A型肉毒毒素治疗面肌痉挛53例临床观察

目的：研究分析A型肉毒毒素对面肌痉挛的临床治疗安全性和可行性,分析长期重复治疗面肌痉挛是否可行。方法：选择2009年9月～2012年5月我院收治的面肌痉挛患者53例为临床研究对象,其中首次治疗患者28例,重复治疗患者25例,对两组患者进行跟踪随访。观察比较两组患者疗效、疗效持续时间及不良反应。结果：重复治疗组患者的总有效率为100％,疗效持续时间为（4．98±1．05）月,患者发生不良反应6例,与首次治疗组患者的治疗效果无明显变化,组间比较,P〉0．05,差异无统计学意义。结论：使用A型肉毒毒素对面积痉挛进行治疗可以进行重复治疗,不会影响患者的治疗效果,且不会增加不良反应的发生,安全性较高。     

A型肉毒毒素在偏侧面肌痉挛治疗中的临床体会

目的 探讨A型肉毒毒素在偏侧面肌痉挛治疗中的临床体会。方法 回顾性分析2016年6月至2020年8月间采用A型肉毒毒素治疗的12例偏侧面肌痉挛患者的病例资料。对每位入组患者应用的A型肉毒毒素剂量、注射方式、治疗效果和并发症进行汇总分析。结果 入组患者局部注射A型肉毒毒素后,患侧面肌痉挛症状得到明显控制。其中4例患者在随访期内无复发,6例患者予以追加注射1次,2例程度较重的患者,进行了2次追加注射,患侧面肌痉挛得到良好控制,随访期内未再复发。入组患者均未出现不良反应。结论 A型肉毒毒素注射可以很好地控制面肌痉挛发作,具有治疗简便、痛苦小、起效快等优点。其具体注射剂量和位点选择需依据患者性别、面肌痉挛程度等因素综合评估后进行相应调整。     

A型肉毒毒素治疗Meige综合征的方法及效果分析

目的：探讨A型肉毒毒素治疗Mei ge综合征的方法及疗效。方法：47例患者在肌电图引导下用兼作注射器的针电极进行,在患者肌痉挛部位用A型肉毒毒素肌肉内注射,每点注射量为0.1～0.2ml（含肉毒毒素2.5～5 U）,注射点数为数点～8点。根据Cohen、Albert痉挛强度分级评估疗效。结果：注射后一般3～4天起效,疗效持续3～6个月,复发者重复注射仍有效。治疗后患者肌痉挛强度明显下降,与治疗前比较有极显著性差异（P〈0.01）;症状完全缓解和明显缓解者达89.4%,治疗前后疗效比较有极显著性差异（P〈0.01）。不良反应主要有：局部水肿、咬肌无力、眼睑下垂等,一般两周内均能恢复。结论：局部注射A型肉毒毒素治疗Meige综合征为一种安全有效、简便易行的治疗手段。     

应用A型肉毒毒素治疗面肌痉挛

目的：应用国产A型肉毒毒素治疗面肌痉挛55例并观察其远期疗效、并发症,提出治疗时的注意事项。方法：根据注射的肌肉大小决定注射点及每点的注射剂量,肌肉震颤最明显处。每注射点的肉毒毒素注射量约在15U左右,一次注射的总量一般控制在130U。首次注射后2周后复查,若痉挛未完全控制,可追加注射1次,方法相同,但注射量应减半。结果：55例患者首次注射后完全缓解38例,占69%,部分缓解17例,占31%,对部分缓解的患者10天后追加注射1次,疗效基本满意。所有患者均未出现全身及局部副作用。结论：该注射方法简单,安全无痛苦,毒副作用小,疗效佳,应当是目前治疗面肌痉挛较好的方法,尤其适合基层单位应用推广。     

肉毒杆菌毒素A治疗难治性肱骨外上髁炎58例

肉毒杆菌毒素A是一种嗜神经毒素，常用于神经科多种肌肉痉挛性疾病，如面肌痉挛等，效果确切。近几年来，国外陆续报道使用肉毒毒素A局部注射治疗难治性肱骨外上髁炎，取得满意疗效。自2003年9月至2005年12月采用肉毒杆菌毒素A局部注射治疗难治性肱骨外上髁炎58例，疗效满意，现报告如下。     

A型肉毒毒素治疗眼睑及面肌痉挛体会

自2003年8月至2004年8月，我们应用A型肉毒毒素治疗眼睑及面肌痉挛10例，均获得良好的疗效，现体会如下。     

肉毒毒素治疗难治性玫瑰痤疮研究进展

本文总结了难治性玫瑰痤疮的临床表现及治疗难点,分析了肉毒毒素对人体的相关作用机制,并将肉毒毒素与难治性玫瑰痤疮的治疗机制相结合,总结两者之间的联系,综述了肉毒毒素治疗难治性玫瑰痤疮的相关研究进展,就近年来肉毒毒素治疗玫瑰痤疮的方法、疗效及安全性进行评估,希望对提高难治性玫瑰痤疮的疗效提供参考和帮助。     

A型肉毒毒素治疗眼睑及面肌痉挛体会

自2003年8月至2004年8月,我们应用A型肉毒毒素治疗眼睑及面肌痉挛10例,均获得良好的疗效,现体会如下. 1 临床资料     

A型肉毒毒素注射治疗咬肌肥厚对面型的影响

目的 客观评价A型肉毒毒素注射治疗咬肌肥厚对面型的影响.方法 选择正面观用力咬(牙合)时能看到双侧咬肌区体积变化的患者,进行咬肌内多点注射,每侧注射A型肉毒毒素30～50 U,然后观察面部外形变化及患者满意度,并于治疗前和治疗后2～3个月,拍摄面部正位照片,在照片上测量形态面高(FH)、面中部宽度(FWz)和面下部宽度(FWg),根据测量值计算并分析面指数FH/FWz和FWg/FWz在治疗前后的变化.结果 本组共32例患者,在接受注射治疗后的2～4周咬肌区体积开始缩小,面型改善,效果最明显出现在注射后2～3个月,所有患者对治疗后所产生的效果均满意.FH/FWz在治疗前后的值分别是0.8309±0.0423,0.8331±0.0382;FWg/FWz在治疗前后的值分别是0.8281±0.0209,0.7925±0.0206(P＜0.01).结论 A型肉毒毒素注射治疗咬肌肥厚可降低面指数FWg/FWz,对面型有改善作用.     

肉毒毒素注射与射频温控热凝术治疗原发性半侧面肌痉挛的疗效比较

目的 对比肉毒毒素注射与射频温控热凝术治疗原发性单侧面肌痉挛的临床疗效,以寻求最佳的治疗方法.方法 118例患者分别采用面部肌肉肉毒毒素-A注射法与面神经总干射频温控热凝术治疗.治疗后随访,对两种治疗方式的疗效、并发症和复发率进行统计对比.结果 肉毒毒素-A注射疗法的近期疗效(1个月)优于射频温控热凝疗法,远期(6个月)疗效下降,复发率72.5％,但引发面瘫并发症的概率极低;射频温控热凝术治疗的远期疗效优于肉毒毒素-A注射,6个月后复发率仅为21.4％,但有出现治疗后面瘫并发症之虞.结论 肉毒毒素-A注射和射频温控热凝术相比较“各有千秋”,治疗后在短期内两者均具有较高的有效性,前者的副作用更小,但复发率高,临床治疗中应当量情分别选用.     

Effect of botulinum A toxin injection in the management of hemifacial spasm]

The present study was carried out on the effect of botulinum A toxin, made in Japan, in the management of 30 hemifacial spasm patients. In almost all cases, alleviation of hemifacial spasm reached its peak in a few days. Availability was 93.3% and its effect lasted about 4 months. Side effects were observed in 12 patients (40%), but no serious complications were observed.     

Introduction to primary hemifacial spasm: A neurosurgical disease

Primary hemifacial spasm is a hyperactive cranial nerve syndrome. The cause is always a neurovascular compression, generally at the root exit zone from the brainstem. Its curative treatment is microvascular decompression, that may be performed as a first option, or secondarily when botulinum toxin injections fail.     

Local injection of botulinum toxin type A for hemifacial spasm

The preliminary experience of botulinum toxin treatment for hemifacial spasm is reported in this study. Five patients were treated with 10 injections of botulinum toxin in total. Botulinum toxin had a good to excellent effect in all cases. Improvement was observed 2 weeks to 1 month after the injection. The duration of improvement was 0-9 months (mean 4.2 months). The peak rank tended to decrease and the duration of improvement increased after several treatments. Hemifacial spasm caused by the anterior inferior cerebellar artery tended to subside easily. In contrast, compression by the vertebral artery was more refractory. Continuous facial spasm caused by operative trauma subsided after the injection, but paroxysmal spasm still occurred when eating or laughing. Spasm caused by trauma disappeared 4.5 months after the injection. The complications, which were facial nerve paresis in two cases (3 injections, 30%) and diplopia in one case (1 injection, 10%), were transient and subsided in 2 weeks.     

Anwendung von Botulinumtoxin beim Blepharospasmus, Spasmus facialis und bei Synkinesien nach Fazialisdefektheilung

Involuntary facial movements are caused by various diseases. This article describes three of these diseases: blepharospasm, hemifacial spasm and facial synkinesis following facial nerve paralysis. The different etiologies, clinical symptoms and diagnosis are discussed. A common therapeutic approach for these three diseases is presented. Involuntary facial movements can be reduced or even completely suppressed by local injections of botulinum toxin.     

Blepharospasm and hemifacial spasm

Opinion statement  

Is hemifacial spasm accompanied by hemodynamic changes detectable by ultrasound?

Background

Arterial tortuosity of the posterior circulation compressing the facial nerve induces the ephaptic axono-axonal cross-talk that sparks hemifacial spasm. We sought if a noninvasive method such as color duplex of these arteries might detect hemodynamical changes in this condition.

Methods

Nine patients with hemifacial spasm, successfully treated with botulinum toxin, were examined with color-coded duplex ultrasound. Mean blood flow velocities of the vertebral, basilar, posterior inferior cerebellar, and anterior inferior cerebellar arteries were measured and side-to-side comparison performed.

Results

In all nine patients, the mean blood flow velocity, averaging across the two arteries, was higher on the side of the hemifacial spasm (Fisher’s exact p?<?0.008; two-tailed). The results of the repeated measures ANOVA show that the main effect of side of flow was statistically significant, F(1,8)?=?17.354, p?=?.0032, with higher mean blood flow velocities observed on the side of the hemifacial spasm. There was no significant association between the mean flow velocity of the vertebral artery and the side of spasm (p?=?0.523).

Conclusions

Hemifacial spasm also seems to relate to hemodynamic changes, which may be detectable by color duplex imaging.     

Side effects of the use of botulinum toxin for treatment of benign essential blepharospasm and hemifacial spasm

From April 1983 to April 1988, 381 botulinum toxin injections for lid spasms were administered to 106 patients. Sixty-nine had bilateral blepharospasm and 37 had hemifacial spasm. Of the 381 injections, 308 had been given to patients who returned for follow-up examinations. No systemic effects were noted at any of these visits; all side effects were temporary; there were no serious complications. Ptosis, the most frequently encountered problem, occurred after 26 (8.4%) of the injections. Other complications included: corneal exposure (after eight injections, 2.59%); face droop (after 11 injections, 3.57%); diplopia (after five injections, 1.62%); and subtle visual blurring (after eight injections, 2.59%). One patient noted jaw tenseness, another mentioned tearing, one reported brow droop, and another complained of crossed eyes. Ten injections had minimal effect; in these cases a repeat injection usually was effective. Only four patients chose surgery after beginning injections. We conclude that botulinum toxin injections are a safe, effective means of treating lid spasms.     

Factors affecting quality of life after minimally invasive Heller myotomy for achalasia

The effect of prior nonoperative treatment, type of fundoplication, and surgical approach on quality of life after minimally invasive Heller myotomy (MIHM) for achalasia in not known. MIHM for achalasia was performed in 105 patients (primary 102; redo 3). Sixty-five patients had prior nonoperative treatment (dilations in 41; botulinum toxin injections in 13; dilations and botulinum toxin injections in 11). Primary laparoscopic MIHM with fundoplication (Dor in 32; Toupet in 56) was performed in 88 patients and thoracoscopic MIHM without fundoplication in 14. Achalasia and quality-of-life-related symptoms were evaluated prospectively with a visual analogue scoring scale. Median follow-up was 25 months. There was a trend toward a higher incidence of intraoperative esophageal perforation and recurrent dysphagia in patients with prior nonoperative treatment. Patients with prior nonoperative treatment had significant improvement in achalasia-related symptoms postoperatively. Patients with prior botulinum toxin injections with or without dilations had no improvement in quality of life after MIHM. The operative success of MIHM may be compromised if prior nonoperative treatment is used. Botulinum toxin injections may blunt the beneficial effect of MIHM on quality of life. The outcome of MIHM is good regardless of the type of fundoplication or surgical approach. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21, 2003 (poster presentation).     

Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm. Case report

The lateral spread response (LSR) is used in the electrophysiological diagnosis of a hemifacial spasm or for monitoring during microvascular decompression. The authors used LSRs for intraoperative monitoring during endovascular surgery in a rare case of vertebral artery (VA) aneurysm that caused intractable hemifacial spasm. A 49-year-old woman presented with a right hemifacial spasm that had persisted for 9 months. No other clinical symptom was observed. Vertebral artery angiography revealed a saccular aneurysm of the right VA. Magnetic resonance (MR) imaging demonstrated that the aneurysm was compressing the root exit zone of the right facial nerve. Endovascular treatment of the VA aneurysm was performed while monitoring the patient's LSRs. During occlusion of the VA at sites distal and proximal to the aneurysm, the LSRs temporarily disappeared and then reappeared with a higher amplitude than those measured preceding their disappearance. The hemifacial spasm alleviated gradually and disappeared completely 6 months after treatment. The LSRs changed in parallel with the improvement in the patient's hemifacial spasms and eventually disappeared. No recurrence of symptoms has been noticed as of 18 months postoperatively. This is the first report of the use of LSR monitoring during endovascular surgery for an intracranial aneurysm that causes hemifacial spasm. Intraoperative and postoperative changes in the LSRs provided useful information regarding the pathophysiology of hemifacial spasm.