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

Exploration of effect and dosage of botulinum toxin type A for long-term treatment of idiopathic blepharospasm

AIM: To explore the relationship between the efficacy and the dosage of botulinum toxin type A (BTXA) for long-term and repetitive treatment of blepharospasm. METHODS: 178 patients repetitively treated with BTXA were followed up for 7 a. The dosage, effect, effect duration, and adverse reations of 6 sessions were compared among themselves. The severity of blepharospasm was gauged by Cohen scale. SAS software package was administered for statistic analysis. RESULTS: 178,138,112,83,63, and 48 patients were enrolled in the consequently 6 sessions in 7 a. The withdraw rates were 14.0 %(25/178) (P<0.05),5.1 %(7/138), 5.4 %(6/112),6 %(5/83) and 6 %(4/63) since the second session. The effective rate of each session was 89.9 %(160/178),97.1 %(134/138),96.4 %(108/112),95 %(79/83),95 %(60/63), and 98 %(47/48), respectively. The average BTXA dosage was about 70 U, and the mean duration of improvement was 15-16 wk. Though the lower effective rate in the first session compared with the second and third sessions, there were no significant differences among other sessions in the effective rate, mean dosage and duration of improvement. The incidence rates of adverse reactions were 36.5 %(65/178),31.9 %(44/138),31.3 %(35/112),31 %(26/83),30 %(19/63) and 29 %(14/48) respectively in each session, and there were no significant differences in statistic analysis. The adverse reactions of focal weakness occurred at 2-3 d after effect emerged and lasted 2-6 wk. The most concerned complications were ptosis, blurred vision and diplopia. The ptosis occurred 10.1 % in the first session, which had statistic difference (P<0.05) compared with the second and third sessions (3.6 %-3.6 %). The adverse reaction rate was 30 % on the whole. CONCLUSION: Without increasing dose, the long-term therapeutic effect and duration of improvement can be maintained by repeated topical BTXA injection. The incidence of adverse reactions such as ptosis can be reduced.