A型肉毒毒素治疗局限性肌张力障碍的临床应用

目的：摸索国产A型肉毒素(BTX—A)在神经科的临床用途。方法：用A型肉毒素局部治疗面肌抽搐25例，眼睑痉挛11例，Meige综合征2例，咬肌痉挛2例，紧张性头痛6例，脑卒中后肢体痉挛10例，脑炎后肢体痉挛2例。结果:面肌抽搐、眼睑痉挛有效率100％，Meige综合征部分缓解，紧张性头痛5例有效，1例无明显疗效，咬肌痉挛1例有效，1例无效，脑卒中后肢体痉挛8例缓解，2例效，脑炎后肢体痉挛2例均有不同程度改善。结论:A型肉毒毒素注射治疗不失为神经科治疗局限性肌张力障碍一有效手段，其操作简便，副作用少。     

A型肉毒毒素肌肉注射治疗脑血管病后肢体痉挛36例

目的：探讨A型肉毒毒素（BTX－1）肌肉注射治疗脑血管病后肢体痉挛的疗效。方法：对36例血管病后肌痉挛患用国产BTX－A注射，注射剂量、位点根据受累肌肉大小多少程序个体化用药，观察注射前后肌力肌张力变化分别以康复治疗。结果：治疗后随着注射部位肌肉痉挛程度降低，配合康复治疗对痉挛性肌张力增高患较前明显改善。结论：BTX－A肌肉注射配合康复治疗对脑血管病后肌痉挛是有较好的治疗效果。     

A型肉毒毒素治疗睑肌及面肌痉挛的疗效观察与安全性

近年来应用A型肉毒毒素（BTX—A）治疗睑肌及面肌痉挛，取得良好疗效。作于2003年3月至2005年6月，应用BTX—A治疗睑肌及面肌痉挛79例，结果报告如下。     

A型肉毒毒素治疗局限性肌张力障碍的临床应用

目的摸索国产A型肉毒素(BTX-A)在神经科的临床用途。方法用A型肉毒素局部治疗面肌抽搐25例,眼睑痉挛11例,Meige综合征2例,咬肌痉挛2例,紧张性头痛6例,脑卒中后肢体痉挛10例,脑炎后肢体痉挛2例。结果面肌抽搐、眼睑痉挛有效率100%,Meige综合征部分缓解,紧张性头痛5例有效,1例无明显疗效,咬肌痉挛1例有效,1例无效,脑卒中后肢体痉挛8例缓解,2例效,脑炎后肢体痉挛2例均有不同程度改善。结论A型肉毒毒素注射治疗不失为神经科治疗局限性肌张力障碍一有效手段,其操作简便,副作用少。     

A型肉毒毒素治疗肌张力障碍：409例疗效分析

目的：分析A型肉毒毒素治疗肌张力障碍的疗效及其安全性。方法：肌张力障碍患者采用A型肉毒毒素局部多点注射痉挛肌肉，治疗前后对照，评价其治疗效果并观察其不良反应。结果：面肌抽搐175例，眼睑痉挛63例，Meige综合征40例，脑性瘫痪37例，痉挛性斜颈34例，紧张性头痛31例，脑卒中后痉挛29例，总有效率达99．3％。起效时间平均4h-3d，疗效维持时间平均7个月，局部副作用轻微、短暂。结论：A型肉毒毒素治疗肌张力障碍是一种安全有效、副作用轻微且可逆、简便易行的治疗方法。     

肉毒素A在痉挛性脑性瘫痪中的应用

目的 观察肉毒素A(BTX—A)在治疗痉挛性脑性瘫痪中肌肉注射矫治肌痉挛的疗效及副作用。方法 BTX—A4～6u／kg体质量，注射到肌腹部痉挛变硬的部位。开始用中小剂量，六七天疗效不明显，可用足量分一两次，间隔6～8h补充注射。重复注射3～6个月。注射后lO～24h观察疗效，随诊观察2～6个月。结果 49例患儿，总有效率98％，肌痉挛均有不同程度的缓解。78％患儿得到较好的缓解。无一例出现副作用。结论 BTX—A注射，安全、实用、缓解肌痉挛快，不损伤肌组织。     

A型肉毒毒素治疗头颈部肌张力障碍100例

目的观察A型肉毒毒素治疗面肌抽搐、眼睑痉挛及痉挛性斜颈的疗效。方法采用国产A型肉毒毒素局部注射治疗100例头颈部局限性肌张力障碍患，应用肌电图确定注射肌肉及用同轴电极针局部注射A型肉毒毒紊治疗8例痉挛性斜颈，分析其治疗效果与剂量、注射位点的关系。结果采用Cohen等分级标准，76例偏侧面肌痉挛，完全缓解15例，明显缓解57例；16例眼睑痉挛，完全缓解7例，明显缓解9例；采用Tsui等评分标准，8例痉挛性斜颈明显缓解；总有效率100％。治疗后跟睑及面肌抽搐明显减轻或消失，患满意率100％。偏侧面肌痉挛及眼睑痉挛起效时间8～48h，使用剂量20～40u，最佳使用剂量30～35u；痉挛性斜颈起效时间7～10d。副反应轻微、短暂，无全身反应及过敏反应。结论A型肉毒毒紊局部肌肉注射是治疗局限性肌张力障碍病的首选方法。主张多位点、小剂量注射，肌电图定位引导注射A型肉毒毒素对痉挛性斜颈可减少药物使用剂量，提高疗效。     

A型肉毒毒素治疗头颈部肌张力障碍196例临床研究

目的：探讨进一步提高A型肉毒毒素治疗多种类型头颈部肌张力障碍的有效性及降低药物副作用的方法。方法：对196例患者采用A型肉毒毒素局部多点肌注。结果：治疗偏面肌痉挛、眼睑痉挛、Meige综合征和痉挛性斜颈的显效率分别为100%,96.9%,91.7%和83.3%。局部副作用轻微、短暂且可自行消失。结论：A型肉毒毒素治疗头颈部肌张力障碍疗效显著且安全性好,可作为首选疗法。严格操作规程及掌握适当剂量甚为重要。     

国产A型肉毒毒素治疗眼睑及面肌痉挛疗效评价

目的评价国产A型肉毒毒素局部注射法治疗眼睑痉挛及面肌痉挛的效果。方法120例眼睑痉挛患者，92例面肌痉挛患者，根据病情选择注射点局部注射A型肉毒毒素，2～6个月后观察痉挛缓解症状。结果完全缓解者140例，占66％；明显缓解62例，占29．2％；部分缓解10例，占4．8％；总有效率100％。疗效维持时间为2～6个月，绝大部分病人维持3-4个月，个别病例观察半年仍未复发。治疗后复发者156例，再次重复注射痉挛又获得缓解，维持时间与初次治疗大致相同。结论应用国产A型肉毒毒素治疗眼睑痉挛及面肌痉挛安全有效，是目前治疗肌张力障碍性疾病较为理想的治疗方法，又因其操作简单，不需特殊设备，值得在基层医院推广应用。     

A型肉毒毒素治疗脑卒中后肌张力障碍的疗效及安全性

目的 探讨A型肉毒素治疗脑卒中后肢体肌张力障碍或痉挛的疗效及安全性。方法 根据肌肉大小和痉挛程度，选择位点及剂量。每个位点测量5－10U，总剂量不超过200U，于注射前，注射后1，2，4周，采用Ashowrth量表评定肌张力。结果 注射后1-3d起效，注射后1周与注射前比较肌张力显减低；注射后2周Ashowrth评分虽有减少，但与注射后1周比较，Ashowrth评分无显性差异；注射后4周与注射后2周比较，Ashowrth评分无显性差异，未发现局部副作用及全身并发症。结论 BTX－A局部肌肉注射，治疗脑卒中后肢体肌张力障碍安全有效。     

Cognitive Performance After Facial Botulinum Toxin Treatment in a Cohort of Neurologic Patients: An Exploratory Study

ObjectiveTo investigate higher cognitive functions after mimicry changes after facial botulinum toxin (BTX) injections, we tested verbal and nonverbal reasoning in patients with blepharospasm or hemifacial spasm before and after their long-term botulinum toxin treatment.DesignExplorative, nonrandomized, clinical trial.SettingPatients receiving ambulatory care and control participants from the general community.ParticipantsVolunteer sample (N=84) of patients (n=21) with blepharospasm or hemifacial spasm who received facial BTX injections. Control participants included patients (n=30) with cervical dystonia who received cervical BTX injections and individuals without neurological disorders (n=33).InterventionsThe 2 groups receiving injections were tested before and 3 weeks after their treatment. The group without neurological disorders received no injections.Main Outcome MeasuresVerbal and nonverbal reasoning scores.ResultsThe key unexpected finding was that patients who received facial BTX injections perform significantly worse in nonverbal reasoning tasks, when compared with those who did not receive injections (P=.022). There was no significant difference in the baseline reasoning scores and at follow-up for verbal reasoning between the 3 groups. There was no correlation between toxin dose and reasoning scores (verbal: P=.132; nonverbal: P=.294).ConclusionsBecause of potential confounders, the results do not yet allow any conclusion on causality. Further research is needed to confirm our findings.     

A型肉毒杆菌毒素治疗面肌痉挛235例临床研究

目的探讨A型肉毒杆菌毒素(BTXA)治疗面肌痉挛(HFS)的疗效及副作用.方法对235例HFS病人进行面肌多点注射BTXA,对治疗前后的病情分级进行比较,并随访12～36周.结果BTXA治疗的总有效率为98.3%(231/235),无全身反应,半年复发率为60%,药效作用时间平均16周;重复注射同样有效.结论局部注射BTXA是治疗HFS的一种有效手段.     

A型肉毒毒素注射治疗眼睑及面肌痉挛的效果与护理

目的探讨小剂量A型肉毒毒素多点注射治疗眼睑及面肌痉挛的临床疗效、安全性及护理方法。方法105例眼睑及面肌痉挛患者,给予小剂量A型肉毒毒素多点注射治疗,进行复诊或电话随访,记录复诊、电话随访的临床指标,并给予心理护理、注射护理和健康教育。结果经过电话随访或复诊,105例患者均在1～3d内显效,平均（1．1±0．5）d;完全缓解64例（60．95％）,明显缓解28例（26．67％）,部分缓解6例（5．71％）。无全身中毒及过敏反应,局部不良反应轻微、短暂。结论小剂量A型肉毒毒素多点注射治疗眼睑及面肌痉挛的临床疗效确切,安全性较高,针对患者给予细心周到的护理,对患者康复、减轻其身心痛苦具有重要意义。     

Long-term treatment with botulinum toxin: dosage, treatment schedules and costs

Local injection of botulinum toxin A (BTX) is considered as the treatment of choice for spasmodic torticollis (ST), blepharospasm (BS) and, with certain limitations, for hemifacial spasm (HFS). Long-term data from 89 patients with ST, 39 patients with BS and 15 patients with HFS were evaluated and subgroups of patients who received at least three (60 ST, 17 BS, 9 HFS), six (35 ST, 10 BS, 8 HFS) and nine (26 ST) re-injections were formed. These groups were investigated in regard of increases in the dosage of BTX and in regard of shorter treatment intervals in cases of repeated treatment. Annual drug costs were calculated from these data. Patients treated at least three times were asked to fill out a questionnaire concerning satisfaction and the quality of life after BTX treatment. Furthermore, the patients' "willingness to pay" for BTX treatment was investigated. Our calculations showed neither a significant increase in the dosage of BTX nor a significant reduction in the length of treatment intervals after 3 or 6 treatment sessions. Annual drug costs for BTX for the treatment of ST were 10,542 ATS, of BS 2847 ATS and of HFS 1029 ATS. 86.1% of patients with ST, 88.9% with BS and 100% with HFS were very satisfied or satisfied with the BTX treatment. In all 3 diagnostic groups, a significant mean improvement of quality of life was measured on a visual analogue scale (p < 0.001). We conclude that the injection of botulinum toxin A is a highly effective and cost effective treatment for ST, BS and HFS, and significantly increases the quality of life of all these patients.     

全内镜血管减压术治疗面肌痉挛疗效分析

目的探讨全内镜血管减压术(EVD)治疗面肌痉挛(HPS)的疗效。方法选取2019年5月至7月宁波市鄞州第二医院就诊的HFS患者15例,均行EVD手术。术中探查面神经与责任血管的压迫程度,术后随访6~8个月,观察临床疗效。结果患者术后即刻缓解率达100%,痊愈14例,明显缓解1例。术中发现面神经根部均存在责任血管压迫。除个例颅神经损害外,无颅内及切口感染患者。结论EVD治疗HFS安全、有效,并能确认责任血管以及面神经受压部位,有助于提高血管减压术治愈率。     

书写痉挛责任肌群的认定及肉毒毒素治疗的疗效观察

目的　寻找引起患者书写痉挛 (writer scramp)并导致字迹抖动不清的主要责任肌群 ,并同时观察局部注射肉毒毒素 A (botulinumtoxin A ,BTX A)对书写痉挛病症的治疗效果及副反应发生情况。方法　通过对前臂肌群的选择性运动 ,判断各肌群对书写痉挛症状的影响 ,并初步认定责任肌群 ,然后用维库溴铵对初步确定的责任肌群进行选择性注射 ,以进一步确定引起书写痉挛的主要责任肌群 ,最后对已确定的主要责任肌群进行BTX A多点注射 ,观察其疗效及副反应发生情况。结果　本研究发现 ,当前臂旋转肌群运动时会加重书写痉挛症状 ,对该群肌肉注射维库溴铵后可消除痉挛症状。当对旋转肌群进行BTX A注射后 ,受试的 3例患者 (共 5侧患肢 )症状全部得到改善 ,无一例发生可察觉的握力减退及垂腕等副反应。结论　前臂旋转肌群是导致书写痉挛并致使字迹抖动不清的主要责任肌群 ,对其进行BTX A选择性多点注射可获得满意疗效 ,同时还可避免握力减退及垂腕等副反应的发生。     

微血管减压术治疗颅神经疾病疗效分析

目的 探讨微血管减压术治疗三叉神经痛、面肌痉挛、舌咽神经痛的疗效. 方法 微血管减压手术治疗颅神经疾病156例(三叉神经痛119例,面肌痉挛34例,舌咽神经痛3例). 结果 总有效151例,有效率96.8%,其中三又神经痛、面肌痉挛和舌咽神经痛患者手术有效率分别为94.2%、97.1%和66.7%. 结论 微血管减压术治疗颅神经疾病疗效确切.     

A型肉毒毒素注射治疗偏侧面肌痉挛的临床应用价值

目的：探讨A型肉毒毒素注射治疗偏侧面肌痉挛的临床应用价值及其安全性。方法：应用A型肉毒毒素注射治疗105例偏侧面肌痉挛患者,单纯口服药物治疗44例偏侧面肌痉挛患者。对比观察2组平均起效时间、疗效持续时间、不良反应发生率、不良反应持续时间、年平均治疗次数、年平均治疗费用、显效率及总有效率。结果：2组平均起效时间分别为（3．4±1．4）d和（12．6±3．9）d,疗效持续时间分别为（169．5±46．3）d和（6．8±2．8）d,不良反应发生率分别为28．6％和68．2％,不良反应持续时间分别为（16．5±5．7）d和（6．3±1．1）d,年平均治疗天数分别为（2．6±0．7）d和（292．6±8（1．4）d,年平均治疗费用分别为（972．4±67．4）元和（1873．3±547．6）元,显效率分别为94．3％和34．1％,总有效率分别为100．0％和59．1％,2组上述结果之间比较均有显著差异（P〈0．（）1）。结论：与口服药物治疗相比,应用A型肉毒毒素局部注射治疗偏侧面肌痉挛不仅临床起效快,疗效显著,不良反应较少,临床安全性好,而且治疗成本较低,具有较高的临床应用价值,可作为无禁忌证偏侧面肌痉挛患者的首选治疗。     

彩超水囊引导下A型肉毒毒素注射治疗面肌痉挛的临床疗效

目的:探讨彩超水囊引导下肉毒毒素注射治疗面肌痉挛的疗效。方法:面肌痉挛患者96例,随机分为A、B组各48例,A组给予口服药物6个月,B组给予彩超水囊引导下局部注射A型肉毒毒素(BTX-A)。治疗前后分别采用Cohen、Acbert痉挛强度分级评估疗效,观察2组疗效、持续时间、显效率和治疗前后肌痉挛强度及变化情况。结果:A组治疗后肌痉挛强度变化无统计学差异,B组治疗后肌痉挛强度变化有显著性差异(P<0.01),且显效率高于A组(P<0.01)。结论:彩超水囊引导下BTX-A注射治疗能显著降低面肌痉挛的肌张力,且安全、简单易行。     

Botulinum neurotoxin for the treatment of migraine and other primary headache disorders: from bench to bedside

Botulinum toxin type A, a neurotoxin, is effective for treating a variety of disorders of involuntary muscle contraction including cervical dystonia, blepharospasm, and hemifacial spasm. It inhibits neuromuscular signaling by blocking the release of acetylcholine at the neuromuscular junction. The biological effects of the toxin are transient, with normal neuronal signaling returning within approximately 3 to 6 months postinjection. Recent clinical findings suggest that botulinum toxin type A may inhibit pain associated with migraine and other types of headache. However, the mechanism by which this toxin inhibits pain is not fully understood and is under investigation. Research findings suggest that botulinum toxin type A inhibits the release of neurotransmitters from nociceptive nerve terminals and, in this way, may possess an analgesic effect. A number of retrospective open-label chart reviews and 3 double-blind, placebo-controlled trials have demonstrated that localized injections of botulinum toxin type A significantly reduce the frequency, severity, and disability associated with migraine headaches. Although the majority of patients in these studies experienced no botulinum toxin type A-mediated side effects, a small percentage of patients did report transient minor side effects including blepharoptosis, diplopia, and injection-site weakness. Currently, 4 randomized, placebo-controlled, clinical trials are being conducted to evaluate the efficacy, optimal dosing, and side-effect profile of botulinum toxin type A as a novel treatment for migraine and other types of headache. These studies may provide further evidence that botulinum toxin type A is an effective option for the preventive treatment of migraine.