A型肉毒毒素治疗睑肌痉挛伴发睁眼性失用的疗效观察

Therapeutic effect observation of Botulinum toxin type A in the treatment of blepharospasm associated with apraxia of lid opening

目的探讨A型肉毒毒素治疗睑肌痉挛伴发睁眼性失用的疗效及安全性。方法对11例睑肌痉挛伴发睁眼性失用患者行局部A型肉毒毒素注射治疗,每14周1次,共3次。观察每次注射后起效时间、疗效持续时间及不良反应,并在每次注射后第3周根据改良痉挛性斜颈量表Ⅰ(TWSTRSⅠ)由固定医师对患者进行功能性评定,依据TWSTRSⅡ由患者进行生活残疾自评。结果治疗后平均(3.21±1.88)d起效,疗效持续(11.55±2.11)周。3次治疗的功能改善率分别为89.09%、87.27%、88.18%;3次治疗前TWSTRSⅡ评分分别为22.36±4.03、20.27±3.77及20.77±3.77,治疗3周后分别为7.55±4.44、8.00±5.25、9.27±4.98,治疗前后比较差异有极显著性(均P<0.01)。主要不良反应为睑下垂、疼痛烧灼感,但程度轻,多在48h内自行缓解。结论A型肉毒毒素局部注射可以改善患者的痉挛症状及日常生活能力,治疗原发性睑肌痉挛伴发睁眼性失用安全有效。

Objective To investigate the efficacy and safety of Botulinum toxin type A （BTX-A） （Dysport） on blepharospasm associated apraxia of lid opening （BALO）. Methods These 11 patients with clinically and electrophysiologically diagnosed BALO were received BTX-A totally 3 times every 14 weeks. The therapeutic effect was judged by the modified Toronto Western Spasmodic Torticollis Rating Scale （part Ⅰ and Ⅱ ） （TWSTRS）. The improvements of spasm were judged according to the modified TWSTRS （part Ⅰ） by the same neurologist. Patients rated their disabilities using the TWSTRS （ part Ⅱ ）. Dosage of BTX-A, onset benefit, duration of benefit and side effects were also studied. Results The functional improvements of the three consecutive treatments with BTX-A were 89.09%, 87.27% and 88. 18%, respectively. The patients＇ daily activities in terms of the TWSTRS （ part Ⅱ ） score were significantly improved after the treatment when compared with those before the treatment （ 22. 36±4. 03 VS 7. 55±4.44;20. 27±3.77 VS 8.00± 5.25 ;20.77±3.77 VS 9. 27±4.98 ） （ all P 〈 0. 01 ）. The average effectproducing time and the average efficacy duration were （3.21±1.88） days and （ 11.55±2. 11 ） weeks respectively. Adverse effects were ptosis, pain, but minor and well tolerated. Conclusions Administration of BTX-A can not only alleviate symptoms of spasm but also improve the patients＇ daily activities. It can be an effective and safe treatment tool for BALO.