A型肉毒毒素治疗面肌痉挛、眼睑痉挛疗效观察

目的观察A型肉毒毒素治疗面肌、眼睑痉挛的疗效。方法采用A型肉毒毒素局部注射治疗偏侧面肌痉挛51例、眼睑痉挛8例,并使用Cohen和Albert量表对疗效进行评估。结果31例(52.5%)症状完全缓解,22例(37.2%)明显改善,6例(10.1%)部分改善,疗效平均持续约9～33周,复发者重复注射仍有效。不良反应可出现眼睑闭合不全、面肌无力、眼睑下垂等共18例,均在4周内恢复。结论局部注射A型肉毒毒素确为一种安全有效的治疗面肌、眼睑痉挛的方法。     

A型肉毒毒素治疗面肌及眼睑痉挛的临床疗效

我们从 1997年 5月～ 2 0 0 0年 7月采用Ａ型肉毒杆菌毒素治疗面肌及眼睑痉挛 180例 ,结果报告如下。1　临床资料1.1　一般资料　男 76例 ,女 10 4例 ;年龄 32～ 74岁 ,平均 5 4± 14岁。病程 3个月～ 12年。面肌痉挛 16 8例 ,眼睑痉挛12例。右侧 80例 ,左侧 84例 ,双侧 16例 ;痉挛强度分级 :Ⅱ级 8例 ,Ⅲ级 116例 ,Ⅳ级 5 6例。均为药物、手术及针灸等治疗无效者 ,并至少随访 6个月 (6～ 16个月 )。1.2　治疗方法　Ａ型肉毒毒素行眼轮匝肌及面肌多点注射 ,每点注射量为 0 .1～ 0 .2ｍｌ(2 .5～ 5 .0Ｕ) ,总剂量为各注射点剂量之和 ,有残存…     

A型肉毒毒素治疗眼睑痉挛与面肌痉挛的临床研究(附68例报告)

<正> 对象和方法 一、对象 本组68例,男38例,女30例,年龄32～78岁(平均56±10.4岁),病程6个月～30年,眼睑痉挛16例,偏侧面肌痉挛52例,均为药物、针灸、理疗治疗未能控制者。随访时间一年。     

A型肉毒毒素治疗眼睑及面肌痉挛的临床分析

目的观察A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛的临床疗效，探讨眼睑及面肌痉挛的病因。方法应用A型肉毒毒素对105例眼睑及偏侧面肌痉挛患者行面部肌肉局部多点注射，对治疗前后的病情分级进行对比，分析治疗效果。结果71例面肌痉挛者完全缓解35例（49．3％），明显缓解34例（47．8％），无效2例（2．8％）。34例眼睑痉挛者，22例完全缓解，12例明显缓解，总有效率达98％。起效时间数小时至7d，缓解时间3～8个月，局部不良反应轻微、短暂，无全身反应及过敏反应，其中2例引起面肌萎缩。4例MRA中3例检出有椎动脉、小脑后下动脉、小脑前下动脉变异，并造成对面神经的压迫。结论A型肉毒毒素局部肌肉多点小剂量注射，可有效控制眼睑痉挛及偏侧面肌痉挛，部分眼睑及面肌痉挛的病因为血管压迫。     

A型肉毒毒素治疗面肌痉挛44例疗效观察

面肌痉挛以往由于对其病因不明，在临床中予以抗痉挛药物，如卡马西平、氟派啶醇；局部封闭、针炙、手术等均无明确、持久的疗效。近年来，我们应用A型肉毒毒素(BTX-A)局部注射治疗面肌痉挛44例，效果满意，报告如下。     

A型肉毒毒素治疗面肌痉挛临床分析

<正> 面肌痉挛是临床上一种常见的慢性进行性神经肌肉疾病,其在治疗上一直是神经科医生感到棘手的问题,我科自1996年9月以来用A型肉毒毒素治疗本病30例,有24例完成随访,结果显示效果显著,现报告如下。     

A型肉毒毒素治疗眼睑及面肌痉挛的临床分析

目的观察A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛的临床疗效,探讨眼睑及面肌痉挛的病因。方法应用A型肉毒毒素对105例眼睑及偏侧面肌痉挛患者行面部肌肉局部多点注射,对治疗前后的病情分级进行对比,分析治疗效果。结果71例面肌痉挛者完全缓解35例(49.3%),明显缓解34例(47.8%),无效2例(2.8%)。34例眼睑痉挛者,22例完全缓解,12例明显缓解,总有效率达98%。起效时间数小时至7d,缓解时间3～8个月,局部不良反应轻微、短暂,无全身反应及过敏反应,其中2例引起面肌萎缩。4例MRA中3例检出有椎动脉、小脑后下动脉、小脑前下动脉变异,并造成对面神经的压迫。结论A型肉毒毒素局部肌肉多点小剂量注射,可有效控制眼睑痉挛及偏侧面肌痉挛,部分眼睑及面肌痉挛的病因为血管压迫。     

A型肉毒杆菌毒素治疗眼睑痉挛及面肌痉挛临床研究

应用Ａ型肉毒杆菌毒素局部注射治疗眼睑痉挛９例及面肌痉挛３３，例完全缓解者分别为６例及３１例，明显缓解者分别为３例及２例，所有病例均有效，总有效期分别为４～２０周（平均１４周）及１６～３４周（平均２２周）。局部副反应轻微、短暂，无全身反应及过敏反应，且操作简单。认为Ａ型肉毒杆菌毒素是一种安全有效的生物制剂，该方法可作为治疗眼睑痉挛及面肌痉挛的新方法．     

偏侧面肌痉挛和良性特发性眼睑痉挛的临床与治疗特点

目的 探讨偏侧面肌痉挛(HFS)和良性特发性眼睑痉挛(BEB)的临床特点、治疗现状以及对A型肉毒毒素(BTX-A)治疗的反应.方法 对2013年4~10月在武汉大学人民医院神经内科门诊就诊的HFS患者和BEB患者进行调查,其中HFS患者110例,BEB患者90例.所有的患者均接受了BTX-A局部注射治疗.注射后2周左右复诊,在每周二下午的专病门诊随访,并记录BTX-A的疗效持续时间.结果(1)入组200例患者中,BTX-A治疗起效时间0~30 d(中位数4 d),疗效持续时间2~128周(中位数16周),总有效率96.9%.HFS患者症状明显好转(完全和明显缓解)占99.3%,BEB患者占90.2%.总的来说,BEB患者的疗效持续时间[(13.6±5.5)周]与HFS患者[(20.3±10.2)周]相比较短.HFS患者所用BTX-A剂量[(53.2±15.8)U]较BEB患者[(74.8±20.2)U]少.(2)BTX-A注射(70.9%)、针灸(68.2%)和口服药(65.5%)是HFS患者曾经选择的最多的非手术治疗方法.针灸和口服药大部分效果不好而自行停用.BTX-A注射(88.9%)、口服药(86.7%)和眼轮匝肌切割术(31.1%)是BEB患者曾经选择的最多的治疗方法,但患者均反映手术无效.结论 HFS和BEB是运动障碍门诊最常见的两种疾病,BTX-A治疗HFS和BEB安全、有效,对HFS效果更好,BEB患者需要更频繁的注射,其面部肌张力障碍的治疗更具挑战性.     

The management of blepharospasm and hemifacial spasm

Summary The aetiology of blepharospasm and hemifacial spasm is different, but both produce involuntary eye closure and facial movements which do not respond to systemic drug treatment. The introduction of therapeutic focal muscle weakening with botulinum toxin injections in the early 1980s appeared to offer great promise in the management of these conditions. In this paper the results of botulinum toxin treatment of 234 patients with blepharospasm and 73 patients with hemifacial spasm over a 7-year period have been analysed. Most patients receive sustained benefit from repeated injections whilst side-effects become less frequent. A clinically recognisable subgroup of patients with blepharospasm respond poorly and may be better treated surgically.     

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     

两种浓度A型肉毒毒素治疗偏侧面肌痉挛的疗效比较

目的　评估两种浓度A型肉毒毒素治疗偏侧面肌痉挛的疗效 ,并探讨减少其并发症的方法。方法　将 60例患者随机分为A、B两组 ,A组对上、下睑及面肌进行多点注射 ,A型肉毒毒素 (BTA)浓度为 5 0u/0 1ml,B组注射浓度为 2 2 5u/0 1ml。比较两组间疗效、副作用发生情况。结果　两组治疗疗效相似 ,总有效率为 10 0 % ,A组症状完全缓解 18例 (60 % ) ,明显缓解 6例(2 0 % ) ,部分缓解 6例 (2 0 % ) ,总显效率 80 % ;B组完全缓解 16例 (5 3 3 % ) ,明显缓解 6例 (2 0 % ) ,部分缓解 8例 (2 6 7% ) ,总显效率73 3 %。两组均无过敏和全身中毒反应 ,但A组出现上睑下垂、眼睑闭合不全、视物模糊等不良反应例数明显增多 ,差异显著 ,P <0 0 5。结论　BTA治疗面肌痉挛以小剂量为宜。A型肉毒毒素治疗偏侧面肌痉挛安全有效 ,简单易行 ,副作用少而轻微、短暂 ,为治疗面肌痉挛的首选方法     

Obsessive-compulsive symptoms among patients with blepharospasm and hemifacial spasm

Objective

The aim of this study was to compare the prevalence and the severity of different obsessive-compulsive disorder (OCD) symptoms reported by patients with blepharospasm (BSP) with those reported by patients with hemifacial spasm (HFS). We hypothesized that, since patients with BSP present a dysfunctional striato-thalamo-cortical circuitry, they would exhibit higher prevalence and/or greater severity of OCD symptoms than patients with HFS, a condition that results from peripheral irritation of the facial nerve.

Methods

Twenty-two patients with BSP and 31 patients with HFS were systematically evaluated by means of a sociodemographic and clinical questionnaire, the Mini International Neuropsychiatric Interview, the Obsessive-Compulsive Inventory-Revised, the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the Mini Mental State Examination (MMSE). Diagnostic groups were compared using the Mann-Whitney U test for continuous variables and the Pearson's goodness-of-fit χ² test for categorical ones; Fisher's Exact Test was employed when indicated. Correlations between continuous variables were evaluated by means of Spearman coefficients.

Results

Patients with BSP and HFS were not significantly different in terms of sociodemographic characteristics and most neuropsychiatric features. Nevertheless, while checking was associated with shorter duration of BSP (Spearman's rho=−0.54; P=.01), hoarding correlated with a longer duration of HFS (Spearman's rho=0.40; P=.04). Length of abnormal movements did not correlate with the BDI, BAI and MMSE scores.

Conclusions

The finding that the severity of different OCD symptoms did not differ between the BSP and HFS groups suggests that BSP may not interfere significantly with behavioral components of the striato-thalamo-cortical circuitry. However, the fact that OCD symptoms were found to follow different courses in distinct diagnostic groups deserves further study.     

肉毒毒素治疗偏侧面肌痉挛伴耳部症状的临床和电生理研究

目的 探讨偏侧面肌痉挛(HFS)伴耳部症状患者耳后肌受累以及A型肉毒毒素耳后肌注射的作用.方法 2009年7月至2010年1月就诊我科临床诊断为特发性HFS,同时伴有耳鸣或杂音、耳中"滴答声"或弹响、耳部不适等耳部症状的63例患者,其中33例于额肌、眼轮匝肌、颧肌及颊肌等常规位点注射(常规组),30例除常规位点外另予以耳后肌注射(耳后组).注射前后记录口轮匝肌和耳后肌的异常肌反应(AMR)、测量峰-峰波幅值;注射后至少4周,平均(29.5±2.5)d时随访.结果 (1)注射后两组患者均有耳部症状缓解,耳后组[76.7％(23/30)]的缓解率比常规组[45.5％(15/33)]更高(x2=6.40,P=0.011).(2)注射后痉挛侧AMR波幅均显著降低.注射前后常规组口轮匝肌波幅(μV)分别为304.0±30.3、129.3±9.6(t=5.820,P=0.000),耳后肌波幅(μV)分别为298.0±33.3、184.7±20.2(t=2.818,P=0.014);注射前后耳后组口轮匝肌波幅(μV)分别为405.3±66.7、116.0±10.0(t=4.214,P=0.001),耳后肌波幅(μV)分别为390.0±53.6、72.0±9.7(t=6.011,P=0.000).(3)在耳后组,注射后耳后肌AMR波幅降低比常规组更明显(t=4.237,P=0.001).结论 在HFS伴耳部症状患者中电生理检测有助于指导治疗;除常规位点外,耳后肌注射可更好地改善患者的耳部症状.