A型肉毒毒素治疗难治性三叉神经痛临床观察

目的：评价A型肉毒毒素（BTX-A）治疗难治性三叉神经痛的疗效。方法：选取难治性三叉神经痛患者6例,其中原发性5例,继发性1例。采用视觉模拟评分（VAS）于局部多点注射BTX-A,予治疗前及治疗后2周、2个月和6个月时进行疼痛测评。结果：VAS评分：BTX-A治疗前为（8.86±0.75）分;BTX-A注射后2周和2个月分别降至（1.00±1.26）分和（2.00±2.45）分,与治疗前比,差异均有统计学意义（P〈0.05）;6个月时为（5.33±2.16）分,与治疗前比,差异仍有统计学意义（P〈0.05）。6例患者均无明显并发症出现。结论：BTX-A注射治疗难治性三叉神经痛是一种安全有效的新疗法。     

穴位注射A型肉毒素治疗偏头痛的临床研究

目的探讨穴位注射A型肉毒素（BTX-A）治疗偏头痛的疗效。方法将60例偏头痛患者分为固定点注射和针灸穴位点注射两组，每例患者BTX-A注射总剂量均为25U，采用单盲法比较两组患者治疗前及治疗后1、2、3、4个月头痛症状的改善情况。结果治疗后两组偏头痛患者的发作频率、强度及持续时间均较治疗前降低（P〈0．01），但两组治疗后各指标比较差异均有统计学意义（P〈0．01）。结论穴位注射法较固定点注射法治疗偏头痛效果明显，是一种安全、有效的新方法。     

西酞普兰联合认知行为疗法治疗强迫症对照观察

目的：比较西酞普兰联合认知行为治疗与单用西酞普兰治疗强迫症的临床疗效。方法：将Yale-Brown强迫量表（Y-BOCS）评分≥16分的64例强迫症患者随机分为研究组（西酞普兰联合认知行为治疗）和对照组（单用西酞普兰治疗）,每组各32例,疗程6个月。于治疗前及治疗1、2、4和6个月时采用Y-BOCS评定疗效。结果：治疗后研究组和对照组Y-BOCS评分分别为（9.41±3.87）分和（12.37±5.34）分,较治疗前（25.26±5.38）分和（24.23±4.25）分显著下降（P〈0.05或P〈0.01）;以研究组下降更为显著（P〈0.05或P〈0.01）,其中强迫性思维和强迫性行为因子评分在治疗6个月时仍维持降分（P〈0.01）。结论：西酞普兰联合认知行为治疗强迫症较单用西酞普兰疗效更好。     

园农治疗对慢性精神分裂症社会功能的作用

目的：探讨园农康复治疗对长期住院慢性精神分裂症患者社会功能的康复效果。方法：185例长期住院的慢性精神分裂症患者（残留期113例,衰退期72例）随机分为残留期治疗组57例和对照组56例,衰退期治疗组和对照组各36例。治疗组进行系统的院外开放式园农康复治疗,对照组进行院内封闭式传统工娱康复治疗。疗程10个月。于康复治疗前、治疗5个月和10个月时分别进行社会功能评定量表（SSPI）评定。结果：残留期治疗组治疗后社会功能有显著改善,SSPI评分在治疗前、治疗5个月和10个月时分别为（16.3±4.9）分、（18.3±5.2）分和（19.6±5.7）分（P〈0.05或P〈0.01）;而残留期对照组治疗后社会功能无改善,SSPI评分分别为（15.9±5.2）分、（16.1±4.9）分和（16.3±6.1）分（P均〉0.05）。衰退期治疗组治疗后社会功能有一定的改善,SSPI评分分别为（12.5±4.3）分、（12.9±5.2）分和（14.9±5.3）分（P〈0.05）,而衰退期对照组治疗后社会功能无改善,SSPI评分分别为（12.2±5.2）分、（12.2±5.8）分和（12.4±4.9）分（P均〉0.05）。结论：园农康复治疗对长期住院的慢性精神分裂症患者社会功能的康复有良好的效果,其中残留期患者的社会功能恢复较早、效果更好。     

文拉法辛联合米氮平治疗难治性抑郁症患者的疗效观察

目的：探讨文拉法辛联合米氮平治疗难治性抑郁症患者的疗效。方法：31例难治性抑郁症患者给予文拉法辛联合米氮平治疗,疗程8周。于治疗前及治疗1、2、4、6和8周应用汉密尔顿抑郁量表（HAMD）和治疗中出现的症状量表（TESS）分别评定疗效和不良反应。结果：治疗2周,HAMD评分从治疗前（23.32±5.25）分降至（19.03±4.27）分（t=3.53,P〈0.01）;治疗8周,HAMD评分降至（8.77±5.18）分（t=9.83,P〈0.01）。TESS评定显示不良反应发生率低,程度轻。结论：文拉法辛联合米氮平治疗难治性抑郁症安全有效     

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。     

A型肉毒毒素局部注射治疗面肌痉挛的临床疗效

目的探讨A型肉毒毒素(BTX-A)局部注射治疗面肌痉挛的临床疗效。方法给46例面肌痉挛患者的面部17点位皮下注射BTX-A。在治疗前和治疗后进行面肌痉挛强度评级。在注射治疗后4周,根据面肌痉挛强度评级进行疗效评定。对症状复发的患者给予重复BTX-A注射治疗。结果本组患者BTX-A注射治疗后完全缓解15例,明显缓解29例,部分缓解2例;有效率95.6%。起效时间为(2.62±1.10)d;疗效持续(19.1±2.3)周。其中注射治疗1次5例、2次23例、3次11例、≥4次7例。重复注射治疗的起效时间[(2.61±1.03)d]、疗效持续时间[(19.24±2.12)周]及有效率(100%)与初次注射治疗时的差异无统计学意义。出现注射侧局部面肌轻度麻痹6例,2~4周后自行完全恢复。结论 BTX-A局部注射是一种治疗面肌痉挛安全有效地方法,无明显不良反应;并且重复治疗的效果不减退。     

高压氧治疗前交通动脉瘤术后认知功能障碍的效果分析

目的探讨高压氧治疗（HOT）前交通动脉瘤患者术后认知功能障碍的效果。方法50例前交通动脉瘤术后出现认知功能障碍患者,随机分为HOT组（26例）和对照组（24例）。两组患者治疗前及治疗后30d均采用简明精神状态检查量表（MMSE）和日常活动能力量表（ADL）评估认知功能。结果HOT组治疗前后MMSE评分分别为（23±4．1）分和（28±3．2）分,两者差异显著（P〈0．05）。对照组治疗前后MMSE评分分别为（22±2.3）分和（24±2．1）分,差异显著（P〈0．05）。HOT组治疗前后ADL评分分别为（47±2．3）分和（24±1．2）分,两者差异显著（P〈0．05）。对照组治疗前后ADL评分分别为（46±4．23）分和（37±2．4）分,两者差异显著（P〈0．05）。治疗后HOT组MMSE、ADL评分与对照组比较,均差异显著（P〈0．05）。结论早期HOT可有效改善前交通动脉瘤患者术后认知功能障碍。     

微创血肿引流术对高血压脑出血患者神经功能及日常生活活动能力的影响

目的：观察微创血肿引流术对高血压脑出血（HICH）患者神经功能及日常生活活动能力的影响。方法将我院收治的44例H IC H患者随机分为观察组和对照组各22例,对照组接受常规药物治疗,观察组实施微创血肿引流术。观察2组神经功能以及日常生活活动能力。结果2组治疗前神经功能缺损程度（NIHSS）评分差异无统计学意义（P＞0.05）;观察组手术后1个月和3个月后NIHSS评分分别为（19.3±4.9）分和（16.3±6.5）分,对照组为（25.4±7.3）分、（22.4±4.1）分,2组NIHSS评分均低于入院前,且观察组NIHSS评分明显低于对照组（P＜0.05）;对照组手术后1个月和3个月后日常生活活动能力评分分别为（62.7±7.2）分和（69.3±9.3）分,观察组为（85.4±6.9）分、（89.7±5.8）分,观察组日常生活活动能力评分明显高于对照组（P＜0.05）。结论微创血肿引流术可减少 HICH脑内血肿吸收时间,改善神经功能,减轻神经损伤,提高患者生活能力,适用于高血压颅内少量出血患者的治疗,并能够有效改善患者的生活质量。     

亚低温治疗老年重型颅脑损伤50例体会

目的 探讨亚低温治疗老年重型颅脑损伤的临床效果.方法 选择2010-03-2012-03我院收治的老年重型颅脑损伤后行开颅手术患者共50例,随机分为实验组和对照组各25例,实验组术后采用亚低温治疗,对照组术后常规治疗,2组治疗2周、1个月及3个月时分别进行格拉斯哥预后评分（GOS评分）,并于术后6个月统计总有效率,比较2组的治疗效果.结果 实验组治疗后2周、1个月及3个月的GOS评分分别为：26分、30分和40分,与对照组的19分、18分及16分相比较差异有统计学意义（P〈0.05）.对照组治疗6个月后的总有效率为24%,较实验组48%明显减少,差异有统计学意义（P〈0.05）.结论 亚低温治疗有利于降低对老年重型颅脑外伤的患者尽早实施亚低温治疗,可明显提高治愈率,减少病死率,有效改善患者预后,是一种安全可靠的治疗措施.     

Ultrasound-guided versus 'blind' intraparotid injections of botulinum toxin-A for the treatment of sialorrhoea in patients with Parkinson's disease

OBJECTIVE: To investigate the efficacy and safety of intraparotid botulinum toxin-A (BTX-A) injections into parotid gland using ultrasound-guided versus nonguided techniques for the treatment of sialorrhoea in patients with Parkinson's disease (PD). METHODS: 15 patients with PD and sialorrhoea were included and divided into two groups. Group A patients (n=8) were injected with BTX-A using ultrasound guidance. Group B patients (n=7) were injected with BTX-A without ultrasound guidance. Saliva secretion was assessed quantitatively at baseline and at weeks 1, 4, and 12. Patients and/or caregivers also assessed the saliva secretion using visual analog scale (VAS). RESULTS: All patients except one reported subjective improvement in sialorrhoea at the first week. Group A patients showed significantly higher rate of saliva reduction at the first week, whereas in Group B the reduction was not statistically significant from baseline at the first week (P>0.05). Comparisons of quantitative saliva assessments at each follow-up visit also showed that ultrasound-guided injections were superior to blind injections for saliva reduction. VAS scores showed an improvement in the mean rate of saliva secretion in each group at first week (P<0.05). Two patients suffered from dry mouth in mild severity lasting 1 month. CONCLUSION: Intraparotid BTX-A injections using ultrasound guidance may be an effective, easy, and safe treatment for parkinsonian sialorrhoea.     

Treatment of sialorrhoea with ultrasound guided botulinum toxin type A injection in patients with neurological disorders

OBJECTIVES: To investigate the safety and efficacy of ultrasound guided botulinum toxin type A (BTX-A) injections into salivary glands for the treatment of sialorrhoea in patients with neurological disorders. METHODS: The parotid and submandibular glands of 10 patients were injected with BTX-A using ultrasound guidance. Before injection, the baseline rate of salivation was assessed using a visual analogue scale. Postinjection, assessments were repeated at regular intervals for up to 1 year. RESULTS: Of the 10 patients treated, nine (90%) reported a subjective reduction in salivation post-treatment and one patient (10%) found no improvement. Visual analogue scale scores showed a reduction of 55% in the mean rate of salivation for all patients and a reduction of 60.8% for the group of responders. No serious adverse events occurred and no procedure related complications were reported. CONCLUSIONS: This is the first study to report (1) the injection of BTX-A (BOTOX) into both parotid and submandibular glands, and (2) the use of ultrasound guidance during the administration of BTX-A into salivary glands. The results suggest that the technique is safe and that BTX-A injections are effective for the treatment of sialorrhoea in patients with neurological disorders.     

Parotid and submandibular botulinum toxin A injections for sialorrhoea in children with cerebral palsy

The aim of this study was to determine whether botulinum toxin A (BTX-A) injected into the parotid and submandibular salivary glands of children aged 6 to 16 years with cerebral palsy (CP) and relative sialorrhoea significantly decreases their drooling and improves their quality of life. Twenty children (10 males, 10 females; mean age 10y 1mo [SD 3y 8mo]; range 6y 1mo-16y 7mo) with CP, identified as having significant daily drooling (scoring at least 6 on drooling frequency/severity scales) were recruited. BTX-A (2U/kg; maximum 70U) was injected under sedation, using ultrasound guidance (1.4U/kg and 0.6U/kg divided between parotid and submandibular glands respectively). Nineteen children completed the study: 15 with spastic quadriplegia (Gross Motor Function Classification System [GMFCS] Level V); one with dystonia (GMFCS Level V); one with hemiplegia (GMFCS Level II); and two with a mixed pattern of CP (GMFCS Levels III and V). Drooling was assessed by five methods at baseline, and 4 and 12 weeks after injection. Qualitative assessment of drooling frequency and severity scores showed statistically significant reductions at 4 weeks (p<0.001) and 12 weeks (p=0.006). Qualitative assessment of quality of life scores (rated by parents and teachers separately) also significantly improved (p<0.001 and p=0.023 respectively). Quantitative assessments showed that the number of bibs/scarves changed per day was significantly reduced at 4 weeks (p<0.001). There was no side effect from the injections themselves; 89% of parents and children wished for further intrasalivary BTX-A injections in the future. We conclude that percutaneous intrasalivary BTX-A injections into the parotid and submandibular salivary glands can reduce drooling in children with CP and relative sialorrhoea, leading to an improvement in their quality of life.     

A randomized trial of botulinum toxin A for treatment of drooling

The authors compared the efficacy of three different doses (18.75, 37.5, and 75 MU per parotid gland) of botulinum toxin A (BTX-A; Dysport, Ipsen Pharma, Germany) injections vs vehicle in patients with sialorrhea (n = 32) using a single-center, prospective, double-blind, placebo-controlled dose-finding study. The primary endpoint was achieved with 75 MU BTX-A without treatment-related adverse events, suggesting BTX-A is a safe and effective treatment for patients with sialorrhea.     

Botulinum toxin type A treatment of cerebral palsy: an integrated approach

We have applied a multilevel approach to the management of spasticity associated with cerebral palsy (CP). All of the following factors are important in forming an integrated strategy for botulinum toxin type A (BTX-A) therapy: the timing of injections, patient selection, multilevel BTX-A treatment, optimal dosage and injection technique, follow-up treatment and objective measurements of functional outcome. Data on all these factors are presented here. CP patients had a mean age of 6.5 years (n = 315), and the dose of BTX-A (BOTOX®) ranged from 2 to 29 U/kg body weight ( n = 156). The combination of muscles injected in our multilevel approach differed for patients with diplegia, hemiplegia and quadriplegia: patients with hemiplegia received injections in the gastrocnemius and medial hamstrings; this combination was extended to the adductors for patients with diplegia and quadriplegia ( n = 156). For patients with quadriplegia, muscles in a three-level (gastrocnemius, medial hamstrings, adductors and iliopsoas) or two-level (excluding the gastrocnemius) combination were also frequently injected. The duration of effect of BTX-A treatment was mainly determined by follow-up treatment consisting of: serial casting, day and night orthoses and physiotherapy. No major side effects of BTX-A were reported. This integrated approach appears to prolong the duration of BTX-A treatment, resulting in a duration of about 1 year between injections.     

Fast voluntary neck movements in patients with cervical dystonia: a kinematic study before and after therapy with botulinum toxin type A.

OBJECTIVE: To study fast voluntary neck movements in patients with cervical dystonia (CD) before and after therapy with botulinum toxin type-A (BTX-A). METHODS: A selected sample of 15 patients with CD (with prevalent torticollis) and 13 age-matched control subjects performed both right and left rotational, and flexion and extension neck movements as fast as possible. Movements were recorded with a motion analysis system (SMART, BTS). Movement time, angular amplitude, and peak angular velocity were analyzed. In patients, rotational neck movements were pooled as "pro-dystonic" (toward the dystonic side) and "anti-dystonic" (toward the non-dystonic side). Results obtained in patients before BTX-A treatment were compared with those of control subjects. The effect of BTX-A treatment was evaluated by comparing movement performance before and after treatment. RESULTS: Before receiving BTX-A, patients performed pro- and anti-dystonic movements with lower peak angular velocity than control subjects. Pro-dystonic movements had a reduced angular amplitude. Anti-dystonic movements showed an abnormally long movement time. Flexion and extension movements required longer movement times, but the other kinematic variables were normal. After BTX-A injections, pro-dystonic movement amplitude and anti-dystonic movement peak angular velocity increased, whereas flexion and extension movements remained unchanged. CONCLUSIONS: Before BTX-A injection patients with CD perform fast voluntary neck movements abnormally and BTX-A injections improved their peak velocity and amplitude. SIGNIFICANCE: Kinematic studies can detect specific neck movement disturbance in patients with CD, and can quantify both the severity of clinical picture and the effect of BTX-A injections in these patients.     

Initial efficacy of intramuscular injection of botulinum toxin type A against cervical dystonia and general muscular hypertonia in persons with severe motor and intellectual disabilities

We introduced an intramuscular injection of botulinum toxin type A (hereafter, BTX-A) in 5 cases of cervical dystonia (CD) with generalized muscular hypertonia (GMH). The patients all had severe motor and intellectual disabilities (SMID). The initial injections (first and second) of BTX-A exerted a focal muscular relaxant effect in all 5 cases. It is interesting that they decreased hypertonia in the lower extremities, which resulted in an improved activity of daily living (ADL) in 4 cases (80%). This fact reveals the involvement of many muscles in regard to CD and GMH, especially in patients with severe cerebral palsy. As for adverse effects, a mild increase of saliva and cough indicated transient misswallowing in 2 cases (40%) and changes in the pattern of head movement and posture in 2 cases (40%). These effects were all mild and did not disturb ADL in any patient. BTX-A is considered to be safer and worthier of trying to decrease complaints related to CD and GMH than we expected. Furthermore, a modified Tsui's score cannot explain the many benefits from BTX-A in the treatment of SMID. For a reliable assessment of BTX-A therapy used to treat CD and GMH, especially in persons with SMID, more expressible and specific assessment methods will need to be established.     

Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm

Although the beneficial effect of subcutaneous injections of botulinum toxin type A (BTX-A) is well known in both blepharospasm and hemifacial spasm, the position of the injection sites around the orbicularis oculi may influence the effectiveness and side effects. Here we report results of preseptal and pretarsal BTX-A injections in 53 patients (25 blepharospasm and 28 hemifacial spasm) in whom we used both injection techniques successively. Pretarsal injections were used in 102 out of 186 treatments in blepharospasm group and in 84 out of 202 treatments in hemifacial spasm group. Pretarsal BTX-A treatment produced significantly higher response rate and longer duration of maximum response in both patient groups. This technique was also associated with a lower frequency of major side effects such as ptosis. We concluded that injections of BTX-A into the pretarsal, rather than the preseptal portion of the orbicularis oculi is more effective for treatment of involuntary eyelid closure due to contractions of this muscle. Received: 15 January 2001, Received in revised form: 11 May 2001, Accepted: 17 May 2001     

Muscle paralysis produced by botulinum toxin type A injection in treated torticollis patients compared with toxin naive individuals.

We sought to determine whether the response to varying doses of botulinum toxin type A (BTX-A) injected in BTX-A-treated torticollis patients differed from the same injections given in toxin-naive individuals. We have developed a technique to objectively measure muscle weakness resulting from BTX injections in humans and have validated the technique in those not previously treated with BTX. We now examine BTX-A-treated torticollis patients to see if their response to BTX-A injection is similar to that of toxin-naive individuals. We injected 11 torticollis patients who had been receiving BTX-A injections with a standard 5-mouse unit (mu) dose into one extensor digitorum brevis (EDB) muscle and a varying dose into the other EDB, measuring muscle paralysis 2 weeks after the injection. Nine of the 11 patients were clinical and electrophysiologic responders. Two patients were non-responders. In the 9 responding patients the dose response curve to increasing doses of BTX-A was very similar to that seen in toxin-naive individuals. The mean muscle paralysis from the standard 5 mu dose was also similar to that previously reported in toxin-naive individuals. Torticollis patients who continue to respond clinically to BTX-A injections demonstrate essentially the same degree of muscle paralysis from the EDB injections as do subjects who have never been exposed to BTX-A.     

肌电图引导下A型肉毒毒素治疗痉挛性斜颈146例临床研究

目的:探讨肌电图引导下A型肉毒毒素局部肌肉注射治疗原发性痉挛性斜颈的疗效。方法:对146例痉挛性斜颈患者在肌电图引导下进行A型肉毒毒素局部肌肉注射,观察其治疗效果以及不良反应。结果:146例痉挛性斜颈患者,治疗后Tsui量表评分明显下降;重复治疗者复发症状减轻,治疗剂量下降,疗效仍良好。所有患者均未见严重不良反应。结论:肌电图引导下A型肉毒毒素局部肌肉注射是一种治疗痉挛性斜颈有效和安全的手段。