A型肉毒毒素治疗肌张力过强1

AIM To evaluate the efficacy and safety of botulin um toxin type A (BTA) in treating hemifacial spasm and cranial－cervical dystonia . METHODS Injection sites and dosage of BTA were depending on the involved muscles. The efficacy and side effects were compared between the results before and aft er injection. RESULTS The 250 patients with hemifacial spasm received a total 1028 injection sessions. Seventy－eight patients with blephrospasm received 260 sessi ons. Fifty－three patients with oramandibular spasm received 181 sessions. Twenty －eight patients with spasmodic torticollis received 79 sessions. The effective r ates and average relief duration were 100% and 16 wk±s 4 wk,93.9% an d 15 wk±4 wk,85.1% and 14 wk±4 wk,81% and 14 wk±4 wk,respectively. Side ef fe cts were mild and reversible. CONCLUSION Local injection of BTA is a simple,ef fective and safe therapy for hemifacial spasm and cranial－cervical dystonia.     

A型肉毒毒素治疗局限性肌张力障碍

目的：观察A型肉毒毒素（BTX－A）对局限性肌张力障碍的治疗效果和不良反应。方法：31例偏侧面肌痉挛、9例睑痉挛、3例痉挛性斜颈、2例Meige综合征和1例痛性痉挛患者均点皮下或肌注BTX－A,并随访6个月,对治疗后第7天,3个月和6个月进行疗效统计,结果：治疗后7d、3个月、6个月的有效率为91．3％、97．8％和71．7％,痉挛程度分级变化均有显著性（P＜0．05）。6例出现轻微的局部不良反应,2例左右自然消失。46例中1例无效。结论：BTX是治疗局限性肌张力障碍的见效快,安全有效和简便易行的方法。     

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型肉毒毒素治疗局限性肌张力障碍的临床研究

目的 探讨A型肉毒毒素(BTX—A)局部注射治疗局限性肌张力不全(偏侧面肌痉挛、眼睑痉挛、Meige综合症)的临床疗效及安全性。方法：对186例病人采用BTX—A局部多点注射痉挛肌肉，并进行治疗前后的病情分级及疗效对比。结果：治疗后随访至少半年，BTX—A治疗有效率为100％，疗效持续8W～28W，最好疗效维持2月左右。复发者重复注射治疗同样有效。注射后病人可出现轻度的局部肌无力，如眼睑闭合不良、轻度面瘫。但均在短期内恢复，副作用轻微可逆。结论：BTX—A治疗方法简单、安全、有效，可作为头面部肌张力障碍的首选治疗。     

A型肉毒毒素治疗面肌、眼睑痉挛及Meige综合症临床观察

目的 探讨A型肉毒毒素治疗面肌、眼睑痉挛及Meige综合症的疗效。方法 采用A型肉毒毒素局部注射偏侧面肌痉挛102例，眼睑痉挛41例及Meige综合症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月，复发重复注射仍有效，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综合症的手段。     

A型肉毒毒素治疗面肌及眼睑痉挛

目的观察A型肉毒毒素治疗面肌和眼睑痉挛的疗效。方法对168例面肌及12例眼睑痉挛患者进行眼面部痉挛肌肉局部多点注射A型肉毒毒素,评价治疗效果。结果180例面肌及眼睑痉挛患者,完全缓解率67.8%、明显缓解率22.8%、部分缓解率9.4%,总有效率达100%;起效时间1～7d,疗效持续时间在面肌痉挛和眼睑痉挛分别为(14.6±4.7)和(13.4±5.4)周。局部不良反应轻微、短暂,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面肌及眼睑痉挛的一种安全、有效、简便、易行的治疗方法。     

A型肉毒毒素治疗面肌、眼睑痉挛及Meige综合症临床观察

目的探讨A型肉毒毒素治疗面肌、眼睑痉挛及Meige综合症的疗效。方法采用A型肉毒毒素局部注射偏侧面肌痉挛102例,眼睑痉挛41例及Meige综合症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综合症的手段。     

应用A型肉毒毒素治疗Meige综合征的临床观察

Meige综合征又称眼睑痉挛,口下颌肌张力障碍综合征,是一种比较少见的局灶性肌张力障碍性疾病,应用A型肉毒毒素(BTX-A)治疗。我院近4年诊治18例Meige综合征,效果报道如下。     

A型肉毒毒素临床应用中的副作用

综述了A型肉毒毒素 (botulinumtoxintypeA ,BTA)临床应用中 (包括局限性与非局限性肌张力障碍性疾病、斜视及其他眼部疾病等 )可能出现的各种副作用。根据文献报道BTA注射治疗中所引起的副作用轻微、短暂 ,不留后遗症 ,更无全身副作用。     

小剂量A型肉毒毒素治疗面肌痉挛

目的 :探讨小剂量 (2 .0U )A型肉毒毒素局部注射治疗面肌痉挛的临床疗效和安全性。方法 :面肌痉挛病人 5 8例 (男性 2 4例 ,女性 34例 ;年龄 4 7a±s 13a)采用A型肉毒毒素 (2 .0U )局部多点注射痉挛肌肉 ,治疗前后对照。结果 :治疗面肌痉挛 5 8例 ,有效率 97% (5 6 /5 8) ,作用持续 15wk± 4wk。副作用轻微、可逆。结论 :小剂量A型肉毒毒素治疗面肌痉挛疗效肯定 ,副作用少     

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型肉毒毒素治疗偏头痛的临床研究

目的:观察A型肉毒毒素治疗预防偏头痛 发作的临床疗效和不良反应。方法:选取30例偏头 痛病人,应用A型肉毒毒素进行颅周肌内注射治 疗,问卷调查记录每例偏头痛病人治疗前3mo,治 疗后mo1,2,3偏头痛发作情况,比较偏头痛发作频 率、发作持续时间、发作严重程度及使用止痛药物情 况,观察不良反应。结果:A型肉毒毒素治疗后 mo1,偏头痛发作频率、发作持续时间、发作严重程 度均较治疗前明显下降(P<0.01),止痛药物的使 用较治疗前减少(P<0.01),疗效可至少维持3mo, 且不良反应轻微、短暂。结论:A型肉毒毒素颅周肌 内注射治疗预防偏头痛发作临床疗效显著,不良反 应轻微、短暂,值得临床研究。     

Questionnaire about the Adverse Events and Side Effects Following Botulinum Toxin A Treatment in Patients with Cerebral Palsy

Botulinum toxin A (BoNT-A) injections for treatment of spasticity in patients with cerebral palsy (CP) have been used for about two decades. The treatment is considered safe but a low frequency of adverse events (AE) has been reported. A good method to report AEs is necessary to verify the safety of the treatment. We decided to use an active surveillance of treatment-induced harm using a questionnaire we created. We studied the incidence of reported AEs and side effects in patients with CP treated with BoNT-A. We investigated the relationship between the incidence of AEs or side effects and gender, age, weight, total dose, dose per body weight, Gross Motor Function Classification System (GMFCS) and number of treated body parts. Seventy-four patients with CP participated in our study. In 54 (51%) of 105 BoNT-A treatments performed in 45 (61%) patients, there were 95 AEs and side effects reported, out of which 50 were generalized and/or focal distant. Severe AEs occurred in three patients (4%), and their BoNT-A treatment was discontinued. Consecutive collection of the AE and side-effect incidence using our questionnaire can increase the safety of BoNT-A treatment in patients with CP.     

Ultrasound-Guided Injection of Botulinum Toxin Type A for Piriformis Muscle Syndrome: A Case Report and Review of the Literature

Piriformis muscle syndrome (PMS) is caused by prolonged or excessive contraction of the piriformis muscle associated with pain in the buttocks, hips, and lower limbs because of the close proximity to the sciatic nerve. Botulinum toxin type A (BoNT-A) reduces muscle hypertonia as well as muscle contracture and pain inhibiting substance P release and other inflammatory factors. BoNT-A injection technique is important considering the difficult access of the needle for deep location, the small size of the muscle, and the proximity to neurovascular structures. Ultrasound guidance is easy to use and painless and several studies describe its use during BoNT-A administration in PMS. In the present review article, we briefly updated current knowledge regarding the BoNT therapy of PMS, describing also a case report in which this syndrome was treated with an ultrasound-guided injection of incobotulinumtoxin A. Pain reduction with an increase of hip articular range of motion in this patient with PMS confirmed the effectiveness of BoNT-A injection for the management of this syndrome.     

原发性偏侧面肌痉挛与Meige综合征及A型肉毒素对其治疗的研究现状

对国内外关于原发性偏侧面肌痉挛及Meige综合征和A型肉毒素对其治疗的文献进行回顾性分析,阐述原发性偏侧面肌痉挛及Meige综合征的发病机制、诊断及治疗现状,重点阐述A型肉毒毒素注射治疗原发性偏侧面肌痉挛及Meige综合征的适应证、药物使用浓度、药效、药效持续时间、注射位点、并发症及对情绪的影响等。明确A型肉毒毒素治疗原发性偏侧面肌痉挛及Meige综合征的优越性。     

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。     

Cost-Effectiveness of Treating Upper Limb Spasticity Due to Stroke with Botulinum Toxin Type A: Results from the Botulinum Toxin for the Upper Limb after Stroke (BoTULS) Trial

Stroke imposes significant burdens on health services and society, and as such there is a growing need to assess the cost-effectiveness of stroke treatment to ensure maximum benefit is derived from limited resources. This study compared the cost-effectiveness of treating post-stroke upper limb spasticity with botulinum toxin type A plus an upper limb therapy programme against the therapy programme alone. Data on resource use and health outcomes were prospectively collected for 333 patients with post-stroke upper limb spasticity taking part in a randomized trial and combined to estimate the incremental cost per quality adjusted life year (QALY) gained of botulinum toxin type A plus therapy relative to therapy alone. The base case incremental cost-effectiveness ratio (ICER) of botulinum toxin type A plus therapy was £93,500 per QALY gained. The probability of botulinum toxin type A plus therapy being cost-effective at the England and Wales cost-effectiveness threshold value of £20,000 per QALY was 0.36. The point estimates of the ICER remained above £20,000 per QALY for a range of sensitivity analyses, and the probability of botulinum toxin type A plus therapy being cost-effective at the threshold value did not exceed 0.39, regardless of the assumptions made.     

High Doses of Botulinum Toxin Type A for the Treatment of Post-Stroke Spasticity: Rationale for a Real Benefit for the Patients

In the past few years, there was a great interest in the use of higher doses of botulinum toxin type A, especially in case of upper and lower limb severe spasticity. To date, only one prospective, non-randomized, single-arm, multicenter, open-label, dose-titration study with the employment of incobotulinum toxin up to 800 U has been published, and the authors investigated safety and tolerability. Other researches showed efficacy in spasticity reduction, but there is a lack of evidence about the reasons to use high doses of botulinum toxin. This short communication highlights the benefits of higher doses for subjects with upper and lower limb spasticity.