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偏侧面肌痉挛和良性特发性眼睑痉挛的临床与治疗特点
彭彬张申起董红娟罗瑛卢祖能
0
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摘要:
目的 探讨偏侧面肌痉挛(HFS) 和良性特发性眼睑痉挛(BEB) 的临床特点、治疗现状以及对A 型肉毒毒素(BTX-A) 治疗的反应。方法 对2013 年4~10 月在武汉大学人民医院神经内科门诊就诊的HFS 患者和BEB 患者进行调查,其中HFS 患者110 例,BEB 患者90 例。所有的患者均接受了BTX-A 局部注射治疗。注射后2 周左右复诊,在每周二下午的专病门诊随访,并记录BTX-A 的疗效持续时间。结果 (1) 入组200 例患者中,BTX-A 治疗起效时间0~30 d( 中位数4 d),疗效持续时间2~128 周( 中位数16 周),总有效率96.9%。HFS 患者症状明显好转( 完全和明显缓解) 占99.3%,BEB 患者占90.2%。总的来说,BEB 患者的疗效持续时间[(13.6±5.5)周]与HFS 患者[(20.3±10.2)周]相比较短。HFS 患者所用BTX-A 剂量[(53.2±15.8)U]较BEB 患者[(74.8±20.2)U]少。(2)BTX-A 注射(70.9%)、针灸(68.2%) 和口服药(65.5%)是HFS患者曾经选择的最多的非手术治疗方法。针灸和口服药大部分效果不好而自行停用。BTX-A 注射(88.9%)、口服药(86.7%) 和眼轮匝肌切割术(31.1%) 是BEB 患者曾经选择的最多的治疗方法,但患者均反映手术无效。结论 HFS 和BEB 是运动障碍门诊最常见的两种疾病,BTX-A 治疗HFS 和BEB 安全、有效,对HFS 效果更好,BEB 患者需要更频繁的注射,其面部肌张力障碍的治疗更具挑战性。
关键词:  A 型肉毒毒素  偏侧面肌痉挛  良性特发性眼睑痉挛  治疗
DOI:10.3969/j.issn.1009-6574.2017.03.006
基金项目:湖北省卫计委重点项目(WJ2015MA007);武汉市科技局2015年应用基础研究计划项目(2015060101010047)
Clinical and therapeutic features of patients with hemifacial spasm and benign essential blepharospasm
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Abstract:
Objective  To confirm the clinical features and therapeutic efficacy of botulinum toxin type A(BTX-A)for hemifacial spasm(HFS) and benign essential blepharospasm(BEB) patients. Methods  Totals of 110 HFS patients and 90 BEB patients from Department of Neurology,Renmin Hospital of Wuhan Universitybetween April 2013 and October 2013 were included in this cross-section study. All patients were instructedto be reviewed in the second week after BTX-A injection. The duration of effects of BTX-A injection was re-corded. Results (1) Of 200 patients who were included,the mean duration was 61.6 months. The onset time was 0-30 d (median 4 d). The duration of response was 2-128 weeks (median 16 weeks). Of all patients,the effective rate was 96.9%,while 99.3% for HFS patients and 90.2% for BEB patients. Patients with HFS received a lower mean dose of BTX than patients with BEB [(53.2±15.8)U vs (74.8±20.2)U]. And patients with HFS had a longer treatment duration than patients with BEB[(20.3±10.2)weeks vs (13.6±5.5)weeks]. (2) BTX-A injection was the most commonly used treatment (70.9%),followed by acupuncture (68.2%) and oral medication (65.5%) inHFS patients. Most patients gave up acupuncture and oral medication because of the ineffectiveness. In BEB patients,BTX-A injection was the most commonly used treatment (88.9%),followed by oral medication (86.7%) and orbicu-laris oculi myectomy (31.3%),whereas orbicularis oculi myectomy was not effective. Conclusions HFS and BEB are most common diseases in movement disorder clinic. BTX-A treatment is safe and effective for both BEB and HFS,with better effect for HFS. BEB patients require more frequent injections,highlighting that facial dystonia in patients with BEB is more challenging to manage.
Key words:  Botulinum toxins,type A  Hemifacial spasm  Benign essential blepharospasm  Treatment

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