长期重复应用A型肉毒毒素治疗面肌痉挛的疗效及对面神经CMAP的影响
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摘要
第一部分长期重复应用A型肉毒毒素治疗面肌痉挛的疗效、安全性的评价
目的:观察长期重复应用A型肉毒毒素治疗面肌痉挛的疗效、副反应是否有变化。
方法:将48例面肌痉挛患者依据接受A型肉毒毒素治疗的次数分为两组:首次治疗组(30例)、长期重复治疗组(连续接受4次及4次以上A型肉毒毒素治疗)(18例)。本次注射A型肉毒毒素后随访6个月,比较两组在起效时间,达峰时间,疗效等级,疗效维持时间及副反应等方面有无差别。
结果:两组患者注射A型肉毒毒素后在起效时间、达峰时间、疗效等级、疗效维持时间及副反应等方面比较均无明显差异。
结论:长期重复应用A型肉毒毒素治疗面肌痉挛疗效依然显著,在起效时间、疗效等级、维持时间等方面保持不变。
第二部分长期重复应用A型肉毒毒素对面神经CMAP的影响
目的:观察长期重复应用A型肉毒毒素对面神经CMAP的影响。
方法:将48例面肌痉挛患者分别依据病程及接受肉毒毒素治疗的次数分为三组:早期组(20例)、长期未治疗组(病程在2年以上且未接受过A型肉毒毒素治疗)(10例)、长期重复治疗组(病程在2年以上,接受4次及4次以上A型肉毒毒素治疗,且每次治疗间隔均超过6个月)(18例)。1.早期组、长期未治组HFS患者CMAP潜伏期及波幅自身患健侧、组间患侧比较,以明确HFS对患者面神经CMAP有无影响,并了解两者的基线水平。2.监测7例首次接受治疗HFS患者A型肉毒毒素治疗前、后1周、2周、1月、3月、6月时的CMAP潜伏期及波幅的变化,以明确A型肉毒毒素对面神经的阻滞作用及随时间恢复的情况。3.长期未治组及长期重复治疗组治疗6个月后CMAP潜伏期、波幅自身患健侧、组间患侧比较,以了解长期重复注射A型肉毒毒素对面神经CMAP的影响。
结果:1.早期组、长期未治组的CMAP潜伏期、波幅分自身比较及组间患侧比较均无显著性差异。2. 7例早期组HFS患者A型肉毒毒素注射后其面神经CMAP潜伏期较治疗前明显延长、波幅显著降低。两者均随时间缓慢恢复,CMAP潜伏期大约注射后3个月恢复至正常水平,波幅则需6个月。3.长期重复治疗组患侧CMAP潜伏期与自身健侧、长期未治组患侧比均无明显差异,长期重复治疗组患侧CMAP波幅与自身健侧、长期未治组患侧比均有显著性差异。
结论:1.未发现HFS对面神经CMAP有影响,既使长期患病亦如此。2.A型肉毒毒素注射后对面神经的阻滞作用明显,表现为CMAP潜伏期的延长及波幅的显著降低。两者均随时间缓慢恢复:其中潜伏期于注射后3个月恢复至正常水平,而波幅则需6个月或更长。3.长期重复注射A型肉毒毒素后面神经CMAP潜伏期仍能如期恢复正常,而波幅的恢复更加缓慢持久。
1. The effectiveness and safety to HFS by long-term repeat BTX injection.
Objective:To observe the effctiveness and safety of long-term repeat BTX injection for HFS.
Methods: 48 patients with hemifacial spasm were divided into two groups based on the times of the patients had received BTX injection:first BTX injection group(30 patients) and long-term repeat BTX injection group(received 4 times BTX injection or more consecutively)(18 patients).following up 6 monthes visit,to compare the time of clinical effect begains,the times of reach the maximum therapeutic effect ,the grade and the duration of the effect within the two groups.
Results: There were no difference in the time of effect begains between the two groups,the time of reach the maximum therapeutic effct,the grade and the duration of the effect.
Conclusion: The effectiveness to HFS by long-term repeat BTX injection is still prominent,and the time of effect begains,the time of reach the maximum therapeutic effct,the grade and the duration of the effect still keep sustained.
2. The influence to facial never’s CMAP by long-term repeat BTX injection.
Objective:To investigate the influence to facial nerve’s CMAP by long-term repeat BTX injection.
Methods:44 patients with hemifacial spasm were divided into three groups based on the course of the disease and the times patient received BTX-A injection:short term group(20 patients), long-term without BTX-A injection group(10 patients) and long-term repeat BTX-A injection group(18 patients). The examination of the latency and amplitude of facial never were determined with EMG before this BTX-A injection to investigate the function of facial never.1.Comepare the facial nerver’s latency and amplitude of the two side within short term group and long-term without BTX-A injection group,and comepare the facial nerver’s latency and amplitude of the affected side between the two groups, in order to determine if HFS can influence the latency and amplitude of the facial nerver or not,even determine the baseline of the facial nerver’s latency and amplitude of the two groups. 2. Monitor the change of the facial nerver’s CMAP of 7 patients who received BTX-A injection for the first time at before and after BTX-A injection,in order to determine the blockage of BTX-A to facial nerve.3.Comepare the facial nerver’s latency and amplitude of the two side within long-term without BTX injection group and long-term repeat BTX-A injection group,and comepare the facial nerver’s latency and amplitude of the affected side between the two groups,in order to determine the influence to facial never’s CMAP by long-term repeat BTX injection.
Results:1.There were no significant difference in the facial nerver’s latency and amplitude of the two side within the short term group and long-term without BTX injection groups,and the same to the affected side between the two groups. 2. A significant decrease of facial nerver’s amplitude was observed at 1 week、2 week、1 month、3 month after BTX-A injection,comeparing with before BTX-A injection.and a significant extend of facial nerver’s latency was also observed at 1 week、2 week、1 month after BTX-A injection. 3. There were no significant difference in the affected facial nerver’s latency of long-term repeat BTX-A injection group, comeparing with the unaffected side and the affected side of long-term without BTX-A injection group.But there were significant decrease in the affected facial nerver’s amplitude of long-term repeat BTX-A injection group, comeparing with the unaffected side and the affected side of long-term without BTX-A injection group.
Conclusion:1.We found that the facial nerve’s CMAP was not influented in HFS patients,even in long-term HFS patients.2. BTX-A can markly block the facial nerve:the facial nerver’s amplitude was significant decreased and the facial nerver’s latency was markly delayed after BTX-A injection.But this is a reversible procedure:the latency recover to norma baseline at 3 month after BTX-A injection,but the amplitude need 6 month to recover normal.3.After long-term repeat BTX-A injection,the facial nerve’s latency can recover normal on time,but the recovery of facial nerver’s amplitude need more time.
目的:观察长期重复应用A型肉毒毒素治疗面肌痉挛的疗效、副反应是否有变化。
方法:将48例面肌痉挛患者依据接受A型肉毒毒素治疗的次数分为两组:首次治疗组(30例)、长期重复治疗组(连续接受4次及4次以上A型肉毒毒素治疗)(18例)。本次注射A型肉毒毒素后随访6个月,比较两组在起效时间,达峰时间,疗效等级,疗效维持时间及副反应等方面有无差别。
结果:两组患者注射A型肉毒毒素后在起效时间、达峰时间、疗效等级、疗效维持时间及副反应等方面比较均无明显差异。
结论:长期重复应用A型肉毒毒素治疗面肌痉挛疗效依然显著,在起效时间、疗效等级、维持时间等方面保持不变。
第二部分长期重复应用A型肉毒毒素对面神经CMAP的影响
目的:观察长期重复应用A型肉毒毒素对面神经CMAP的影响。
方法:将48例面肌痉挛患者分别依据病程及接受肉毒毒素治疗的次数分为三组:早期组(20例)、长期未治疗组(病程在2年以上且未接受过A型肉毒毒素治疗)(10例)、长期重复治疗组(病程在2年以上,接受4次及4次以上A型肉毒毒素治疗,且每次治疗间隔均超过6个月)(18例)。1.早期组、长期未治组HFS患者CMAP潜伏期及波幅自身患健侧、组间患侧比较,以明确HFS对患者面神经CMAP有无影响,并了解两者的基线水平。2.监测7例首次接受治疗HFS患者A型肉毒毒素治疗前、后1周、2周、1月、3月、6月时的CMAP潜伏期及波幅的变化,以明确A型肉毒毒素对面神经的阻滞作用及随时间恢复的情况。3.长期未治组及长期重复治疗组治疗6个月后CMAP潜伏期、波幅自身患健侧、组间患侧比较,以了解长期重复注射A型肉毒毒素对面神经CMAP的影响。
结果:1.早期组、长期未治组的CMAP潜伏期、波幅分自身比较及组间患侧比较均无显著性差异。2. 7例早期组HFS患者A型肉毒毒素注射后其面神经CMAP潜伏期较治疗前明显延长、波幅显著降低。两者均随时间缓慢恢复,CMAP潜伏期大约注射后3个月恢复至正常水平,波幅则需6个月。3.长期重复治疗组患侧CMAP潜伏期与自身健侧、长期未治组患侧比均无明显差异,长期重复治疗组患侧CMAP波幅与自身健侧、长期未治组患侧比均有显著性差异。
结论:1.未发现HFS对面神经CMAP有影响,既使长期患病亦如此。2.A型肉毒毒素注射后对面神经的阻滞作用明显,表现为CMAP潜伏期的延长及波幅的显著降低。两者均随时间缓慢恢复:其中潜伏期于注射后3个月恢复至正常水平,而波幅则需6个月或更长。3.长期重复注射A型肉毒毒素后面神经CMAP潜伏期仍能如期恢复正常,而波幅的恢复更加缓慢持久。
1. The effectiveness and safety to HFS by long-term repeat BTX injection.
Objective:To observe the effctiveness and safety of long-term repeat BTX injection for HFS.
Methods: 48 patients with hemifacial spasm were divided into two groups based on the times of the patients had received BTX injection:first BTX injection group(30 patients) and long-term repeat BTX injection group(received 4 times BTX injection or more consecutively)(18 patients).following up 6 monthes visit,to compare the time of clinical effect begains,the times of reach the maximum therapeutic effect ,the grade and the duration of the effect within the two groups.
Results: There were no difference in the time of effect begains between the two groups,the time of reach the maximum therapeutic effct,the grade and the duration of the effect.
Conclusion: The effectiveness to HFS by long-term repeat BTX injection is still prominent,and the time of effect begains,the time of reach the maximum therapeutic effct,the grade and the duration of the effect still keep sustained.
2. The influence to facial never’s CMAP by long-term repeat BTX injection.
Objective:To investigate the influence to facial nerve’s CMAP by long-term repeat BTX injection.
Methods:44 patients with hemifacial spasm were divided into three groups based on the course of the disease and the times patient received BTX-A injection:short term group(20 patients), long-term without BTX-A injection group(10 patients) and long-term repeat BTX-A injection group(18 patients). The examination of the latency and amplitude of facial never were determined with EMG before this BTX-A injection to investigate the function of facial never.1.Comepare the facial nerver’s latency and amplitude of the two side within short term group and long-term without BTX-A injection group,and comepare the facial nerver’s latency and amplitude of the affected side between the two groups, in order to determine if HFS can influence the latency and amplitude of the facial nerver or not,even determine the baseline of the facial nerver’s latency and amplitude of the two groups. 2. Monitor the change of the facial nerver’s CMAP of 7 patients who received BTX-A injection for the first time at before and after BTX-A injection,in order to determine the blockage of BTX-A to facial nerve.3.Comepare the facial nerver’s latency and amplitude of the two side within long-term without BTX injection group and long-term repeat BTX-A injection group,and comepare the facial nerver’s latency and amplitude of the affected side between the two groups,in order to determine the influence to facial never’s CMAP by long-term repeat BTX injection.
Results:1.There were no significant difference in the facial nerver’s latency and amplitude of the two side within the short term group and long-term without BTX injection groups,and the same to the affected side between the two groups. 2. A significant decrease of facial nerver’s amplitude was observed at 1 week、2 week、1 month、3 month after BTX-A injection,comeparing with before BTX-A injection.and a significant extend of facial nerver’s latency was also observed at 1 week、2 week、1 month after BTX-A injection. 3. There were no significant difference in the affected facial nerver’s latency of long-term repeat BTX-A injection group, comeparing with the unaffected side and the affected side of long-term without BTX-A injection group.But there were significant decrease in the affected facial nerver’s amplitude of long-term repeat BTX-A injection group, comeparing with the unaffected side and the affected side of long-term without BTX-A injection group.
Conclusion:1.We found that the facial nerve’s CMAP was not influented in HFS patients,even in long-term HFS patients.2. BTX-A can markly block the facial nerve:the facial nerver’s amplitude was significant decreased and the facial nerver’s latency was markly delayed after BTX-A injection.But this is a reversible procedure:the latency recover to norma baseline at 3 month after BTX-A injection,but the amplitude need 6 month to recover normal.3.After long-term repeat BTX-A injection,the facial nerve’s latency can recover normal on time,but the recovery of facial nerver’s amplitude need more time.
引文
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1. Comella CL, Pullman SL. Botulinum toxins in neurological disease. Muscle & Nerve.2004,29:628-644.
2. 万新华,汤晓芙.肉毒毒素在神经科疾病的治疗作用.中华神经科杂志.1996,29(2): 111-114.
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4. 史玉泉.实用神经病学.第 2 版.上海:上海科学技术出版社.1994:196-198.
5. Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment.Muscle & Nerve.1998,21:1740-1747.
6. Néstor Gálvez-Jiménez, Maurice R Hanson, and Mehul Desai. Unusual Causes of Hemifacial Spasm. Seminars in Neurolog.2001,21(1):75-83.
7. Heuser K, Kerty E, Eide P K, Cvancarova M, Dietrichs E. Microvascular decomdecompression for hemifacial spasm:postoperative neurologic follow-up and evaluation of life quality. European Journal of Neurology.2007,14(3):335-340.
8. 刘好义,李娜,田成林等.A 型肉毒毒素治疗 118 例面肌痉挛的疗效观察.中华神经科杂志.1998,31(4):207- 209.
9. 朱力,王恒 ,黄留玉.肉毒毒素研究进展.生物通迅技术.2005,6(2): 186-19 0.
10. 蔡华英,胡兴越,蒋红.A型肉毒毒素肌注后神经芽生的实验研究.中华物理医学与康复杂志.2006,28(2):98-101.
11. 蔡华英,胡兴越,蒋红. 丙烯酰胺抑制大鼠肌注 A 型肉毒毒素后的神经芽生.中国药理学及毒理学杂志.2006,20(2):125-130.
12. Duchen LW.Changes in the electron microscopic structure of slow and fast skeletal muscle fibres of the mouse after the local injection of botulinum toxin. Neurological Sciences.1971,14:61-74.
13. Duchen LW.An electron microscopic study of the changes induced by botulinum toxin in the motor end-plates of slow and fast skeletal muscle fibres of the mouse. Neurological Sciences.1971,14:47-60.
14. de Paiva A,Meunier FA,Molgo J,Aoke KR,Dolly JQ.Functional repair of motor endplates after botulinum neurotoxin type A poisoning:biphasic switch of synaptic activity between nerve sprouts and their parent terminals.Proc.Natl.Acad.Sci.U.S. 1999,96(3):3200-3205.
15. Borodic GE,Ferrante R,Pearce LB,Smith K.Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum-A toxin injections.Mov.Disord.1994,9:31-39.
16. Lorenzano C,Bagnato S,Gilio F et al.No clinical or neurophysiological evidence of botulinum toxin diffusion to non-injected muscles in patients with hemifacial spasm.Neurotoxicity Research.2006,9(2-3):141 -144.
17. Ma J,Elsaidi GA,Smith TL et al. Time Course of Recovery of Juvenile Skeletal Muscle AfterBotulinum ToxinA Injection: An Animal Model Study. Am.J.Phys.Med. Rehabil.2004,83(10):774-780.
18. Roberto Eleopra,Valeria Tugnoli,Rossetto O et al.Different time courses of recovery after poisoning with botulinum neurotoxin serotypes A and E in humans. Neuroscience Letters.1998,256(3):135-138.
19. Jae-Hong Kim,Jun Han Shin,Seong Taek Kim,Chong-Youl Kim. Effects of two different units of botulinum toxin type A evaluated by computed tomography and electromyographic measurements of human masseter muscle. Plastic and Reconstrctive Surgery. 2007,119(2):711-717.
20. 刘玉生,柳大烈,杜本军,郑健生.肉毒神经毒素 A 诱导兔咬肌萎缩及其组织形态学研究.中华神经医学杂志.2006,5(4):386-389.
21. Chen CM,Stott NS,Smith HK.Effects of botulinum toxin A injection and exercise on the growth of juvenile rat gastrocnemius muscle.J Appl Physiol.2002,93(4): 1437-1447.
22. Kim H J, Yum K W, Lee S S,Heo M S,Seo K.Effects of botulinum toxin type A on bilateral masseterichypertrophy evaluated with computed tomographic measurement. Dermatol.Surg.2003,29: 484-489.
23. Neale EA,Bowers LM,Jia M et al.Botulinum neurotoxin ablocks synaptic vesicle exocytosis but not endocytosis at the nerve terminal.Cell Biology International. 1999,147:1249-1260.
24. 王锦玲,卢连军,刘顺利.A 型肉毒毒素对面神经核运动神经元的影响.中华耳鼻喉科杂志.2006,37(3):180-183.
1. 史玉泉.实用神经病学.第 2 版.上海:上海科学技术出版社.1994:196-198.
2. Wang A,Jankovic J.Hemifacial spasm:clinical findings and treatment.Muscle & Nerve.1998,21:1740-1747.
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1. Comella CL, Pullman SL. Botulinum toxins in neurological disease. Muscle & Nerve.2004,29:628-644.
2. 万新华,汤晓芙.肉毒毒素在神经科疾病的治疗作用.中华神经科杂志.1996,29(2): 111-114.
3. 卢祖能,曾庆杏等.实用肌电图学.第 1 版.北京市:人民卫生出版社.2000:256-273.
4. 史玉泉.实用神经病学.第 2 版.上海:上海科学技术出版社.1994:196-198.
5. Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment.Muscle & Nerve.1998,21:1740-1747.
6. Néstor Gálvez-Jiménez, Maurice R Hanson, and Mehul Desai. Unusual Causes of Hemifacial Spasm. Seminars in Neurolog.2001,21(1):75-83.
7. Heuser K, Kerty E, Eide P K, Cvancarova M, Dietrichs E. Microvascular decomdecompression for hemifacial spasm:postoperative neurologic follow-up and evaluation of life quality. European Journal of Neurology.2007,14(3):335-340.
8. 刘好义,李娜,田成林等.A 型肉毒毒素治疗 118 例面肌痉挛的疗效观察.中华神经科杂志.1998,31(4):207- 209.
9. 朱力,王恒 ,黄留玉.肉毒毒素研究进展.生物通迅技术.2005,6(2): 186-19 0.
10. 蔡华英,胡兴越,蒋红.A型肉毒毒素肌注后神经芽生的实验研究.中华物理医学与康复杂志.2006,28(2):98-101.
11. 蔡华英,胡兴越,蒋红. 丙烯酰胺抑制大鼠肌注 A 型肉毒毒素后的神经芽生.中国药理学及毒理学杂志.2006,20(2):125-130.
12. Duchen LW.Changes in the electron microscopic structure of slow and fast skeletal muscle fibres of the mouse after the local injection of botulinum toxin. Neurological Sciences.1971,14:61-74.
13. Duchen LW.An electron microscopic study of the changes induced by botulinum toxin in the motor end-plates of slow and fast skeletal muscle fibres of the mouse. Neurological Sciences.1971,14:47-60.
14. de Paiva A,Meunier FA,Molgo J,Aoke KR,Dolly JQ.Functional repair of motor endplates after botulinum neurotoxin type A poisoning:biphasic switch of synaptic activity between nerve sprouts and their parent terminals.Proc.Natl.Acad.Sci.U.S. 1999,96(3):3200-3205.
15. Borodic GE,Ferrante R,Pearce LB,Smith K.Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum-A toxin injections.Mov.Disord.1994,9:31-39.
16. Lorenzano C,Bagnato S,Gilio F et al.No clinical or neurophysiological evidence of botulinum toxin diffusion to non-injected muscles in patients with hemifacial spasm.Neurotoxicity Research.2006,9(2-3):141 -144.
17. Ma J,Elsaidi GA,Smith TL et al. Time Course of Recovery of Juvenile Skeletal Muscle AfterBotulinum ToxinA Injection: An Animal Model Study. Am.J.Phys.Med. Rehabil.2004,83(10):774-780.
18. Roberto Eleopra,Valeria Tugnoli,Rossetto O et al.Different time courses of recovery after poisoning with botulinum neurotoxin serotypes A and E in humans. Neuroscience Letters.1998,256(3):135-138.
19. Jae-Hong Kim,Jun Han Shin,Seong Taek Kim,Chong-Youl Kim. Effects of two different units of botulinum toxin type A evaluated by computed tomography and electromyographic measurements of human masseter muscle. Plastic and Reconstrctive Surgery. 2007,119(2):711-717.
20. 刘玉生,柳大烈,杜本军,郑健生.肉毒神经毒素 A 诱导兔咬肌萎缩及其组织形态学研究.中华神经医学杂志.2006,5(4):386-389.
21. Chen CM,Stott NS,Smith HK.Effects of botulinum toxin A injection and exercise on the growth of juvenile rat gastrocnemius muscle.J Appl Physiol.2002,93(4): 1437-1447.
22. Kim H J, Yum K W, Lee S S,Heo M S,Seo K.Effects of botulinum toxin type A on bilateral masseterichypertrophy evaluated with computed tomographic measurement. Dermatol.Surg.2003,29: 484-489.
23. Neale EA,Bowers LM,Jia M et al.Botulinum neurotoxin ablocks synaptic vesicle exocytosis but not endocytosis at the nerve terminal.Cell Biology International. 1999,147:1249-1260.
24. 王锦玲,卢连军,刘顺利.A 型肉毒毒素对面神经核运动神经元的影响.中华耳鼻喉科杂志.2006,37(3):180-183.
1. 史玉泉.实用神经病学.第 2 版.上海:上海科学技术出版社.1994:196-198.
2. Wang A,Jankovic J.Hemifacial spasm:clinical findings and treatment.Muscle & Nerve.1998,21:1740-1747.
3. Nielsen VK.Pathophysiology of hemifacial spasm,I.ephaptic transmission and ectopic excitation. Neurology.1984,34:418-426.
4. Nielsen VK.Pathophysiology of hemifacial spasm:II.Lateral spread of the supraorbital nerve reflex.Neurology.1984,34:427–431.
5. Tan NC, Chan LL, Tan EK.Hemifacial spasm and involuntary facial movements.QJM. 2002,95:493-500.
6. Néstor Gálvez-Jiménez,Maurice R Hanson and Mehul Desai.Unusual Causes of Hemifacial Spasm.Seminars in Neurolog.2001,21(1):75-83.
7. 万杰青,李善泉.面肌痉挛的神经电生理研究.国外医学神经病学神经外科学分册.1997,24(1):29-31.
8. 李善泉,万杰青等.面肌痉挛神经电生理检查的临床诊断意义.中国神经精神疾病杂志.1997,23(3):174-175.
9. Ishikawa M,Ohira T,Namiki J,et al.Abnormal muscle response (lateralspread) and F-wave in patients with hemifacial spasm. J Neurol Sci.1996,137:109–116.
10. Mami Ishikawa,Jun Namiki,Moriichiro Takase,et al.Effect of repetitive stimulation on Lateral spreads and F-waves in hemifacial spasm. Journal of the Neurological ScIences.1996,142:99-106.
11. Ishikawa M,Ohira T,Namiki J,Gotoh M,Takase M,Toya S.Electrophysiological investigation of hemifacial spasm: F-wave of the facial muscles.Acta Neurochir.1996, 138:24-32.
12. Ishikawa M,Ohira T,Namiki J,et al.Electrophysiological investigation of hemifacial spasm after microvascular decompression:F waves of the facial muscles,blink reflexes,and abnormal muscle responses. J Neurosurg.1997,86:654-661.
13. Fine EJ,Sentz L,Soria E.The history of the blink reflex.Neurology.1992,42:450–454.
14. Kimura J.Clinical uses of the electrically elicited blink reflex.Adv Neurol. 1983,39: 773–786.
15. Auger R G.Hedacial spasm: Clinical and electrophysiologic observations.Neurolology. 1979,29(9):1261-1272.
16. M?ller AR, Jannetta PJ. Blink reflex in patients with hemifacial spasm:Observations during microvascular decompression operations.J Neurol Sci.1986,72:171-182.
17. Josep VS,Eduardo ST.Blink reflex excitability cycle in hemifacial spasm.Neurology. 1989,39:1061-1066.
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