素治疗面肌痉挛

面肌、眼睑肌痉挛是临床上一种常见的慢性进行性神经肌肉疾病,表现为一侧面肌不自主的间断性、强直性抽搐.常自眼轮匝肌开始,逐渐向下半部面肌扩展,口角歪斜,病侧眼裂变小,有损形象,影响社交,并可引起功能性运动残废.病因不明,采用针灸、理疗、药物等难以控制[1].我科2008年应用卫生部兰州生物制品研究所生产的A型肉毒素治疗本病42例,疗效较好,现报告如下.     

A型肉毒毒素治疗Meige综合征

ｅｉｇｅ综合征亦称特发性眼睑痉挛—口下颌肌张力异常综合征 ,临床不甚多见 ,好发于中、老年人。一年多来我们应用Ａ型肉毒毒素 (ＢＴＸ Ａ)局部注射治疗Ｍｅｉｇｅ综合征 12例 ,取得满意疗效 ,现报告如下。1　临床资料本组 12例中 ,男 4例 ,女 8例 ,年龄 4 4～ 6 7岁 ,平均年     

A型肉毒毒素加强法治疗面肌痉挛

面肌痉挛确切病因不明．口服药物疗效差。此研究采用A型肉毒毒素(BTX～A)加强法治疗面肌痉挛并进行长期随访，旨在提高其远期治愈率。     

Prophylactic treatment of chronic tension-type headache using botulinum toxin type A

Chronic tension-type headache is a common condition, the pathophysiology of which is not well understood. Over-activity of the pericranial muscles is thought to play a role, although sustained muscle contraction is probably a consequence, rather than a cause, of headache. Botulinum toxin type A (BTX-A) is useful in many conditions involving excessive muscle contraction and may therefore be effective in relieving the pain associated with this type of headache. To investigate the efficacy of BTX-A in relieving pain associated with chronic tension-type headache, a double-btind, randomised, placebo-controlled study was carried out, in which 37 patients received BTX-A, injected into the temporalis or cervical muscles of the neck. Clinical outcome was measured over a 4-month study period using headache diaries and chronic pain index scores. Patients treated with BTX-A showed an improvement in headache severity over the 4-month study period, with 13 out of 22 patients showing a 25, 50 or >50% improvement in headache score at Month 3 compared with two out of 15 patients in the placebo group. The number of headache-free days increased significantly in the BTX-A-treated patient group, and patients recorded an improvement in quality of life following BTX-A injection. It can be concluded that intramuscular injection of BTX-A is an effective treatment for chronic tension-type headache.     

颈部肌张力障碍临床分型及肉毒毒素疗效

目的根据颈部肌张力障碍患者的不同临床特点进行临床分型并观察不同类型患者A型肉毒毒素治疗效果。方法分析186例颈部肌张力障碍患者头颈部的异常姿势，进行临床分型，并对152例患者采用A型肉毒毒素肌肉注射治疗。结果186例颈部肌张力障碍患者头颈部异常姿势中，单纯扭转型88例（47．3％），侧倾型10例（5．4％），前屈型1例（0．5％），后仰型12例（6．5％），单纯震颤型5例（2．7％），旋转前屈型26例（14．0％），旋转后仰I型13例（7．0％），旋转后仰Ⅱ型3l例（16．7％）。有152例局部注射A型肉毒毒素治疗颈部肌张力障碍，其中10例资料不完整者剔除。临床症状显著缓解121例（85．2％），其中单纯扭转型缓解率最高，为93．4％（71／76），旋转后仰Ⅱ型缓解率最低（43．8％，7／16）。最常见的副作用是注射局部的肌肉疼痛和颈肌无力。结论熟悉颈部肌张力障碍的临床分型，精确定位受累肌肉及注射适宜剂量的肉毒毒素是有效治疗的关键。     

Treatment of chronic daily headache with comorbid anxiety and depression using botulinum toxin A: a prospective pilot study

Background: Psychiatric comorbidities, including depression and anxiety, are clinical entities associated with chronic daily headache (CDH). Botulinum toxin A (BTA) is a Food and Drug Administration approved drug for the treatment of chronic migraine, a subtype form of CDH. This study aimed to investigate the potential efficacy and safety of BTA for controlling psychiatric symptoms in CDH patients. Methods: A prospective, open-label, pilot study (n = 30; 7 males, 23 females) was performed. A single low-dose of BTA (40–120 U) was injected into the pericranial muscle at multiple sites. Participants were evaluated before and 1, 4, 8, 12, 16, 20 and 24 weeks after BTA treatment. Primary outcomes included: (1) headache severity, determined by a visual analog scale; (2) depression and anxiety severity, assessed via the Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A, respectively); (3) headache frequency per month and (4) single headache episode duration. Results: Headache severity was significantly ameliorated one week after treatment. Depression and anxiety symptoms were significantly reduced one month after treatment. At month four, the headache incidence per month decreased from 28.83 ± 2.95 to 17.57 ± 11.30 d (p < 0.001), and the single headache duration decreased from 12.03 ± 9.47 to 6.63 ± 8.98 h (p < 0.001). Furthermore, the percentage of patients who required analgesics significantly decreased. BTA was well tolerated, and the adverse events were mild and transient. Conclusion: BTA treatment alleviated the severity and frequency of CDH, with improvements in depression and anxiety. These novel findings indicate that BTA may represent an effective and safe intervention to target psychiatric comorbidities in CDH.     

三叉神经-颈反射在无先兆偏头痛和慢性紧张型头痛中的意义

目的 研究三叉神经-颈反射(trigemino-cervical reflex,TCR)在无先兆偏头痛(migraine without aura,MWOA)和慢性紧张型头痛(chronic tension-type headache,CTTH)中的意义.方法 选取2009年1月至2010年2月福建省级机关医院门诊25例单侧MWOA患者、25例CTTH患者及36名健康成年对照进行TCR检测.刺激一侧眶下神经(infraorbital nerve,ION),可在同侧胸锁乳突肌(sternocleidomastoid muscle,SCM)上记录到一个短潜伏期正-负波,即TCR.比较各组TCR参数[峰潜伏期(PL)、刺激前后波幅比率的平方根(A值)]的差异.结果 MWOA组和CTTH组双侧PLP19[MWOA右侧(19.81±1.79)ms,左侧(19.49±1.95)ms;CTTH右侧(19.16±1.67)ms,左侧(19.56±2.02)ms]、PLN31[MWOA右侧(30.75±2.35)ms,左侧(30.44±3.75)ms;CTTH右侧(30.32±3.47)ms,左侧(30.11±3.34)ms]较对照组缩短(t=2.027～3.654,P＜0.05);CTTH组和MWOA组双侧PLP19、PLN31及A值差异无统计学意义.结论 MWOA组和CTTH组的双侧PLP19、PLN31潜伏期较对照组缩短,提示三叉神经、脑干系统参与MWOA、CTTH的发病机制;但两组病例无明显差异,MWOA和CTTH在内源性疼痛调节系统的某个部位如三叉神经或脑干系统,存在共同的功能障碍.     

Idiosyncratic adverse reactions to intramuscular botulinum toxin type a injection

Three cases of adverse reactions to repeated intramuscular botulinum toxin A (BTA) injections are described: a persistent rash on the face at the site of injection, a localized anaphylactic reaction following BTA injection into one leg, and bilateral ptosis repeatedly following BTA injection into neck muscles. The mechanisms for these idiosyncratic adverse responses are not known.     

Botulinum toxin therapy of migraine and tension‐type headache: comparing different botulinum toxin preparations

Most of the initial reports on botulinum toxin in tension‐type headache (TTH) and in migraine were positive. Unfortunately, these results were not reproduced in well‐designed, randomized controlled trials. So far, doses from 20 U (Botox®) to 500 U (Dysport®) have been studied in patients with chronic TTH, and doses from 16 to 200 U (Botox®) in patients with migraine. Overall, there is no evidence for a beneficial effect of botulinum toxin, although trends favoring botulinum toxin were reported. Experience with botulinum toxin type B (Myobloc®/NeuroBloc®) is limited and similar to the experience with the type A. Thus, a widespread use of botulinum toxin therapy in headache can currently not be recommended.     

Evidence based medicine on the use of botulinum toxin for headache disorders

Botulinum toxin blocks the release of acetylcholine from motor nerve terminals and other cholinergic synapses. In animal studies botulinum toxin also reduces the release of neuropeptides involved in pain perception. The implications of these observations are not clear. Based on the personal experiences of headache therapists, botulinum toxin injections have been studied in patients with primary headaches, namely tension-type headache (TTH), chronic migraine (CM) and chronic daily headache (CDH). So far, the results of randomized, double-blind, placebo controlled trials on botulinum toxin in a total of 1117 patients with CDH, 1495 patients with CM, and 533 patients with TTH have been published. Botulinum toxin and placebo injections have been equally effective in these studies. In some of the studies, the magnitude of this effect was similar to that of established oral pharmacotherapy. This finding may help to explain the enthusiasm that followed the first open-label use of botulinum toxin in patients with headache. However, research is continuing to determine the efficacy of botulinum toxin in certain subgroups of patients with CM or CDH.     

Experience with long-term treatment with albumin-supplemented botulinum toxin type A

In earlier studies, we have demonstrated the efficacy of albumin-supplemented botulinum toxin type A (ASBTA) in principle. Here, we present long-term data from 106 patients who received ASTBA over 5–10 years for the treatment of cervical dystonia, blepharospasm and hemifacial spasm. Vials of Dysport^® were diluted in 0.1% albumin solution to a concentration of 25 units/ml. Overall patients and indications, the mean latency to response was 7.1 ± 2.2 days, the mean duration of response was 12.3 ± 3.1 weeks and the mean global clinical improvement (scale 0–3) was 2.6 ± 0.2. Only one patient had neutralizing antibodies against BoNT-A. Side effects were less frequent than known for conventional BoNT-A and generally mild. These findings were confirmed by analysis of data of 71 patients who have been reconverted from ASBTA to conventional dilutions of Dysport^® or Botox^®. We conclude that long-term treatment with ASBTA is effective, safe and help to reduce costs.