原发性与面瘫后面肌痉挛患者面部异常运动A型肉毒毒素的治疗效果对比研究
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摘要
目的探讨A型肉毒毒素(botulinum toxin type A,BoNT-A)治疗原发性及面瘫后面肌痉挛患者痉挛及伴随联带运动的疗效差异。方法选取2009年1月-2018年7月具有联带运动的面瘫后面肌痉挛患者12例,按照1∶2配比性别无差异且具有联带运动的原发性面肌痉挛患者24例,分析2组BoNT-A治疗后痉挛严重程度以及伴随联带运动的改善差异。结果面瘫后及原发性面肌痉挛患者在起效时间[(4.38±2.17)vs.(4.67±4.14)d],维持时间[(3.83±2.94)vs.(4.96±2.48)d],注射剂量[(31.35±12.30)vs.(26.98±8.75)U]方面无明显差异(P>0.05)。原发性面肌痉挛组患者满意度显著较高(84.79±19.81vs.64.17±31.54,P<0.05)。2组痉挛改善有效率均高于90%,组间无明显差异(91.67%vs.95.83%,P>0.05)。2组联带运动均有改善,但无明显差异(83.33%vs.58.33%,P>0.05)。5个自主动作相关联带运动改善方面仅发现原发性面肌痉挛患者噘嘴引起联带运动的改善有明显差异(P<0.05)。结论 BoNT-A可以显著改善原发性与面瘫后面肌痉挛患者的痉挛严重程度,在联带运动严重程度改善方面有一定疗效。原发性面肌痉挛患者噘嘴引起的联带运动在BoNT-A治疗后显著改善。
Objective To investigate the therapeutic difference in efficacy of botulinum toxin A(BoNTA)injection between primary and post-paralytic hemifacial spasm patients with facial synkinesis.Methods 12 Patients presented as post-paralytic hemifacial spasm combined with synkinesis from January 2009 to July 2018 were selected for analyzing.With a ratio of 1∶2,24 primary hemifacial spasm patients combined with synkinesis were included according to the similar gender as post-paralytic group.Moreover,improvement of spasm and synkinesis were analyzed in this study.Results Except a significantly higher satisfaction score(84.79±19.81 vs.64.17±31.54,P<0.05)seen in primary hemifacial spasm patients,latency(4.38±2.17 vs.4.67±4.14 days),duration of effect(3.83±2.94 vs.4.96±2.48 days),dosage of injection(31.35±12.30 vs.26.98±8.75 U)were similar in both groups after BoNT-A treatment(P>0.05).Moreover,both group showed a high efficient rate more than 90%(91.67% vs.95.83%,P>0.05)of improvement of spasm after BoNT-A treatment.As for improvement of synkinesis,post paralytic hemifacial spasm showed a higher efficient rate(83.33%vs.58.33%,P>0.05)of severity.As for 5 voluntary facial movement related synkinesis,significant improvement of pouting induced synkinesis was seen in primary group(P<0.05).Conclusion BoNT-A was an efficient and safe intervention not only improving the severity of spasm,but also decreasing the severity of synkinesis.Pouting induced synkinesis was significantly improved in primary group.
Objective To investigate the therapeutic difference in efficacy of botulinum toxin A(BoNTA)injection between primary and post-paralytic hemifacial spasm patients with facial synkinesis.Methods 12 Patients presented as post-paralytic hemifacial spasm combined with synkinesis from January 2009 to July 2018 were selected for analyzing.With a ratio of 1∶2,24 primary hemifacial spasm patients combined with synkinesis were included according to the similar gender as post-paralytic group.Moreover,improvement of spasm and synkinesis were analyzed in this study.Results Except a significantly higher satisfaction score(84.79±19.81 vs.64.17±31.54,P<0.05)seen in primary hemifacial spasm patients,latency(4.38±2.17 vs.4.67±4.14 days),duration of effect(3.83±2.94 vs.4.96±2.48 days),dosage of injection(31.35±12.30 vs.26.98±8.75 U)were similar in both groups after BoNT-A treatment(P>0.05).Moreover,both group showed a high efficient rate more than 90%(91.67% vs.95.83%,P>0.05)of improvement of spasm after BoNT-A treatment.As for improvement of synkinesis,post paralytic hemifacial spasm showed a higher efficient rate(83.33%vs.58.33%,P>0.05)of severity.As for 5 voluntary facial movement related synkinesis,significant improvement of pouting induced synkinesis was seen in primary group(P<0.05).Conclusion BoNT-A was an efficient and safe intervention not only improving the severity of spasm,but also decreasing the severity of synkinesis.Pouting induced synkinesis was significantly improved in primary group.
引文
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[9]Mette Batisti JP,Fadini Kleinfelder AD,Moro A,et al.Treatment of hemifacial spasm with botulinum toxin type a:effective,long lasting and well tolerated[J].Arq Neuropsiquiatr,2017,75(2):87-91.
[10]Choe WJ,Kim J.Increasing the area and varying the dosage of Botulinum toxin a injections for effective treatment of hemifacial spasm[J].Acta Otolaryngol,2016,136(9):952-955.
[11]Wang L,Hu XY,Dong HJ,et al.Clinical features and treatment status of hemifacial spasm in China[J].Chin Med J(Engl),2014,127(5):845-849.
[12]Fujiwara K,Furuta Y,Nakamaru Y,et al.Comparison of facial synkinesis at 6and 12months after the onset of peripheral facial nerve palsy[J].Auris Nasus Larynx,2015,42(4):271-274.
[13]Xiao L,Pan Y,Zhang X,et al.Facial asymmetry in patients with hemifacial spasm before and after botulinum toxin Atreatment[J].Neurol Sci,2016,37(11):1807-1813.
[14]Maria CM,Kim J.Individualized management of facial synkinesis based on facial function[J].Acta Otolaryngol,2017,137(9):1010-1015.
[15]Markey JD,Loyo M.Latest advances in the management of facial synkinesis[J].Curr Opin Otolaryngol Head Neck Surg,2017,25(4):265-272.
[2]Lu AY,Yeung JT,Gerrard JL,et al.Hemifacial spasm and neurovascular compression[J].ScientificWorldJournal,2014,2014(1-7):349319.
[3]Husseman J,Mehta RP.Management of synkinesis[J].Facial Plast Surg,2008,24(2):242-249.
[4]Kollewe K,Mohammadi B,Dengler R,et al.Hemifacial spasm and reinnervation synkinesias:long-term treatment with either Botox or Dysport[J].J Neural Transm(Vienna),2010,117(6):759-763.
[5]Colosimo C,Bologna M,Lamberti S,et al.A comparative study of primary and secondary hemifacial spasm[J].Arch Neurol,2006,63(3):441-444.
[6]Cohen DA,Savino PJ,Stern MB,et al.Botulinum injection therapy for blepharospasm:a review and report of 75patients[J].Clin Neuropharmacol,1986,9(5):415-429.
[7]Ross BR,Fradet G,Nedzelski JM.Development of a sensitive clinical facial grading system[J].Eur Arch Otorhinolaryngol,1994,114(3):S180-S181.
[8]Barbosa E,Takada LT,Goncalves LR,et al.Botulinum toxin type A in the treatment of hemifacial spasm:an 11-year experience[J].Arq Neuropsiquiatr,2010,68(4):502-505.
[9]Mette Batisti JP,Fadini Kleinfelder AD,Moro A,et al.Treatment of hemifacial spasm with botulinum toxin type a:effective,long lasting and well tolerated[J].Arq Neuropsiquiatr,2017,75(2):87-91.
[10]Choe WJ,Kim J.Increasing the area and varying the dosage of Botulinum toxin a injections for effective treatment of hemifacial spasm[J].Acta Otolaryngol,2016,136(9):952-955.
[11]Wang L,Hu XY,Dong HJ,et al.Clinical features and treatment status of hemifacial spasm in China[J].Chin Med J(Engl),2014,127(5):845-849.
[12]Fujiwara K,Furuta Y,Nakamaru Y,et al.Comparison of facial synkinesis at 6and 12months after the onset of peripheral facial nerve palsy[J].Auris Nasus Larynx,2015,42(4):271-274.
[13]Xiao L,Pan Y,Zhang X,et al.Facial asymmetry in patients with hemifacial spasm before and after botulinum toxin Atreatment[J].Neurol Sci,2016,37(11):1807-1813.
[14]Maria CM,Kim J.Individualized management of facial synkinesis based on facial function[J].Acta Otolaryngol,2017,137(9):1010-1015.
[15]Markey JD,Loyo M.Latest advances in the management of facial synkinesis[J].Curr Opin Otolaryngol Head Neck Surg,2017,25(4):265-272.