两种不同剂量A型肉毒毒素治疗偏头痛的疗效观察

目的观察50U、100U两种不同剂量A型肉毒毒素（BTX-A）治疗偏头痛的疗效。方法头痛患者60例,随机分为2组,均选颅周肌肉相同的注射位点。I组注射BTX-A50U;Ⅱ组注射BTX-A100U。分别于0、30、90d观察头痛程度、发作频率、生活质量及不良反应。结果①I组治疗前与治疗后30、90d时,头痛视觉模拟评分（VAs）分别7.2、4.6、4.2;Ⅱ组分别为7.1、3.3、3.1。两组治疗前后比较差异有统计学意义,组间比较差异有统计学意义。②I组治疗前与治疗后30、90d时,头痛发作频率分别6.4次/月、4.6次/月、4.2次/月;Ⅱ组分别为6.3次/月、4.3次/月、4.2次/月。两组治疗前后有统计学意义,组间无统计学意义。③两组均能改善生活质量,组间无统计学意义。④各组不良反应均较轻。结论 A型肉毒毒素（BTX-A）注射可有效减轻偏头痛患者的头痛程度、减少发作频率、提高生活质量;100UBTX-A对头痛程度的减轻优于50UBTX-A,头痛发作频率、生活质量的改善与剂量无关。两组均不良反应轻微。     

A型肉毒毒素治疗慢性偏头痛的临床疗效和安全性观察

目的：观察A型肉毒毒素( BTX-A)治疗慢性偏头痛的有效性和安全性。方法选取2012年9月—2014年9月慢性偏头痛患者39例,对每例患者给予BTX-A治疗,随访记录各时段(治疗前、治疗后1、2、3、6个月)各项观察指标的结果与评分,进行统计学分析。同时记录相关不良反应,来评价该药物的安全性。结果每月偏头痛发作频率、头痛发作持续时间、疼痛视觉模拟量表( VAS)评分、头痛强度、各等级头痛人数在治疗后各时段较治疗前均有改善(P<0．01)。 VAS评分在治疗后2个月时最低,重度头痛的人数变化最明显,疼痛缓解程度在治疗后2个月最明显。本实验共发生4例不良反应,未影响日常生活,轻度可逆。结论 BTX-A治疗慢性偏头痛效果显著,在临床应用中较安全。     

A型肉毒毒素治疗睑痉挛的临床研究

目的　观察A型肉毒毒素对睑痉挛的治疗效果。方法　对 2 0例特发性眼睑痉挛和 2 4例Meige综合征进行面部肌肉局部多点注射A型肉毒毒素 ,评价其治疗效果。结果　 1～ 3d出现症状缓解 ,1周症状明显缓解 ,有效率达 10 0 %。特发性眼睑痉挛有效作用时间为 12～ 32周 (平均 17 4周 ) ,Meige综合征有效作用时间为10～ 2 0周 (平均 13 2周 )。结论　A型肉毒毒素局部肌肉注射治疗睑痉挛是一种安全、有效、简便、易行的方法。     

A型肉毒毒素治疗偏侧面肌痉挛的临床研究

目的观察A型肉毒毒素治疗偏侧面肌痉挛的效果及探讨二种不同剂量与疗效及副作用的关系。方法对107例病人进行面部肌肉多点注射A型肉毒毒素,5年内共注射243例次,243例次随机分成A组:每点注射剂量2.5U/0.1ml,B组:每点注射剂量5U/0.1ml。结果243例次注射后有效率100%,完全缓解87.7%,明显缓解12.3%,药效持续时间3～6个月。B组药效持续时间较A组长(P<0.05),A、B两组副作用发生率差异无显著意义(P>0.05),但B组副作用持续时间比A组长(P<0.05)。重复注射同样有效。结论该药疗效确切,5U/0.1ml治疗组疗效持续时间长,但副作用消失慢。     

A型肉毒毒素治疗偏侧面肌痉挛及重复治疗的剂量探讨

目的　观察A型肉毒毒素治疗偏侧面肌痉挛的效果及复发后两种剂量的治疗作用。方法　 15 9例患者平均年龄 5 6 4± 12 6岁 ,病程 0 5～ 2 0年。首次注射剂量每点 2 5U ,平均每位患者 2 8± 10U。复发后分 2 5U和 5U两种剂量组。结果　首次注射后 15 4例全部缓解 ,完全缓解率达84% ,药效持续时间 19± 6周。复发后 5U治疗组药效持续时间较 2 5U组长。多次注射后症状缓解时间未减少。副反应轻微短暂。结论　A型肉毒毒素治疗偏侧面肌痉挛作用肯定 ,复发后不同剂量均有效。     

A型肉毒毒素治疗眼睑痉挛的临床分析

用A型肉毒毒素局部注射,治疗睑痉挛患者26例。均于治疗后3～5天出现症状缓解;3周好转最明显;5个月后,复发10例。     

肉毒杆菌毒素A

Allergan公司开发的Botox(肉毒杆菌毒素A)获FDA批准用于预防慢性偏头痛患者(或每月头痛发作15次以上,每次持续时间在4小时至1天或更     

A型肉毒杆菌毒素治疗眼睑痉挛及面肌痉挛的临床研究

面肌痉挛和眼睑痉挛是神经科较常见的疾病,对此目前尚未发现十分有效的治疗方法。近几年来国内外关于A型肉毒杆菌毒素治疗神经系统运动障碍疾病的报道日渐增多,并被认为是近年神经科治疗领域的重要进展之一。我科帕金森病及运动障碍诊疗中心门诊在本市率先应用该药局部注射治疗局限性肌张力异常及面肌痉挛110例,取得了满意效果。现将我中心自1994年7月至1996年4     

A型肉毒毒素治疗肌张力障碍

A型肉毒毒素因用于高兴奋性肌肉疾病的有效性而倍受神经内科医生的关注,治疗的方法越来越多,治疗的病种不断扩展,被认为是近几年来神经内科领域重要进展之一.本文从A型肉毒毒素历史、药理、方法与剂量、适应证(偏侧面肌痉挛与单纯眼肌痉挛、痉挛性斜颈、Meige综合征、祛皱美容)、毒副作用、禁忌证等几个方面进行综述.     

A型肉毒毒素降低偏头痛大鼠颈静脉血、脑干和三叉神经节的P物质含量

目的通过观察A型肉毒毒素(botulinumtoxintypeA,BTX-A)对硝酸甘油引发的偏头痛大鼠颈静脉血浆、脑干和三叉神经节中P物质(substanceP,SP)含量变化,探讨BTX-A止痛机理。方法将大鼠分为对照组(n=5)和偏头痛模型组(n=15)。偏头痛模型组造模后分别皮下注0.9%NaCl(n=5)、BTX-A5U·kg-1(n=5)、BTX-A10U·kg-1(n=5)6d后,应用放射免疫检测法测定颈静脉血浆、脑干和三叉神经节中P物质的含量。结果动物皮下注射硝酸甘油后出现偏头痛症状,例如双耳发红、前肢频繁搔头、爬笼次数增多,其评分与对照组相比有明显差异(P<0.01)。生理盐水组颈静脉血浆、脑干和三叉神经节中SP含量与对照组比较显著升高(P<0.01);BTX-A5U·kg-1组、BTX-A10U·kg-1组分别与生理盐水组比较,SP含量显著降低(P<0.05)。结论硝酸甘油导致偏头痛症状产生及SP在颈静脉血浆和延髓、脑桥和三叉神经节中的含量增加。局部皮下注射BTX-A可减轻偏头痛大鼠的症状,并能降低颈静脉血浆、脑干和三叉神经节中SP含量,结果提示BTX-A通过抑制“三叉神经血管系统”(tri-geminalvascularsystem,TVS)中SP释放而减轻偏头痛症状。     

A型肉毒毒素治疗Meige's综合征

目的 评估A型肉毒毒素治疗Meige's综合征的疗效.方法 对A型肉毒毒素治疗的30例Meige's综合征患者资料进行回顾性分析.结果 30例Meige's综合征患者注射A型肉毒毒素后25例完全缓解,5例明显缓解,总有效率100%.起效时间注射当天～第3天.疗效维持平均为5个月.重复治疗有效.局部不良反应轻微、短暂、可逆,无全身不良反应及过敏反应.结论 A型肉毒毒素局部注射是治疗Meige's综合征的一种安全、有效、简便、易行的方法.     

A型肉毒毒素治疗肌张力过强

目的：探讨Ａ型肉毒毒素局部注射治疗面肌痉挛、各型头颈肌张力障碍的临床疗效和安全性。方法：采用Ａ型肉毒毒素局部多点注射痉挛肌肉,治疗前后对照。结果：治疗面肌痉挛２５０例（１０２８轮次）,有效率１００％,作用持续１６ｗｋ±ｓ４ｗｋ;睑痉挛７８例（２６０轮次）,有效率９３．９％,作用持续１５ｗｋ±４ｗｋ;口颌肌痉挛５３例（１８１轮次）,有效率８５．１％,作用持续１４ｗｋ±４ｗｋ;痉挛性斜颈２８例（７９轮次）,有效率８１％,作用持续１４ｗｋ±４ｗｋ。副作用轻微、可逆。结论：该疗法安全、有效,可作为面肌痉挛及各型头颈部肌张力障碍的首选治疗。     

Investigating prophylactic botulinum toxin type A for chronic headache disorders

There is an increasing number of studies on botulinum toxin A in the treatment of idiopathic and symptomatic headache; however, many studies can hardly be compared with each other because of different end points and different trial designs. For the prophylactic treatment of tension-type headache, migraine and cervicogenic headache, no sufficient positive evidence for a successful treatment can be obtained from the randomised, double-blind and placebo-controlled trials performed so far. For the treatment of chronic daily headache (including medication-overuse headache), there is inconsistent positive evidence for subgroups (e.g., patients without other prophylactic treatment). This means that most of the double-blind and placebo-controlled studies do not confirm the assumption that botulinum toxin A is efficacious in the treatment of idiopathic headache disorders; however, it is possible that some subgroups of patients with chronic migraine benefit from a long-term treatment for ≥ 6 months.     

Botulinum toxin A for the treatment of cervical dystonia

Idiopathic cervical dystonia (ICD) is the most common adult-onset focal dystonia. It is characterised by relatively sustained, involuntary contractions of neck muscles. Injections of botulinum toxin (BTX)-A are safe and effective for the treatment of ICD, and have substantially improved its treatment. BTX-A is manufactured by Allergan Pharmaceuticals in the US and Ireland, and is distributed as Botox^®. In Europe, BTX-A is manufactured and distributed by Ipsen Pharmaceuticals as Dysport^®. Success rates for BTX-A injections for ICD ranges 64 – 90%, with 76 – 93% of injected patients experiencing pain reduction. Side effects are generally mild and include dysphagia and neck weakness.     

肉毒素治疗面部皱纹75例疗效观察

目的 使用肉毒毒素，治疗上半面部皱纹。方法 将肉毒素用生理盐水稀释，明确皱纹范围，定位注射点和注射方向，注射剂量根据皱纹部位的不同而调整。结果 所有患者均有效，除局部肿胀和瘀斑外，无其他不良反应。结论 肉毒素是治疗上面部皱纹有效的生物制剂。     

Botulinum toxin as an effective treatment of clozapine-induced hypersalivation

Hypersalivation is a common and frequently disabling side effect of atypical neuroleptics such as clozapine. Current treatment options of this adverse advent are limited by lack of efficacy or additional side effects. Botulinum toxin (BTX) injections into the parotid glands have been shown to be very effective in treating sialorrhea in the context of various neurological disorders, such as Parkinsons and motor neuron disease. Surprisingly, BTX treatment of drug-induced sialorrhea has not yet been described. We here report a patient with clozapine-induced hypersalivation and a good response to BTX injections lasting for more than 12 weeks, resulting in a marked reduction of the hypersalivation and consequently of his social withdrawal. Our patient serves to alert clinicians to the frequent problem of drug-induced sialorrhea and suggests that BTX injections should be considered as an effective and safe treatment for hypersalivation in psychiatric patients treated with clozapine.The first two authors contributed equally to this work.     

A型肉毒毒素重复治疗特发性睑痉挛剂量及长期疗效探讨

目的 :探讨反复局部注射A型肉毒毒素治疗特发性睑痉挛维持疗效是否需增加剂量及能否保持疗效持续时间。方法 :对 178例病人A型肉毒毒素重复治疗 ,随访时间 7a。将 6轮的剂量、疗效、作用持续时间及不良反应比较 ,痉挛程度按Cohen强度分级 ,统计采用SAS软件统计包。结果 :经 7a 6轮观察 ,各轮疗效为 89.9% ,97.1% ,96 .4 % ,95 % ,95 %及 98% ;平均作用持续时间均为 15～16wk、平均剂量均为 70U左右 ,除第 1轮有效率较第 2轮、第 3轮为低 (P <0 .0 5 ) ,其余各轮间疗效、平均剂量、作用持续时间均无显著差异 (P >0 .0 5 )。总体发生不良反应均为 30 %左右。结论 :A型肉毒毒素重复局部注射治疗特发性睑痉挛 ,维持相似疗效和作用持续时间 ,无需增加剂量     

Effect of preventive treatment with botulinum toxin type A on acute headache medication usage in migraine patients

SUMMARY

Objective: To evaluate the impact of preventive treatment of migraine with botulinum toxin type A (BoNT-A as BOTOX^*) on the amount of acute headache medications used.

Research design and methods: Data from four studies of BoNT-A treatment for migraine were pooled for an aggregate analysis. All studies were at least 12 weeks in duration. For each study, the amounts of headache medications used at weeks 8-12 following BoNT-A treatment were compared with pretreatment baseline amounts and expressed as a percentage change.

Main outcome measures: The mean value for the reduction in medication usage was calculated by pooling data from the individual studies and weighting the data according to the sample size of each study.

Results: Four studies (one published, and three presented as recent meeting abstracts) with a total of 167 patients quantified acute headache medication use before and after BoNT-A treatment. The weighted average reduction in medication usage (primarily triptans) was 57% (range 38–75%).

Conclusions: The results of this pooled analysis indicated a 57% reduction in acute headache rmedication use in the 8- to 12-week period following injection of BoNT-A. A reduction of this magnitude could represent substantial savings in the costs of acute medications. This could help to offset the total cost of treatment and suggests BoNT-A may be a cost-reasonable option for preventive headache care considering acute medication offsets alone especially in patients with chronic headache with higher acute medication use. Additional larger controlled efficacy and safety studies must be done to confirm these results since three of the four studies were preliminary research and of different study types. Further prospective studies of direct and indirect costs, including those for disability and lost productivity, are needed to evaluate the overall impact of BoNT-A therapy on the economic, societal, and individual burden of migraine headache.