A型肉毒杆菌毒素治疗眼睑及面肌痉挛

目的：观察A型肉毒杆菌毒素治疗眼睑痉挛及面肌痉挛的效果。方法：对38例眼睑痉挛及18例面肌痉挛患者局部注射A型肉毒杆菌毒素。结果：治疗效果满意，痉挛症状缓解。药效作用时间：眼睑痉挛者为5－17周，平均9．5周；面肌痉挛者为10－24周，平均16周。无全身反应，局部副作用轻微，可重复注射。结论：用A型肉毒杆菌毒素治疗眼睑及面肌痉挛安全、有效，为首选药物。     

Treatment of facial spasm with botulinum toxin. An interim report

Forty-eight patients were given serial injections of botulinum toxin in their eyelids for treatment of eyelid spasm during a two-year interval. Ninety-four percent obtained relief of spasm from botulinum toxin injection. The duration of the spasm-free interval as well as the incidence of ptosis and of diplopia was dose dependent. The marked increase in the incidence of these side effects with only a small increase in the duration of the spasm-free interval, when a dose of 25 units per lid was used, leads the authors to conclude that this dose is too high and should not be used. Since diplopia was most commonly caused by paresis of the inferior oblique muscle, and since blepharospasm usually can be controlled by excising the upper lid protractors, further studies are required to determine whether lower lid injection is necessary and, if it is found to be so, whether injecting only the lateral portion of the lid would be adequate.     

A型肉毒杆菌毒素治疗眼睑及面肌痉挛

目的：评价A型肉毒杆菌毒素治疗眼睑痉挛及面肌痉挛的临床疗效。方法：对56例眼睑痉挛、面肌痉挛患者进行局部A型肉毒杆菌毒素的治疗。结果：19例单纯眼睑痉挛患者中完全缓解者4例（占21.0%）、明显缓解者12例（占63.2%）、部分缓解者3例（占15.8%）。合并面肌痉挛37例中完全缓解者20例（占54.1%）、明显缓解者10例（占27.0%）、部分缓解者7例（占18.9%）。药效作用时间：眼睑痉挛平均10.5周;面肌痉挛平均14.2周。无过敏反应,可重复注射。结论：A型肉毒杆菌毒素是一种安全、有效、可靠的制剂,治疗方法简单,可以作为治疗眼睑痉挛及面肌痉挛的首选方法,于以推广。     

Negative antibody response to long-term treatment of facial spasm with botulinum toxin

Over a period of 163 weeks, 223 injections of botulinum A toxin were administered to 38 patients with facial spasm syndromes. The maximum cumulative toxin dose was 553 units, the maximum number of injections in any given patient was 16, and the maximum dosage of any given injection was 52.5 units. Sera from these patients showed no antibody production when measured with a standard mouse lethality bioassay.     

Treatment of aberrant facial nerve regeneration with botulinum toxin A

purpose To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining eyelid synkinesia in aberrant facial nerve regeneration, while concurrently observing for the presence of side effects to differing treatment doses. methods A prospective interventional study of five patients with eyelid synkinesia resulting from aberrant regeneration of the facial nerve. Patients were treated with injections of either 120, 80 or 40 units of BTX-A (Dysport) into the orbicularis oculi. Objective and subjective reduction in synkinesia, maintenance of response and presence of side effects were recorded. results All five patients had improvement of the synkinesia with BTX-A treatment. Lower doses were found to be as effective as higher doses. Mean duration of abolished synkinesia was three months. Two patients developed a ptosis which resolved spontaneously. None of the patients treated with the lowest dose of 40 units developed a ptosis. conclusion Low-dose BTX-A has a lower incidence of ptosis and is effective in the treatment of aberrant facial nerve regeneration.     

Treatment of hemifacial spasm with botulinum A toxin. Results and rationale

Hemifacial spasm is characterized by unilateral, periodic, tonic contractions of facial muscles, thought to be caused by mechanical compression at the root-exit zone of the facial nerve. Electrophysiologic abnormalities such as ectopic excitation and synkinesis are typical. Although posterior fossa microsurgical nerve decompression is successful in bringing about relief of the spasm in most cases, it carries a risk to hearing. As an alternative treatment, 15 patients with hemifacial spasm were given a total of 41 sets of injections with botulinum A toxin, with a mean follow-up of 14.3 +/- 1.1 months. Relief of symptoms lasted a mean of 108.3 +/- 4.2 days. Mild transient lagophthalmos and ptosis were the only complications. Although the exact mechanism of its action and beneficial effect is speculative at this time, botulinum A toxin appears to offer an effective, safe alternative to more radical intracranial surgery for patients with hemifacial spasm.     

Treatment of blepharospasm and hemifacial spasm with botulinum A toxin: a Canadian multicentre study

Botulinum A exotoxin was recently approved for use in Canada. We describe the efficacy of botulinum toxin in the management of 235 patients with blepharospasm (mean age 64.3 years) and 130 patients with hemifacial spasm (mean age 60.4 years) treated at three Canadian ophthalmologic centres between 1984 and 1989. A total of 98% of the patients with blepharospasm and 100% of the patients with hemifacial spasm had significant relief of their symptoms; however, 11% of the former and 2% of the latter did not respond to the usual starting concentrations of the drug and needed stronger dosages for relief. The duration of relief varied widely in both groups. Up to 7% of patients had ineffective treatments but responded to subsequent injections. Analysis of variance and linear trend statistics showed that there were no changes in the mean duration of relief over the first several treatments for individual patients in either group. Side effects were transient and included ptosis, exposure keratitis, epiphora and strabismus.     

Orbicular synkinesis after facial paralysis: Treatment with botulinum toxin

Involuntary lid closure not rarely accompanies aberrant regeneration of nerve fibers after different types of facial paralysis. 23 patients with such synkinesis were treated with botulinum toxin injections into the orbicularis oculi muscle. After periocular injections all patients showed much improvement: a period of, on the average, 13 symptom-free weeks was followed by a period of minimal symptoms. There were only minor complications. Whenever repeated treatment is necessary, botulinum toxin proves to be an effective therapy for involuntary lid closure after defective healing following facial paralysis.     

A型肉毒毒素治疗半侧面肌痉挛

目的:探讨A型肉毒毒素治疗半侧面肌痉挛疗效。方法:局部注射A型肉毒毒素,注射前后观察,复发后重新注射。结果:121例痉挛患者,IV级痉挛18例,III级痉挛55例,II级痉挛47例,I级痉挛1例。完全缓解111例,部分缓解10例。结论:A型肉毒毒素是治疗半侧面肌痉挛有效、完全、方便的治疗药物。     

Treatment of blepharospasm and facial hemispasm by injection of botulinum toxin

13 patients with hemifacial spasm and 19 patients with blepharospasm (essential blepharospasm or Meige syndrome) were treated with injection of botulinum A toxin in the eyelids. The effectiveness of this therapy is constant and the treatment offers relief to almost all patients. The response times for repeated treatment was 6 months for blepharospasm and 7 months for hemifacial spasm. Repeated injections were performed in several patients and gave the same improvement. Transient ptosis or diplopia were observed in 11 patients. Possible systemic side effects (respiratory trouble) were documented in two patients. Botulinum toxin injection is an effective treatment but the relief is usually temporary and repeated treatments are necessary.     

A型肉毒毒素治疗眼睑及面肌痉挛364例临床观察

目的探讨A型肉毒毒素治疗眼睑及面肌痉挛的疗效.方法行眼部常规检查和确定痉挛强度,按眼睑面肌痉挛强度分级标准评估,进行不同剂量局部注射.注射剂量眼睑1.25u～2.5u,面肌2.5u～5u.结果总有效率为100%,364例患者均于注射后1～7天症状开始改善,于3天症状改善者为多,占80%,部分缓解者37例,占10%,药效作用时间4～6个月.结论用A型肉毒毒素治疗眼睑及面肌痉挛是一种可靠、简单的方法,该方法无明显副作用,无痛苦,其并发症少且短暂而可逆,虽需要重复注射,但药效维持时间长,易于被患者所接受.     

肉毒毒素治疗特发性睑痉挛的临床疗效

目的 探讨局部注射A型肉毒杆菌毒素治疗特发性睑痉挛的疗效。方法 对35例特发性睑痉挛患者局部注射A型肉毒杆菌毒素。结果 35例患者均取得满意疗效，无全身反应，局部副作用轻微，短暂。可重复注射，无过敏反应。结论 A型肉毒杆菌毒素为一安全，有效，可靠的制剂，治疗方法简便易行，可作为治疗眼睑痉挛的首选药物。     

Treatment of acquired nystagmus with botulinum A toxin

We injected botulinum A toxin into the retrobulbar space of one eye each in two patients who had acquired nystagmus with oscillopsia and decreased vision. After injection of 25 units of botulinum A toxin, visual acuity improved from 20/80 to 20/30 in one patient, and both patients were able to read and watch television. Improved vision lasted from five to 13 weeks. No adverse side effects were observed after a total of five injections in each patient.     

肉毒杆菌毒素A治疗先天性眼球震颤22例

目的:观察肉毒杆菌毒素A(BTA)治疗先天性眼球震颤(CN)的效果。方法:先天性眼球震颤患者22例,男17例,女5例。用眼震图(ENG)检查BTA注射相应眼外肌前与注射后1wk,1,3,6mo的近、远距离眼震,视力,3级视功能情况,各组进行统计学处理,并比较统计学差异。结果:各组注药前后视力改变无统计学差异(P>0.05)。注药后1mo与注药前相比,远近距离原眼位的各眼震参数降低均有明显统计学差异(P<0.05);注药后3,6mo与注药前相比近、远距离原眼位振幅降低有明显统计学差异(P<0.05);最小震强位置注药后1wk,1,3,6mo与注药前相比虽无明显差异,但从频数分布图中可见最小震强出现的位置有向原眼位集中的趋势。注药后3,6mo3级视功能与注药前相比仅融合范围扩大有显著差异(P<0.05)。结论:该方法治疗先天性眼球震颤可使近、远距离原眼位眼震有所减轻,视力、代偿头位及3级视功能有所改善。注药后1mo疗效最显著,6mo后疗效下降。该方法治疗先天性眼球震颤有明显效果。     

A型肉毒杆菌毒素治疗麻痹性斜视

采用眼外肌注射A型肉毒杆菌毒素的方法,治疗17例(18只眼)麻痹性内斜视患者。最大的肌肉麻痹作用发生于注射后7～14天,最大斜视矫正度为50-,随访时间为4～20周,5例最终获得双眼视。未见全身副作用。认为,这种疗法可在部分患卉中替代斜视矫正术。