重复局部注射A型肉毒毒素治疗眼睑及面肌痉挛的疗效观察

目的:观察重复局部注射A型肉毒毒素(BTXA)治疗眼睑及面肌痉挛的长期疗效。方法:对80例眼睑、面肌痉挛的患者(眼睑痉挛75侧,面肌痉挛65侧),连续重复局部注射BTXA 4~20次,共886次,面肌痉挛每次剂量为22.5~32.5 U,眼睑痉挛为12.5~15.0 U。随访2~8年,观察其长期疗效。结果:起效时间多于治疗后2~3 d。眼睑及面肌痉挛治疗后部分缓解、明显缓解、完全缓解分别为0、67.7%、32.7%及1.4%、72.3%、26.3%,总有效率100%。随注射次数增加,药物剂量未增加,药效持续时间分别为(19.9±4.5)周及(20.7±4.2)周(P>0.05)。局部不良反应轻微、短暂。结论:重复局部注射BTXA治疗面肌及眼睑痉挛,在不需增加剂量的情况下,可长期维持其疗效和作用持续时间,而且是一种安全、有效和简便的治疗方法。     

A型肉毒毒素在面颈部肌痉挛的应用

近10年来,临床上A型肉毒毒素(BTXA)局部注射治疗面颈部肌痉挛的应用越来越广泛,但由于剂量和方法不同,其疗效和不良反应亦不同。我们对1998年8月～2004年2月接受BTXA注射治疗的2160例面、颈部肌痉挛患者进行回顾性分析,现报告如下。1资料与方法1.1临床资料2160例患者,男1107例,     

肉毒杆菌毒素A治疗味觉出汗的一些新进展

味觉出汗主要发生在腮腺手术后 ,部分是由于腮腺外伤或感染所致 ,约有 15 %的患者自觉症状严重 ,迫切要求治疗 ;肉毒杆菌毒素 A能抑制乙酰胆硷的释放 ,局部注射是治疗味觉出汗的一种简便、安全、有效的方法 ,且疗效持续时间长 ,同时患者对此具有良好耐受性。该作者首先发现并予以报道 ,随后得到同道的证实。近年来 ,随着对有关味觉出汗的诊断和治疗的进一步研究 ,作者发现一些特殊情况 ,并基于这些有关情况取得令人满意的疗效。本文着重介绍如下 :1使用肉毒杆菌毒素 A治疗前应掌握明确的既往史是成功治疗的保证。含有抑副交感神经作用的药…     

肉毒杆菌毒素A在耳鼻咽喉科的应用

文章对肉毒杆菌毒素Ａ的药理作用、毒副作用、禁忌证及在耳鼻喉科的应用进行综述,认为在治疗局灶性肌张力障碍方面,是安全而有效的,值得推广应用。     

肉毒杆菌毒素在耳鼻咽喉科的临床应用

肉毒杆菌毒素(Botulinum Toxin,BTX)早在1897年被发现,1977年开始在志愿者人体应用,1980年第一篇有关报道在文献发表,1989年获FDA认证,现已被安全广泛的应用于临床.在耳鼻咽喉科的治疗应用发展很快,至少用于12种疾病,其中包括各种发音障碍、张力障碍、痉挛、斜颈、面神经麻痹及面部皱纹等[1].     

肉毒杆菌毒素在耳鼻咽喉科的作用和应用的回顾

肉毒杆菌毒素是一种由肉毒杆菌产生的神经毒素 ,对神经肌肉接头处有高度特异性 ,可产生暂时的和可逆的去神经作用 ,副作用和并发症有限。肉毒杆菌毒素正在被安全广泛应用于临床 ,被 FDA(食品、药品管理局 )许可的疾病为 :痉挛 ,半面痉挛 ,斜视等。在耳鼻咽喉科 ,肉毒杆菌毒素用于治疗至少 12种疾病 ,研究表明注射肉毒杆菌毒素对于暂时缓解症状有很高的成功率。痉挛性发音困难可能是肉毒杆菌毒素在耳鼻咽喉科最广为人知的用处 ,该病包括内收型和外展型。从1984年开始 ,将肉毒杆菌毒素经皮肤或经口注射入甲杓肌用于治疗内收肌痉挛性发音困难…     

A 型肉毒毒素治疗半面痉挛及眼睑痉挛

目的观察Ａ型肉毒毒素治疗半面痉挛及眼睑痉挛的效果。方法Ａ型肉毒毒素局部注射（每点２．５～５Ｕ）治疗眼睑痉挛１２例（１５侧）及半面痉挛３８例。结果完全缓解分别为１０例（１３侧，占８６．７％）及３２例（８４．２％），明显缓解分别为２例（１３．３％）及５例（１３．２％），部分缓解分别为０例及１例（２．６％）。总有效率１００％。药效作用时间分别为１０～２４周（平均１８周）及１４～３２周（平均２２周）。局部副反应轻微、短暂，包括轻度面瘫８例、眼睑下垂４例、流泪４例，无全身反应及过敏反应。结论Ａ型肉毒毒素局部注射是治疗眼睑痉挛及半面痉挛的一种安全、有效、简便方法。     

A型肉毒杆菌毒素对血管运动性鼻炎的作用及组织形态学影响

目的：探讨A型肉毒杆菌毒素(BTA)治疗血管运动性鼻炎的作用及机制。方法：32例血管运动性鼻炎患者鼻腔注射BTA，每侧鼻腔各注射两点，每点2．5U，总量10U。记录注射前后鼻溢液、鼻塞、喷嚏、鼻黏膜水肿的情况并评分。12只豚鼠随机分为BTA组和对照组。BTA组左侧鼻腔以浸有10U(0．2ml)BTA的Merocel海绵作用1h；对照组以生理盐水代替BTA。分别于用药后第7、14、28天全麻下切取豚鼠左侧下鼻甲黏膜，行苏木精-伊红染色及电镜观察。结果：鼻溢液亢进完全缓解26例(81．3％)，明显缓解6例(18．8％)；打喷嚏完全缓解10例(31．3％)，部分缓解4例(12．5％)，无缓解18例(56．3％)；鼻塞完全缓解4例(14．8％)，部分缓解5例(18．5％)，无缓解18例(66．7％)；鼻黏膜肿胀完全缓解8例(25．0％)，明显缓解6例(18．8％)，部分缓解4例(12．5％)，无缓解14例(43．8％)。12例患者有一过性鼻干或注射当天鼻溢液加重，无其他并发症。BTA局部应用7、14d，豚鼠鼻黏膜下腺上皮及导管上皮退化、变性，部分腺细胞呈不可逆变性；28d后大部分腺细胞恢复正常。结论：BTA可引起鼻黏膜腺细胞变性，明显减轻血管运动性鼻炎鼻溢液亢进的症状。     

肉毒杆菌毒素的基础研究及其在耳鼻咽喉科临床应用

肉毒杆菌毒素可用于治疗多种耳鼻咽喉科疾病，安全有效，本文重点介绍其结构、药理、毒性、治疗技术及具体的临床应用。     

A型肉毒杆菌毒素对豚鼠鼻黏膜腺细胞凋亡的影响

目的　探讨A型肉毒杆菌毒素 (botulinumtoxintypeA ,BTA)对豚鼠鼻腔黏膜腺细胞凋亡的影响。方法　 1 8只雄性豚鼠随机分为BTA组和对照组。BTA组左侧鼻腔以浸有 1 0U (0 .2ml)BTA的Merocel作用 1h ,对照组以生理盐水代替BTA。分别于用药后第 1周、2周、4周全麻下切取豚鼠左侧下鼻甲黏膜 (每组 3只 ) ,4 %多聚甲醛固定后石蜡包埋。切片行末端脱氧核苷酸转移酶介导的dUTP缺口末端标记 (TUNEL)和AB PAS染色。结果　BTA局部应用第 1、2周豚鼠鼻黏膜腺体及腺上皮中凋亡细胞显著增加 (P <0 .0 1 ) ,第 4周凋亡指数恢复正常。细胞凋亡主要发生在浆液腺。结论　BTA可诱导豚鼠鼻黏膜浆液腺细胞凋亡。     

Botulinum toxin treatment in patients with hemifacial spasm

Hemifacial spasm is nearly always a unilateral disease of the facial musculature and is characterized by involuntary tonic or clonic cramps that considerably reduce the affected patient's quality of life. In the past, a number of different conservative and operative therapeutic procedures have been applied for the treatment of hemifacial spasm. In many cases these attempts failed to control the disease permanently or resulted in unwanted, sometimes strong, side effects. We report our own experiences with botulinum therapy in 29 patients with hemifacial spasm (78 therapeutic sessions). In our patients the mean duration of an effect after treatment with botulinum toxin was 18.2 weeks. Side effects were rare. Our results since 1990 at the University of Göttingen demonstrate that subcutaneous application of toxin from Clostridium botulinum to involved facial muscles represents a reliable method for successful treatment of hemifacial spasm.     

Incidental finding of dysgeusia relieved by injections of botulinum toxin A

OBJECTIVE: We report the unique finding of hemifacial spasm and associated dysgeusia that resolved after treatment with botulinum toxin A (BTX-A). STUDY DESIGN: Case report. METHODS: Three years after undergoing resection of an acoustic neuroma and subsequent resolution of postoperative left-sided facial nerve palsy, a 38-year-old woman presented with new onset of facial spasm and dysgeusia. RESULTS: After three courses of BTX-A injections during a 2-year period, symptoms of both facial spasm and dysgeusia resolved after treatments and returned between treatments. CONCLUSIONS: These findings, which have not been reported previously in the literature, indicate a potential role for BTX-A in the treatment of surgically associated dysgeusia.     

Increasing the area and varying the dosage of Botulinum toxin a injections for effective treatment of hemifacial spasm

Conclusion: Wider-area botulinum toxin (BT) injection with the dosage depending on specific pathology is a promising approach for the treatment of hemifacial spasm (HFS), resulting in effective and long-lasting control of HFS with fewer side-effects. Objective: The aim of this study was to develop a BT injection strategy that minimizes complications by considering the causes, duration, and electrophysiologic features of the disease, as well as the patient’s age. Methods: From July 2011 to July 2015, 26 patients were included in the strategy. The mean age was 61.8?±?14.6. In the case of essential HFS, 2 units/injection site was the standard dosage. If a patient was aged over 60 and had a reduced electromyogram (EMG) amplitude, the dosage was reduced by 0.5 units/site. In the case of post-paralytic and tumor-induced HFS, 1.5 units/site was the standard dosage. All cases were managed by alternating injections of Botox and Dysport with no physical therapy. Results: Most HFS patients treated with the injection strategy had complete remission of HFS within 1 week. The average number of BT injection sites was 22.6?±?6.7. The mean total BT dosage on the affected side was 28.6?±?4.9 units. The mean duration of BT efficacy was 28.6?±?7.7 weeks.     

The use of botulinum toxin for pediatric cricopharyngeal achalasia

Objectives

Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia.

Methods

A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, post-operative need for nasogastric tube placement, and swallow studies.

Results

A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed.

Conclusions

Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy.     

The use of botulinum toxin for pediatric cricopharyngeal achalasia

Objectives

Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia.

Methods

A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, post-operative need for nasogastric tube placement, and swallow studies.

Results

A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed.

Conclusions

Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy.     

Effects of botulinum toxin on vocal tract steadiness in patients with spasmodic dysphonia

Since laryngeal botulinum toxin (BTX) injections have become the treatment of choice for spasmodic dysphonia, the purpose of this study was to examine its effects on the stability of the upper vocal tract as compared to the effects on glottic stability. Two different acoustic methods were used to analyze voice samples from 16 patients with adductor-type spasmodic dysphonias before and after BTX therapy and from a normal control group. Independent acoustic analyses were used to determine laryngeal and upper vocal tract stability. The results showed significantly higher values for the standard deviation of fundamental frequency (SDFO), reflecting laryngeal instability, for the patient group than for the control group and an impressive improvement for the patients after BTX therapy. Further, the equally high values of SDFO for the initial second and a second from the midsegment of phonation were differentially reduced by BTX therapy, resulting in a normal pattern of laryngeal stability during sustained phonation. The variability of the first and second formants, reflecting upper vocal tract instability, showed higher values for the patients compared with the control group, but this difference was not statistically significant. The present findings showed that BTX injections to the thyroarytenoid muscle had no discernible effect on stability of the upper vocal tract.Presented in part at the 65th Annual Meeting of the German Society of Oto-Rhino-Laryngology-Head and Neck Surgery, Chemnitz, 14–18 May 1994 and the First World Voice Congress in Oporto, Portugal, 9–13 April 1995