Impact on quality of life of botulinum toxin treatments for essential blepharospasm

purpose To determine the impact on quality of life of Botulinum toxin therapy for essential blepharospasm. methods A cross-sectional study was undertaken using the Glasgow Benefit Inventory, in the form of a postal questionnaire, to assess the subjective patient benefit of Botulinum toxin treatments for essential blepharospasm in 44 consecutive patients attending a specialist Botulinum toxin clinic. (The Glasgow Benefit Inventory generates a score from ?100 (maximum harm) through 0 (no effect) to +100 (maximum benefit) for the intervention under investigation.) The Wilcoxon signed-ranks test was used to test the significance of the total scores and subdomain scores. results A high response rate of 36 out of 44 (81.8%) was achieved. The median total benefit score was +29.2 (97.1% CI = 16.7 to 38.9, p < 0.0001). The median subdomain scores were: general +43.8 (97.1% CI = 20.8 to 54.2, p < 0.0001), social 0.0 (97.1% CI = 0.0 to 16.7, p = 0.0019) and physical 0.0 (97.1% CI = 0.0 to 0.0, p = 0.4810). conclusions This study demonstrates significant quality of life benefit from Botulinum toxin therapy for essential blepharospasm, and justifies continued treatment.     

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。     

Tear production and drainage after botulinum toxin A injection in patients with essential blepharospasm

Purpose: To evaluate the clinical manifestations of tear production, distribution and drainage in the essential blepharospasm patients, and to analyse the changes after botulinum toxin A injection in these patients. Methods: This prospective study was performed in 23 patients with essential blepharospasm treated with Botulinum neurotoxin A (BoNT‐A; Dysport, Ipsen Biopharm, UK) from November 2010 to February 2011. Ocular examinations, including frequency and severity of blepharospasm, tear break up time (BUT), Schirmer’s test, lower lid tear meniscus height (TMH) measured by optical coherence tomography (OCT, rtvue software version 3.5; Optovue Inc., Fremont, CA, USA), and dacryoscintigraphy using 99m technetium pertechnetate, were performed before and 2 weeks after BoNT‐A injection. We asked all patients about changes in the dry eye symptom score, before and after treatment. Results were analysed with independent t‐test using spss software version 12.0 for Windows XP, (SPSS Inc., Chicago, IL, USA). Results: Botulinum neurotoxin A treatment relieved blepharospasm in all patients. Mean injection dose was 38 ± 5.6 units. After injection, mean tear BUT was significantly increased from 4.7 ± 4.9 to 6.6 ± 1.6 seconds (p = 0.001) Lower TMH increased in all three points and most notably at the lateral point (p = 0.05). On dacryoscintigraphy, tear drainage velocity was not affected by BoNT‐A treatment. But Tc‐99m 50% clearance time in interpalpebral fissure significantly increased from 1564 to 2220 seconds on the time activity curve (p = 0.027). Subjective dry eye symptoms also improved in 16 patients (70%) after injection. Conclusion: Tear film stability and TMH increased, but tear drainage velocity was not affected by BoNT‐A treatment. Overall Tc‐99m 50% clearance time in interpalpebral fissure significantly increased, and tear storage from mild lateral lower eyelid laxity increased after BoNT‐A injection. Botulinum neurotoxin A injection was also effective for combined dry eye symptom in the essential blepharospasm patients.     

Difference in response to botulinum toxin type A treatment between patients with benign essential blepharospasm and hemifacial spasm

Background: Botulinum toxin (BTX) is the first‐line treatment in managing benign essential blepharospasm (BEB) and hemifacial spasm (HFS). We wished to assess the difference in duration of effect and the number of BTX treatments required to treat patients with BEB and HFS. Methods: A prospective study of patients attending the BTX clinic in Manchester Royal Eye Hospital over 6 months. All treatments were administered by a single experienced ophthalmologist. A questionnaire was completed for each patient. In patients with BEB where the BTX was injected bilaterally, one side was randomized to compare with HFS patients. Patient demographics, cumulative dose of BTX, duration of BTX effect with patient satisfaction and the number of previous BTX injections were recorded. Results: Sixty‐four patients were included in the study. The mean age was 60.8 years. Among them, 30 patients had BEB and 34 had HFS. Patients with HFS received a lower mean dose of BTX than patients with BEB (12.23 units vs. 16.2 units). The patients with HFS had a longer duration of effect than patients with BEB, with fewer BTX treatments. Of all patients, 90% with HFS and BEB were satisfied with the effect of their last BTX injection. Three unsatisfied patients in the BEB group were referred on for surgical management of their disorder. Conclusions: We have shown that patients with BEB have a shorter duration of effect with BTX and require more frequent BTX treatments than patients with HFS, highlighting that facial dystonias in patients with BEB is more challenging to manage.     

重度特发性睑痉挛的手术治疗

目的 探讨重度特发性睑痉挛患者施行不同手术方法的临床效果和安全性.方法 选取 重度特发性睑痉挛20例40只眼,均为双眼发病,根据患者不同的临床表现,分别采取三种术式之一:次全肌切除术、全肌切除术、Anderson手术法.术后随访1年至1年半.结果 20例患者,均明显减轻睑痉挛的程度,所有病例眉下垂、上睑下垂、睑裂横径缩小、睑皮松弛等现象均减轻或消失.双眼睑外观基本对称,睑裂开闭自如,上睑缘位于上角巩缘与上瞳孔缘之间,功能性视力障碍消失.结论 手术治疗重度特发性睑痉挛是安全有效的方法.     

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。     

眼轮匝肌痉挛的病因与治疗方法探讨

为探讨单侧眼轮匝肌痉挛的病因及治疗方法，对１８２例患者观察了临床症状、体征，进行了Ａ型肉毒杆菌毒素治疗；３６例作了肌电图检查，１５例作了脑干磁共振血管成像检查（ＭＲＡ）。结果：１８２例眼轮匝肌痉挛者在数月后１７６例扩展致同侧全部面肌，Ａ型肉毒毒素治疗有效率为９４％，半年后复发率为８６％；肌电图检查患侧均出现自发性动作电位；脑干ＭＲＡ检查１５例患者中，１４例出现血管变异。结论：眼轮匝肌痉挛的病因与脑干血管变异，压迫面神经根出脑干处有关；Ａ型肉毒毒素治疗有效率９４％，不失为一种较好的治疗方法     

肉毒毒素治疗眼睑、面肌痉挛的临床疗效

目的 肉毒毒素治疗眼睑、面肌痉挛的临床疗效及其应用。方法 应用肉毒毒素对眼睑、面肌痉挛患者进行局部肌肉多点注射法。结果 21例眼睑、面肌痉挛经注射肉毒毒素，大部分完全缓解或明显缓解，仅少部分为部分缓解，有效率达100％。全部病例均未出现全身毒副作用，局部并发症有轻微上睑下垂，均于治疗后3～4周自然恢复。结论 肉毒毒素局部注射为眼睑、面肌痉挛患者提供了一个安全、有效、可靠的治疗方法，值得临床推广使用。     

眶周肌肉切除术与A型肉毒毒素治疗特发性眼睑痉挛的选择与评估

目的：探讨眶周肌肉切除术与A型肉毒毒素治疗眼睑痉挛的选择依据。
　　方法：回顾性分析2012-03/2014-05来我科诊治的特发性眼睑痉挛患者100例,根据眼睑痉挛的程度将其分成0~Ⅳ级,按分级分为两组：A 组为眼睑痉挛I~Ⅲ级患者60例,行A型肉毒毒素治疗;B组为眼睑痉挛>Ⅲ~Ⅳ级患者40例,采用眶周肌肉切除术治疗。术后随访3~24 mo。结果：A组60例患者行A型肉毒毒素注射后,57例患者眼睑痉挛分级为0级,完全矫正,2例注射后残留部分痉挛,但分级均明显下降,1例无效。 B组40例患者中有25例患者行肉毒毒素治疗已耐受,属复发性并伴有眉下垂和上睑下垂症状,均改行眶周肌肉切除术,患者行眶周肌肉切除术后,30例患者痉挛分级为0级,7例为I级,3例为Ⅱ级。
　　结论：根据眼睑痉挛的临床分级,正确选择特发性眼睑痉挛的治疗方法可提高治疗的有效性和安全性。     

A型肉毒毒素不同注射位置治疗眼睑痉挛的疗效观察

目的：比较A型肉毒毒素不同注射位置治疗眼睑痉挛的治疗效果。方法：选择我院2012-06/2015-06收治的85例136眼眼睑痉挛患者作为研究对象,按随机数字表分为A组(43例66眼)与B组(42例70眼)。两组患者均应用注射用A型肉毒毒素进行治疗,A组采取完全注射模式,B组采取豁免下睑内侧组模式。比较两组患者治疗前、治疗后3 wk的Jankovic评定量表( Jankovic Rating Scale,JRS)评分、眼睑痉挛残疾指数( Blepharospasm Disability Index,BSDI)指数、泪膜破裂时间( break-up time,BUT)、前段OCT泪河高度(tear meniscus height,TMH)、副反应发生率及随访90d复发率。结果：两组患者治疗前的 JRS 评分、BSDI 指数、BUT 与TMH无统计学差异(均P>0.05);治疗后1 wk两组患者BUT与TMH均增大,治疗后3 wk两组患者JRS评分、BSDI指数均下降,组内前后差异有统计学意义(P<0.05);治疗后两组患者JRS评分、BSDI指数、BUT的组间差异无统计学意义( P>0.05);A组TMH高于B组,组间差异有统计学意义(P<0.05)。90d随访结果显示,A组和B组复发率分别为14.0%、11.9%,副反应发生率分别为23.3%和16.7%,两组比较均无统计学差异(P>0.05)。结论：A型肉毒毒素采取完全注射模式及豁免下睑内侧注射模式治疗眼睑痉挛均可有效缓解患者症状,并减轻其对日常生活的影响,随访90 d复发率接近,豁免下睑内侧注射模式可减轻对泪膜稳定及泪液引流的干扰,具有微小优势。     

Videonystagmography as a tool to assess blepharospasm before and after botulinum toxin injection

BACKGROUND: The aim of this paper was to study blinking parameters using a videonystagmography device, in order to objectively determine disability, and to assess the efficiency of botulinum toxin injection in patients with essential blepharospasm. METHODS: Blinking was studied using the features of pupillary occlusion (PO) as recorded on a videonystagmography device. In 23 patients presenting with essential blepharospasm, we studied the frequency, the percentage, the mean duration of PO, and the longest PO in a 5-minute test period. Patients were tested prior to botulinum toxin injection, and 1 month and 3 months after injection, respectively. PO levels lower than 0.3 s and higher than 0.3 s were studied separately. RESULTS: At 1 month after injection, botulinum toxin significantly influenced PO higher than 0.3 s, both in frequency (9.6/min +/- 8.2 on Day 0 and 4.7/min +/- 7.2 at Month 1; p = 0.004), and in mean duration (0.95 s +/- 0.84 on Day 0 and 0.58 s +/- 0.34 at Month 1; p = 0.03). On the other hand, we found no significant effect on PO lower than 0.3 s, both in frequency (32.4/min +/- 28.4 on Day 0 and 31.3/min +/- 29.0 at Month 1; p = 0.7) and in mean duration (0.16 s +/- 0.04 on Day 0 and 0.15 s +/- 0.03 at Month 1; p = 0.04). Botulinum toxin also significantly influenced the mean duration of the longest PO (6.44 s +/- 9.4 on Day 0 and 1.55 s +/- 1.9 at Month 1; p = 0.004) as well as the percentage of PO (29.95% +/- 24.6 on Day 0 and 13.44% +/- 11.1 at Month 1; p = 0.003). CONCLUSIONS: PO can be used as the indirect sign of blinking. Videonystagmography provides a real-time result, and could be used to objectively evaluate the effect of botulinum toxin treatment in essential blepharospasm patients.     

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。     

A型肉毒杆菌毒素不同注射位点在眼睑痉挛治疗中差异的对比研究

目的 研究眼睑痉挛治疗中,A型肉毒杆菌毒素的眼轮匝肌不同注射模式对泪膜和早期疗效的影响.方法 眼睑痉挛患者(20例)左右眼随机分入A组(全注射组)和B组(豁免下睑内侧组),A组20眼注射上睑内外侧、下睑内外侧、外眦部及眉头.B组20眼不注射下睑内侧部位点,其余注射位点同A组.观察注射前、注射后1周、注射后4周,患者眼睑痉挛主观症状评价量表、眼睑闭合不全高度、泪膜破裂时间、基础泪液分泌试验、前段相干光断层扫描测量泪河宽度.结果 注射前、注射后1周和4周3个时间点,A组与B组患者眼睑痉挛Jankovic评价量表得分差异无统计学意义(P＞0.05).注射后1周部分患者出现眼睑闭合不全,但于注射后4周眼睑闭合程度显著减轻,与注射后1周相比差异有统计学意义(P＜0.05),A组和B两组间差异无统计学意义(P＞0.05).泪膜破裂时间、基础泪液分泌试验2组间差异无统计学意义(P＞0.05);前段OCT测量泪河宽度,注射后1周2组较注射前增大(P＜0.05);注射后4周,和注射前相比差异无统计学意义;注射后1周:A组较B组泪河宽度增加,分别为(0.44 ±0.13) μm和(0.33 ±0.18) μm,差异有统计学意义(P＜0.05).结论 在A型肉毒杆菌毒素注射治疗眼睑痉挛中,豁免下睑内侧的注射位点的模式于注射后早期对泪液引流的影响较少,对眼睑痉挛症状的早期控制两者无显著差异.     

Retrobulbar botulinum toxin for treatment of oscillopsia

Two cases are presented in which multiple episodic retrobulbar botulinum toxin injections have diminished incapacitating acquired oscillopsia and nystagmus and improved visual acuity. One transient ptosis occurred in six procedures. Improvement duration averaged approximately three months. This is a simple, safe and effective therapy where alternative treatments are typically unsatisfactory.     

A型肉毒毒素注射与手术治疗儿童共同性斜视的临床比较

目的比较A型肉毒毒素(BTA)注射与手术治疗儿童共同性斜视的疗效。 方法纳入2018年4月至2019年8月就诊于北京同仁医院眼科中心的共同性斜视患儿142例作为研究对象。其中,男性74例,女性68例;年龄3~15岁,平均年龄(7.2±2.6)岁。按照家属的选择意愿分为注射组和手术组。注射组患儿采用BTA眼外肌注射治疗,手术组患儿采用斜视矫正术治疗。检查并记录治疗前与治疗后6个月患儿的斜视度、双眼视觉功能以及并发症情况,治疗后6个月患儿的眼位正位率等指标。注射组和手术组患儿斜视度与双眼视觉功能的定量数据,用均数±标准差描述,采用独立样本t检验进行组间比较,采用配对样本t检验进行组内比较。患儿双眼视觉功能的定性数据,眼位正位率与并发症等指标的描述采用频数和百分率表示,采用卡方检验进行组间比较。 结果治疗后6个月,注射组患儿的眼位正位率为58.2%,手术组患儿的眼位正位率为69.3%。两组患儿眼位正位率的比较,差异无统计学意义(χ²＝1.90,P>0.05)。注射组患儿斜视度绝对值在注射前和注射后6个月分别为(35.23±6.69)△和(12.35±10.16)△;手术组患儿斜视度绝对值在手术前和手术后6个月分别为(35.40±8.74)△和(9.16±9.43)△。治疗前与治疗后6个月,两组患儿斜视度绝对值的比较,差异无统计学意义(t＝-0.13,1.92;P>0.05)。注射组和手术组患儿在治疗后6个月随访时,具有正常同视机Ⅰ级功能(同时视)的分别有25例(占39.1%)和38例(占50.7%);具有正常同视机Ⅱ级功能(融合视)的分别有43例(占67.2%)和70例(占93.3%);具有正常同视机Ⅲ级功能(立体视)的分别有26例(占40.6%)和37例(占49.3%);具有正常近立体视功能的分别有27例(占42.2%)和38例(占50.7%),与治疗前相比均有所增加。治疗后6个月,手术组具有同视机Ⅱ级功能(融合视)患儿的比例高于注射组,差异有统计学意义(χ²＝15.52,P<0.05),其余差异均无统计学意义(χ²＝1.88,1.06,0.99;P>0.05)。注射组所有患儿主诉出现复视,16例患儿表现出轻度上睑下垂和结膜下出血,均于随访1~3个月时消失。 结论对于斜视度为中低度数(15△~50△)的患儿,BTA注射与手术治疗儿童共同性斜视在治疗后6个月临床疗效相近,是一种安全有效的治疗方法。     

Long-term results of treatment of idiopathic blepharospasm with botulinum toxin injections.

One hundred and one patients with idiopathic blepharospasm have been treated with injections of botulinum toxin A into the orbicularis oculi. Ten had previously had facial nerve avulsions and responded well, normal visual function being restored in the majority (7/10) for an average of 14 weeks. Without prior surgical treatment the response was more variable, but 71/91 regained normal or near normal vision. Older patients, those with a family history of the condition, and those without oromandibular dystonia responded slightly better. The severity of the blepharospasm, the length of the history, and spontaneous resolution of an episode of focal dystonia in the past had no influence on the outcome. Results were poor in the presence of an associated neurological disorder. Side effects, particularly a temporary partial ptosis, were common but were well tolerated. The average duration of improvement was eight weeks in men, nine in women, and there was no evidence of any increase in duration after multiple injections. Eighty nine patients continued with injections, 11 opted for surgical treatment, and one resumed drugs.     

肉毒杆菌毒素A治疗特发性上睑退缩的临床观察

目的　研究经结膜下进针提上睑肌及M櫣ｌｌｅｒ肌注射肉毒杆菌毒素Ａ治疗特发性上睑退缩的临床效果。方法　对 2 2例 ( 2 2眼 )特发性上睑退缩患者 ,应用肉毒杆菌毒素A经上睑上 1 / 3内、外侧结膜进针 ,注射于提上睑肌及M櫣ｌｌｅｒ肌 ,根据上睑退缩程度分别给予 2 5u、 4u、 5u。所有病例追踪观察 8～ 2 8周。观察上睑缘位置 ,效果欠佳者隔 1个月可再次注射。结果　所有病例注射肉毒杆菌毒素A后约 1～ 6d出现麻痹效果 ,1 0d左右达到高峰 ,上睑缘下降 1～ 4mm ,效果持续 4～ 2 0周 ,半年后上睑缘均恢复于发病前生理位置。结论　经结膜下的提上睑肌及M櫣ｌｌｅｒ肌注射肉毒杆菌毒素Ａ是治疗特发性上睑退缩的有效方法。     

Early and late botulinum toxin treatment of acute sixth nerve palsy

Ten patients with sixth nerve palsy were treated with botulinum toxin injection to the antagonist nonparetic medial rectus. All patients were followed for a minimum of 14 months after the last injection. Six patients were treated within eight weeks of the onset of the palsy. Within a few days five of the six gained fusion, without the necessity of a marked head turn and none complained of confusing reversal of diplopia. The same five recovered full function. Four patients with no medial rectus contracture on forced duction testing were treated six months or longer after the onset of the palsy and none recovered full function. One of the four patients was permanently over-corrected despite persistent weakness of the lateral rectus.
This preliminary report suggests that early botulinum toxin injection of patients with recent onset (acute) sixth nerve palsy is beneficial. Since some patients may recover spontaneously a randomised double-blind study is necessary to more precisely determine the effectiveness of this form of therapy. Botulinum toxin does not appear to be effective in facilitating recovery in those cases with poor lateral rectus function six months or longer after the onset of the palsy, even when there is no contracture of the medial rectus.     

Long-term results and complications of botulinum A toxin in the treatment of blepharospasm

The authors review their long-term results and complications with the use of botulinum A toxin in the treatment of facial dystonias. Two hundred thirty-two patients in three diagnostic groups--essential blepharospasm, hemifacial spasm, and Meige's syndrome--were treated with botulinum A toxin. A total of 1044 treatments were given over a 4-year period. A reduction in orbicularis spasm intensity was noted in 1012 (96.9%) treatments (mean duration, 13.3 weeks). There was no clear relationship between toxin dose and the amount of spasm reduction or duration of response, and average duration of beneficial effect remained constant from the first through the twelfth injections. Complications occurred in 236 (22.6%) treatments. In most cases, these were local and transient. Symptomatic dry eye was the most common side effect, noted in 7.5% of cases. Ptosis was reported in 7.3% of treatments and photophobia in 2.5%. Diplopia involving the inferior oblique or lateral rectus muscles was seen in less than 1% of cases. There were no differences in degree of response or in complications among the three diagnostic groups, although there was a slight difference in duration of effect. Patients who had undergone previous eyelid surgery for blepharospasm did not respond differently from those without prior surgery.