A型肉毒毒素加强法治疗面肌痉挛

面肌痉挛确切病因不明．口服药物疗效差。此研究采用A型肉毒毒素(BTX～A)加强法治疗面肌痉挛并进行长期随访，旨在提高其远期治愈率。     

A型肉毒毒素治疗面肌痉挛

Ａ型肉毒毒素治疗面肌痉挛姚建华李淑芹宋春伶张昀胡国华面肌痉挛是一侧面肌不自主的间断性强直性抽搐。病因不明，不能控制，病侧睑裂变小，嘴歪口斜，并可引起功能性残废运动。精神抑制药物治疗面肌痉挛无效。我科自１９９７年６月以来应用卫生部兰州生物制品研究所提供...     

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型肉毒毒素治疗面肌痉挛106例

我科自1996年6月～1997年5月采用A型肉毒毒素(BTA,国产)治疗面肌痉挛共106例,疗效满意,现报道如下:     

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型肉毒毒素治疗面肌痉挛60例的疗效观察

目的 评估A型肉毒毒素治疗面肌痉挛的疗效,并探讨减少基其并发症的方法。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;B组仅对下睑及面肌进行多点注射。对治疗前后的病情分级及两组间的疗效、睑下垂副作用发生情况进行对比,并观察A型肉毒毒素治疗后残留的和完全缓解后部分性复发的痉挛症状应用得理多治疗的疗效。随访副作用发生情况及疗效维持时分复发性痉挛症状有效。A型肉毒毒素副作用少。结论 A型肉毒毒素治疗面肌痉挛,安全有效,简单易行,为治疗面肌痉挛的首选方法。     

A型肉毒毒素治疗面肌痉挛86例疗效研究

近年来应用A型肉毒毒素(BTX-A)治疗面肌痉挛疗效较好，但对最佳治疗方法仍有争议。我们自1998年以来采用不同BTX-A治疗剂量和治疗间隔时间局部注射治疗面肌痉挛86例，研究其疗效及不良反应情况，报道如下。     

A型肉毒毒素治疗面肌痉挛38例疗效观察

目的：观察A型肉毒毒素治疗偏侧面肌痉挛的疗效。方法：对38例偏侧面肌痉挛进行面部肌肉多点注射A型肉毒毒素。评价其治疗效果。结果：完全缓解11例，明显缓解27例，总有效率100％。起效时间平均3d。局部反应轻微，无全身反应及过敏反应。结论：A型肉毒毒素局部肌肉注射是治疗面肌痉挛的一种安全、有效、易行的方法。     

A型肉毒杆菌毒素治疗面肌痉挛

面肌、眼睑肌痉挛是临床上一种常见的慢性进行性神经肌肉疾病,表现为一侧面肌不自主的间断性、强直性抽搐.常自眼轮匝肌开始,逐渐向下半部面肌扩展,口角歪斜,病侧眼裂变小,有损形象,影响社交,并可引起功能性运动残废.病因不明,采用针灸、理疗、药物等难以控制[1].我科2008年应用卫生部兰州生物制品研究所生产的A型肉毒素治疗本病42例,疗效较好,现报告如下.     

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     

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型肉毒毒素局部注射治疗对偏侧面肌痉挛患者生活质量的影响

目的 探讨A型肉毒毒素(BTXA)局部注射治疗对偏侧面肌痉挛(HFS)患者生活质量的影响.方法 给予108例HFS患者BTXA局部肌肉注射治疗.在治疗前、治疗后3及6个月时应用Cohen分级标准进行痉挛程度及疗效评价,用生活质量量表(QOL-BREF)、抑郁自评量表(SDS)、焦虑自评量表(SAS)进行测评.结果 治疗后3及6个月时Cohen分级较治疗前明显下降;治疗3个月时显效率及总有效率为90.1％、100％,6个月时为83.3％、96.3％.与治疗前比较,治疗3及6个月时除环境评分外,各项QOL-BREF量表评分明显提高,SDS及SAS评分明显降低(均P＜0.05);有抑郁及焦虑情绪的比率明显降低(均P＜0.05).结论 BTXA治疗HFS疗效显著,并能明显改善其健康相关生存质量.     

Botulinum toxin in the treatment of blepharospasm and hemifacial spasm

Summary Blepharospasm and hemifacial spasm are the two most common craniofacial movement disorders. Blepharospasm is a syndrome characterized by excessive or continuous eye closure related to overactivity of the orbicularis oculi and adjacent muscles bilaterally. Hemifacial spasm is a peripherally-induced movement disorder typically caused by vascular compression of cranial nerve VII (CN VII) leading to involuntary unilateral contractions of muscles used in facial expression. Treatment options for both conditions include medications, botulinum toxin, and various surgical interventions. This article summarizes the existing medical literature which indicates that botulinum toxin is the treatment of choice for blepharospasm and hemifacial spasm. Correspondence: Christopher Kenney, Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, Texas 77030, USA     

Botulinum toxin treatment in patients with focal dystonia and hemifacial spasm. A multicenter study of the Italian Movement Disorder Group

In six Centers belonging to the Italian Movement Disorder Study Group, the efficacy of botulinum toxin treatment was evaluated in an open collaborative study in 251 patients with focal dystonia and hemifacial spasm. The percentage of functional improvement ranged from 66% to 81% in patients with blepharospasm, from 40% to 51% in patients with spasmodic torticollis and from 73% to 81% in those with hemifacial spasm. Good results were also obtained in patients with oromandibular dystonia, laryngeal dystonia and writer's cramp. Side effects were mild and transient. Local botulinum toxin injection is the first choice symptomatic treatment in focal dystonia and hemifacial spasm.

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Sommario In 6 centri facenti parte del Gruppo Italiano per lo Studio dei Disturbi del Movimento è stata valutata l'efficacia della somministrazione di tossina botulinica A in 251 pazienti affetti da distonia focale e da spasmo del facciale. Nei pazienti con blefarospasmo, la percentuale media di miglioramento osservata è compresa tra il 66 e l'81%, mentre nei pazienti con torcicollo varia tra il 40% e il 51%. Nei pazienti affetti da spasmo del facciale la percentuale media di miglioramento è compresa tra il 73% e l'81%. Buoni risultati sono stati ottenuti anche nella terapia di distonie focali meno frequenti, come la distonia oromandibolare e laringea e il crampo dello scrivano. Gli effetti collaterali osservati sono risultati generalmente lievi, locali e transitori. Lo studio conferma quindi l'utilità della tossina botulinica nella terapia sintomatica delle distonie focali e nello spasmo del facciale.

     

Placebo-controlled double-blind cross-over study of botulinum A toxin in hemifacial spasm

The evaluation of the efficacy of botulinum A toxin injection for hemifacial spasm has never previously been done in a double-blind study in spite of its use as a treatment. We thus conducted a double-blind cross-over study of botulinum A toxin use in hemifacial spasm in 55 patients at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Thirteen patients decided to withdraw from the study due to a lack of efficacy, all of them were subsequently found to be in the saline injection group. The remaining 42 patients, in the botulinum A toxin injection (30 mouse units) group, reported the responses as: excellent (34 patients; 80.95%), moderate patients; 2.38%). In contrast, when given the saline injection they reported no excellent outcome, 1 patient (2.38%) with moderate improvement, 5 patients (11.90%) with mild improvement and, 36 patients (85.71%) with no response. Side effects of botulinum toxin injections were found in 14.29% of patients compared with 9.5% of the saline injection group. The side effects of botulinum toxin injection were mild transient facial weakness (7.14%), local pain (4.76%) and excessive lacrimation (2.38%).

We concluded that botulinum A toxin injection was a simple and effective out-patient treatment for the management of hemifacial spasm.     

Botulinum toxin A injection in the treatment of hemifacial spasm

Introduction – There are conflicting reports concerning the variation in duration of symptoms relief for patients with hemifacial spasm who have undergone several injections of botulinum A toxin (BOTX-A). We present our experience of BOTX-A injections in Taiwanese patients to analyze this issues, and to inspect whether the efficacy of treatment depends on the pre-injection severity. Material and method — From July 1992 to December 1994, 137 patients received injections of BOTX-A. We used objective and subjective score system to evaluate the efficacy and side effects of BOTX-A injection. Results — The overall successful rate of substantial relief of spasm was 88%. The mean duration of response was 20 weeks. Patents with more severe spasm tended to have shorter duration of improvement. The effects of consecutive injections remained fairly constant over the first 4 injections. Conclusion — The BOTX-A injection is an effective and safe treatment for patients with hemifacial spasm and the effect could be sustained over the consecutive injections.     

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.     

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．     

注射用A 型肉毒毒素改善亚急性期和恢复期脑卒中患者肌肉痉挛和活动功能效果的比较

目的 评价注射用A型肉毒毒素改善脑卒中亚急性期和恢复期肌肉痉挛和活动功能的效果比较.方法 选择2013年6月~2016年1月在我院就诊的脑卒中患者86例,根据病史长短分为亚急性期组(<1个月)37例和恢复期组(≥1个月)49例,均接受肉毒毒素200 U肌肉注射,疗程4周,评价治疗后改良Ashworth量表(MAS)、改良Tardieu量表(MTS)、徒手肌力检查法(MMT)、被动关节活动度(PROM)、Barthel指数和Fugl-Meyer量表.结果 所有患者均顺利接受治疗,两组随访时间分别为26(22~30)d和29(24~31)d,组间比较差异无统计学意义(Z=1.332,P=0.307);亚急性期组治疗后肘部、腕部MAS评分较疗前改善(P<0.05),而恢复期组MAS无明显差异(P>0.05),亚急性期组均优于恢复期组(P<0.05);亚急性期组治疗后肘部R1、D和腕部R1、R2均有改善(P<0.05),恢复期组治疗后MTS中肘部R1、D和腕部R1较治疗前改善(P<0.05),亚急性期组腕部R1、R2优于恢复期组(P<0.05);亚急性期组治疗后MMT肘部外展较治疗前改善(P<0.05),其他指标无改善;亚急性期组PROM腕部外展、腕部活动度较治疗前改善(P<0.05),恢复期组各指标治疗后无明显改善(P>0.05),亚急性组腕部外展优于恢复期组(P<0.05);亚急性期组Barthel指数、Fugl-Meyer和恢复期Fugl-Meyer较治疗前升高(P<0.05),但组间比较差异均无统计学意义(P>0.05).结论 肉毒毒素能改善脑卒中亚急性期和恢复期肌肉痉挛和功能,但亚急性期治疗效果更明显.