局部注射A型肉毒毒素治疗Meige综合征

目的 观察A型肉毒毒素(BTX—A)治疗Meige综合征，(眼睑痉挛-口颌肌张力障碍综合征)的疗效。方法 用A型肉毒毒素对17例Meige综合征行面部肌肉局部多点注射，分析其治疗结果。结果 17例中完全缓解者9例，明显缓解者5例，部分缓解者2例，无效1例。总有效率94％。起效时间数小时至3天，疗效持续时间3～6个月。局部副反应轻微、短暂，无全身反应及过敏反应。结论 A型肉毒毒素是治疗Meige综合征最有效的方法。     

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Meige综合征

M eige综合征又称Brueghel综合征,即特发性眼睑痉挛及口-下颌肌张力障碍。1910年由法国神经病学家M eige首先描述,临床少见,易被误诊,治疗较困难。我院自2002年3月-2005年3月应用A型肉毒毒素(BTX-A)局部注射治疗M eige综合征患者16例,均取得满意疗效。临床资料一、一般资料16例     

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型肉毒毒素治疗面肌、眼睑痉挛156例临床观察

目的 探讨A型肉毒毒素治疗面肌，眼睑痉挛及Meige综合征的疗效。方法 采用A型肉毒毒素局部注射治疗偏侧面肌痉挛102例。眼睑痉挛41例及Meige综合征13例。并使用Cohen和Albert量表进行评估。结果 症状完全缓解占51.3%。明显改善占37.8%。部分改善占10.9%。疗效平均持续约3-6个月。复发者重复注射仍有效，出现眼睑闭合不全，面肌无力，眼睑下垂共58例，均恢复。结论 局部注射A型肉毒毒素确为一种安全有效。简便易行的治疗面肌。眼睑痉挛及Meige综合征的方法。     

A型肉毒毒素治疗口下颌肌张力障碍

目的观察A型肉毒毒素治疗口下颌肌张力障碍(OMD)患者的临床效果。方法对19例口下颌肌张力障碍患者进行临床分析,依据患者临床特点,将A型肉毒毒素注射到患者一侧或双侧咀嚼肌、颞肌及翼外肌,并根据肌肉收缩力量大小、肌肉体积及患者体重调整剂量。结果 68.4%的患者功能改善评分≥3分,疗效平均维持8～12周(有效范围2～28周)。4例患者注射后有轻度咀嚼无力,2～3周恢复。1例混合型患者注射后出现轻度鼻音,持续13天后症状消失。所有患者未出现其它严重副作用。结论 A型肉毒毒素对于口下颌肌张力障碍的治疗是有效、安全的。熟悉本病的临床特点及分型,选择正确的靶肌肉及注射适宜剂量的肉毒毒素是治疗本病的关键。     

A型肉毒毒素治疗头颈部肌张力障碍的临床观察

目的观察A型肉毒毒素(BTXA)治疗偏侧面肌痉孪、睑痉孪、Meige’s综合征、痉孪性斜颈的疗效。方法治疗组(A组)用BTXA对86例患者进行头颈部肌肉多点注射,对照组(B组)50例根据诊断选用不同的药物或/和针灸、理疗、中医药治疗。观察两组疗效及副作用。结果A组治疗后当日至3d内开始见效,7～15d达高峰,疗效维持2～6月。总有效率为100%,疗效明显高于B组(P<0.001)。BTXA重复注射疗效无下降,1例HFS患者第三次注射产生耐药性,少数患者有轻微的局部副反应,未见全身副作用。B组62%(31例)的患者疗效维持5～15月后减退,需逐渐增加剂量,少数患者出现白细胞减少、肝功能损害、皮疹、共济失调等不良反应。结论A型肉毒毒素局部注射是治疗头颈部肌张力障碍的一种安全、有效、简便的方法。     

Botulinum toxin in blepharospasm and oromandibular dystonia: comparing different botulinum toxin preparations

Amongst all regions of the body, the craniocervical region is the one most frequently affected by dystonia. Whilst blepharospasm – involuntary bilateral eye closure – is produced by spasmodic contractions of the orbicularis oculi muscles, oromandibular dystonia may cause jaw closure with trismus and bruxism, or involuntary jaw opening or deviation, interfering with speaking and chewing. Both forms of dystonia can be effectively treated with botulinum toxin injection. This article summarizes injection techniques in both forms of dystonia and compares doses, potency and efficacy of different commercially available toxins, including Botox®, Dysport®, Xeomin® and Myobloc®/NeuroBloc®.     

Clinical features of patients with blepharospasm: a report of 240 patients

Background and purpose: To characterize patients with benign essential blepharospasm (BEB) by diagnosis, environmental risk factors, and family history. Methods: Two hundred and forty patients with BEB were evaluated through a clinical examination and questionnaire. The questionnaire reviewed personal medical history, demographic factors, risk factors for the development of blepharospasm and family history of dystonia and other neurological conditions. Results: Benign essential blepharospasm was more commonly found in women (2.8:1) and 93% of the patients were Caucasian. Fifty percent had pure BEB, 31% had BEB/Meige’s syndrome, and 4% had BEB and eyelid opening apraxia (+/− Meige’s syndrome). A minority of patients reported preceding photophobia (25%) or other eye conditions (22%). The majority were non‐smokers, had no exposure to anti‐emetic or antipsychotic agents, had a normal birth history, and had no history of head trauma. Seventy‐two percent did report a stressful event immediately prior to the development of symptoms. Treatments reported included botulinum toxin (BoNT), oral medications, surgical procedures, and acupuncture. Thirty‐two percent of patients reported a family history of focal dystonia, and BEB was the most commonly reported. Conclusion: This study confirms previous reports of usual age, sex, caffeine and tobacco use, and family history in patients with blepharospasm. New findings include a report on occupation, lower reports of preceding eye conditions and photophobia, and higher reported stressful events. Further, this study shows a change in treatment with an increase in BoNT use and decrease in surgical procedures.     

Efficacy and safety of incobotulinumtoxinA (NT 201, Xeomin) in the treatment of blepharospasm—A randomized trial

IncobotulinumtoxinA (NT 201, Xeomin) is a highly purified botulinum neurotoxin type A formulation, free from complexing proteins. A randomized, placebo‐controlled, double‐blind trial of efficacy and safety compared incobotulinumtoxinA (up to 50 U per eye) to placebo administered in a single treatment session to patients with blepharospasm. All patients had documented satisfactory response to 2 previous treatments with botulinum neurotoxin type A other than incobotulinumtoxinA and had Jankovic Rating Scale severity subscores ≥ 2. Patients (n = 109) were randomized in a 2:1 ratio to incobotulinumtoxinA or placebo and followed up to 20 weeks; 94% completed the study. A significant difference was observed in the primary efficacy variable (change in Jankovic Rating Scale severity subscore rated by an independent rater 6 weeks following treatment), favoring incobotulinumtoxinA by 1.0 point (95% CI [0.5–1.4]; P < .001). Functional impairment, as measured by the Blepharospasm Disability Index, improved by 0.5 points (95% CI [0.2–0.7]; P = .002) compared with placebo. There was a strong correlation between the 2 scale scores. In addition, all secondary outcome measures favored incobotulinumtoxinA. Patients rated the mean therapeutic effect of incobotulinumtoxinA significantly better than placebo (P < .001). Adverse events were reported in 70.3% of incobotulinumtoxinA patients and 58.8% of placebo patients. Eyelid ptosis (18.9% vs 5.9%), dry eye (18.9% vs 11.8%), and dry mouth (14.9% vs 2.9%) occurred most frequently. Tolerability was rated good/very good by 91.9% of incobotulinumtoxinA versus in 85.2% of placebo patients. In conclusion, incobotulinumtoxinA was well tolerated and was associated with statistically significant and clinically relevant reductions in blepharospasm severity and functional impairment. © 2011 Movement Disorder Society     

Botulinum toxins in neurological disease

Botulinum toxins are among the most potent neurotoxins known to humans. In the past 25 years, botulinum toxin has emerged as both a potential weapon of bioterrorism and as a powerful therapeutic agent, with growing applications in neurological and non-neurological disease. Botulinum toxin is unique in its ability to target peripheral cholinergic neurons, preventing the release of acetylcholine through the enzymatic cleavage of proteins involved in membrane fusion, without prominent central nervous system effects. There are seven serotypes of the toxin, each with a specific activity at the molecular level. Currently, serotypes A (in two preparations) and B are available for clinical use, and have been shown to be safe and effective for the treatment of dystonia, spasticity, and other disorders in which muscle overactivity gives rise to symptoms. This review focuses on the pharmacology, electrophysiology, immunology, and application of botulinum toxin in selected neurological disorders.     

Long-term efficacy of botulinum toxin A in treatment of various movement disorders over a 10-year period.

Although botulinum toxin A (BTX) has been licensed in Canada for treatment of various movement disorders since 1990, few clinical studies regarding its long-term efficacy and side effects have been reported. We conducted a retrospective analysis of 235 patients who received BTX from our movement disorders clinic over a 10-year period (January 1990 to December 1999). A total of 2,616 treatment cycles (multiple injections) were administered to 235 patients with cervical dystonia (CD), hemifacial spasm (HS), blepharospasm (BP), and other movement disorders. Substantial benefit at 5 years was seen in most patients (90% in BP, 88% in HS, 63% in CD, 100% in jaw closing and lower limb dystonia, and 56% in writer's cramp). Benefit was maintained for up to 10 years in CD, HS, and BP data, with a 75.8% benefit reported. Twenty-eight percent of patients discontinued treatment during the follow-up period due to a variety of reasons. Of these, 9.1% of patients developed primary resistance, and 7.5% of patients secondary resistance. Adverse effects, mostly minor, developed in 27% of patients at any one time, occurring over 4.5% of treatment cycles. These were most frequently reported in blepharospasm (22 of 36 patients in 40 cycles), followed by hemifacial spasm (21 of 70 patients in 46 cycles), and cervical dystonia (17 of 106 in 28 cycles). Only 1.3% of patients discontinued therapy due intolerable adverse effects. The results show that BTX is a safe and effective treatment of various types of movement disorders, and most side effects are well tolerated. Discontinuation for any reason was also low after 5 years. Efficacy was maintained after long periods of treatment with high degree of patient satisfaction.     

Blepharospasm 40 years later

Forty years ago, C.D. Marsden proposed that blepharospasm should be considered a form of adult‐onset focal dystonia. In the present paper, we provide a comprehensive overview of the findings regarding blepharospasm reported in the past 40 years. Although prolonged spasms of the orbicularis oculi muscles remain the clinical hallmark of blepharospasm, patients with blepharospasm may be characterized by various types of involuntary activation of periocular muscles. In addition to motor features, blepharospasm patients may also have nonmotor manifestations, including psychiatric, mild cognitive, and sensory disturbances. The various motor and nonmotor symptoms are not present in all patients, suggesting that blepharospasm is phenomenologically a heterogeneous condition. This emphasizes the need for tools for severity assessment that take into account both motor and nonmotor manifestations. The cause of blepharospasm remains elusive, but several lines of evidence indicate that blepharospasm is a multifactorial condition in which one, or several, as yet unknown genes together with epigenetic and environmental factors combine to reach the threshold of the disease. Although blepharospasm was originally believed to be solely a basal ganglia disorder, neurophysiological and neuroimaging evidence point to anatomical and functional involvement of several brain regions. The contribution of multiple areas has led to the hypothesis that blepharospasm should be considered as a network disorder, and this might reflect the varying occurrence of motor and nonmotor manifestations in blepharospasm patients. Despite advances in the aetiology and pathophysiology, treatment remains symptomatic. © 2017 International Parkinson and Movement Disorder Society     

A型肉毒素治疗睑肌痉挛的长期疗效与安全性

目的:探讨A型肉病毒素(dysport)治疗睑肌痉挛的长期疗效及安全性。方法:回顾性分析46例原发性睑肌痉挛患者于第1、3、5年接受dysport注射的剂量、起效时间、疗效持续时间、症状改善率不良反应。结果:46例患者第1、3、5年中位症状改善率分别为90%、85%及80%,治疗5年后仍有93.48%的患者改善率50%,且疗效持续8周以上。第1、3、5年起效时间分别为4、5和7 d,有延长趋势;疗效持续时间稳定维持在12周;治疗剂量略有下降,但无显著性差异。主要不良反应为睑下垂、疼痛烧灼感、复视及局部血肿,1周内自行消失,无过敏及全身不良反应。结论:dysport局部注射治疗睑肌痉挛安全,疗效持久,能最大程度地改善局部痉挛症状,可能成为治疗睑肌痉挛的首选方法。     

Retrospective evaluation of the dose of Dysport and BOTOX in the management of cervical dystonia and blepharospasm: the REAL DOSE study.

The purpose of this study is to evaluate the real-world dose utilization of Dysport and BOTOX for cervical dystonia and blepharospasm. Six investigational sites (five countries) were identified. Investigators abstracted utilization data for patients who received Dysport before switching to BOTOX or BOTOX before switching to Dysport. Patients were identified during scheduled clinic visits and selected if they met study criteria, which included treatment for at least 2 consecutive years (at least 1 year with Dysport or BOTOX, then switched and maintained on BOTOX or Dysport for at least another year). A total of 114 patients were included in the assessment. Ratios of mean dose for Dysport to BOTOX ranged from a low of 2:1 to a high of 11:1. Thirty-one percent of patients fell into the Dysport-to-BOTOX ratio grouping of 5:1 to less than 6:1; 30% of patients had a mean ratio of Dysport to BOTOX of 4:1 to less than 5:1; and only 21% of all patients evaluated fell into the Dysport-to-BOTOX ratio grouping of 3:1 to less than 4:1. Results are consistent with United Kingdom labeling for botulinum toxins stating that units of different serotype A toxins are not interchangeable and simple dose-conversion factors are not applicable.     

Treatment of cervical dystonia with botulinum toxins

Botulinum toxin (BoNT) treatment has been used extensively for the treatment of cervical dystonia. In most studies, there is significant improvement following treatment for head posture and pain. The common side effects following treatment include dysphagia, dry mouth, and neck weakness. There are five brands and two serotypes of BoNT available. The dosing of each serotype and brand differs. Perhaps more importantly, each brand and serotype may differ in immunogenic potential and occurrence of secondary unresponsiveness, an issue that is currently under active investigation. Although many aspects of the technique of injection have not been adequately studied, general guidelines are available.