经皮面神经电刺激结合A型肉毒毒素对偏侧面肌痉挛患者神经电生理、睡眠及复发的影响

Effects of transcutaneous electrical facial nerve stimulation combined with botulinum toxin type A on neurophysiology,sleep and recurrence in patients with lateral facioscapulohumeral spasm

目的探讨经皮面神经电刺激结合A型肉毒毒素治疗偏侧面肌痉挛患者的临床效果。方法选取偏侧面肌痉挛患者80例,按随机数字表法分为对照组、观察组,每组40例。对照组采取A型肉毒毒素重复注射,观察组采取A型肉毒毒素重复注射+经皮面神经电刺激。比较2组起效时间、痉挛缓解时间、不良反应发生率及复发率,比较治疗前后痉挛程度、神经电生理(复合肌肉动作电位、瞬目反射)、睡眠质量[匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)]。结果观察组起效时间短于对照组,痉挛缓解时间长于对照组(P<0.05)。治疗后,2组痉挛程度优于治疗前,观察组痉挛程度优于对照组(P<0.05);2组复合肌肉动作电位高于治疗前,瞬目反射波幅R1、R2、R2′低于治疗前,复合肌肉动作电位高于对照组,瞬目反射波幅R1、R2、R2′低于对照组(P<0.05);2组PSQI评分低于治疗前,观察组PSQI评分低于对照组(P<0.05)。2组不良反应发生率和复发率差异无统计学意义(P>0.05)。结论经皮面神经电刺激结合A型肉毒毒素治疗偏侧面肌痉挛患者安全有效,可改善痉挛症状、神经功能、睡眠质量。

Objective To compare the clinical efficacy of transcutaneous electricalfacial nerve stimulation combined with botulinum toxin type A in patients with hemifacial spasm(HFS).Methods A total of 80 patients with HFS were selected and divided into control group(n=40)and observation group(n=40)according to random number table method.The control group was given repeated injection of botulinum toxin type A,and the observation group was given repeated injection of botulinum toxin type A+transcutaneous electrical facial nerve stimulation.The time to onset,time to spasm remission,incidence of adverse reactions and recurrence rates of the two groups were compared,and the degree of spasticity,neurophysiology(complex muscle action potential,blink reflex),and sleep quality[Pittsburgh sleep quality index(PSQI)]before and after treatment were compared.Results The time to onset was shorter in the observation group than in the control group,while time to spasm remission in the observation group was longer than that in the control group(P<0.05).After treatment,the improvement of spasticity was better than that before treatment,and better in the observation group than in the control group(P<0.05).After treatment,the compound muscle action potential of the two groups was higher than that before treatment,and higher in the observation group than in the control group,and the blink reflex R1,R2,and R2′amplitudes were lower than those before treatment,and lower in the observation group than in the control group(P<0.05).The PSQI score was lower in both groups than that before treatment,and lower in the observation group than in the control group after treatment(P<0.05).There was no significant difference in the incidence of adverse reactions and recurrence rates between two groups(P>0.05).Conclusion Transcutaneous electrical facial nerve stimulation combined with botulinum toxin type A is safe and effective in the treatment of HFS patients,and can improve the spastic symptoms,nerve function and sleep quality of patients.