Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm

Although the beneficial effect of subcutaneous injections of botulinum toxin type A (BTX-A) is well known in both blepharospasm and hemifacial spasm, the position of the injection sites around the orbicularis oculi may influence the effectiveness and side effects. Here we report results of preseptal and pretarsal BTX-A injections in 53 patients (25 blepharospasm and 28 hemifacial spasm) in whom we used both injection techniques successively. Pretarsal injections were used in 102 out of 186 treatments in blepharospasm group and in 84 out of 202 treatments in hemifacial spasm group. Pretarsal BTX-A treatment produced significantly higher response rate and longer duration of maximum response in both patient groups. This technique was also associated with a lower frequency of major side effects such as ptosis. We concluded that injections of BTX-A into the pretarsal, rather than the preseptal portion of the orbicularis oculi is more effective for treatment of involuntary eyelid closure due to contractions of this muscle. Received: 15 January 2001, Received in revised form: 11 May 2001, Accepted: 17 May 2001     

A型肉毒毒素注射治疗锥体外系疾病合并眼睑痉挛的疗效观察

目的:探讨A型肉毒毒素(Bo NT/A)注射治疗锥体外系疾病合并眼睑痉挛(伴或不伴睁眼性失用)的疗效。方法:30例锥体外系疾病(19例帕金森病、5例多系统萎缩、6例进行性核上性麻痹)合并眼睑痉挛的患者局部注射Bo NT/A,在治疗前和治疗后1个月采用Jankcovic评定量表(JRS)、眼睑痉挛残疾指数(BSDI)评估眼睑痉挛改善效果,视觉模拟评分法(VAS)让患者自评疗效,自评改善大于50%定义为治疗有效。结果:治疗后1个月患者JRS-F(1.43±0.68)分、JRS-S(1.23±0.94)分、JRS-T(2.53±1.46)分、BSDI(1.33±0.91)分,均较治疗前[JRS-F(2.47±0.90)分、JRSS(2.70±0.88)分、JRS-T(5.30±1.68)分、BSDI(1.95±0.83)分]明显降低,差异均有统计学意义(均P     

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。     

针刺治疗眼睑痉挛27例临床观察

目的 观察针刺治疗眼睑痉挛的临床疗效.方法 将27例眼睑痉挛患者,随机分为两组,其中对照组予以西药治疗,治疗组采用针刺治疗,比较两组患者的临床疗效.结果 治疗组总有效率为85.7%,对照组总有效率为69.2%,两组总有效率比较,差异有统计学意义(χ2=0.0256,P<0.05).结论 应用针刺对眼睑痉挛的治疗效果优于西药治疗.     

复方樟柳碱治疗眼睑痉挛的疗效观察

目的 观察复方樟柳碱治疗眼睑痉挛的疗效。方法 用复方樟柳碱注射液行眼睑痉挛者患侧颞浅动脉旁皮下注射36例。结果 36例中治愈31例（86％）,好转5例（14％）。随访1月到2年无复发。结论 复方樟柳碱治疗眼睑痉挛是一种安全、有效、简便的方法,操作简单,无并发症。     

肉毒杆菌毒素在眼科的应用进展

肉毒杆菌毒素是由肉毒杆菌在繁殖过程中所产生的一种神经毒素蛋白,其作用机制是阻断乙酰胆碱在胆碱能神经的神经肌肉接头释放而阻断传导冲动。在眼科诊疗中,它已被常规用于眼睑痉挛、斜视、眼周除皱、上睑挛缩等眼部疾病的治疗,其疗效确切。本文综述了肉毒杆菌毒素在眼科的相关应用进展。     

Blepharospasm in Japan: A Clinical Observational Study From a Large Referral Hospital in Tokyo

Focal dystonia is regarded as a characteristic feature of blepharospasm. However, patients do not always present with motor symptoms. To clarify the clinical features of blepharospasm in Japan, we conducted a retrospective observational study involving a large population of patients from a single institution. Common symptoms included difficulty opening the eyes, photophobia, and ocular pain/irritation. Initial symptoms often occurred following the long-term use of psychotropics such as etizoram, benzodiazepines, and zolpidem (32% of patients). Our findings demonstrated that the clinical presentation of blepharospasm is heterogenous, and that understanding regarding sensory-dominant forms of the disease may be poor among practitioners in Japan.     

心理性眼睑痉挛：诊断的困境

概述：眼睑痉挛是眼轮匝肌不受控制的痉挛性收缩导致眼睛异常抽动或抽搐。它通常持续几秒钟到几分钟,但在严重的情况下,眼睛可能会紧闭数小时。它可能是良性的,无论是原发的还是继发于基底节、锥体束的病变,眼部的创伤或局部病理情况引起的,或是药物所致的。在这里,我们报告一例心理性眼睑痉挛的病例。患者,女性,65岁,发作性无法睁眼6个月。她反复出现突然闭眼,往往要持续1 h。这使其无法人际交往,社会功能受损。详细的体检、包括神经影像学在内的检查排除了神经系统或其他系统性病因。口服药物治疗效果不佳,只在右侧眼睑肌射7个单位的肉毒素,几秒钟内,其双眼症状均得以缓解。之后一次治疗时,只用针刺一下一只眼睛,无需任何药物或暗示,患者就睁开紧闭的双眼。本病例中,患者曾报告过最近家务繁重感到有压力。这一病例表明,真正的运动障碍与功能性障碍鉴别往往有一定难度。因此,在进行任何有创治疗之前,评估患者的内外应激,并对此处理,将获益匪浅。