A型肉毒毒素治疗偏侧面肌痉挛及治疗前后双刺激瞬目反射变化

Botulinum toxin-A on treatment of hemifacial spasm and the changes of blink reflex by double stimulation before and after treatment

目的 观察单侧面肌痉挛 (HFS)的A型肉毒毒素 (BTXA)治疗效果 ;探讨治疗前后双刺激瞬目反射 (BR)检测的意义。方法 对 134例患者进行BTXA局部肌肉注射 ,其中 42例治疗前后行BR检测。结果 134例患者中 ,症状完全缓解 6 0例 ,占 44 8% ,明显改善 74例 ,占 5 5 2 %。疗效持续时间 (16 5± 5 7)周。42例患者治疗前患侧BR检测 ,R1、R2 、R'2 潜伏期正常 ,R2 间期缩短 ,R1、R2 、R'2 振幅增高。治疗后复查 ,其中R1消失者 7例 ,R1、R2 、R'2 均消失者 5例 ,余 30例R1、R2 、R'2 潜伏期稍延长 ,但差异无显著意义 ;R1、R2 、R'2 波幅明显降低 (P <0 0 5 )。结论 BTXA治疗HFS疗效显著 ,是首选疗法 ;双刺激BR检测表明 ,患者脑干中间神经元兴奋性升高。

Objective To further observe the effect of botulinum toxin A(BTXA) treatment on hemifacial spasm(HFS) patients and to investigate the value of double stimulation of blink reflex(BR) before and after BTXA injection. Methods Among 134 cases of HFS treated by local injection of BTXA, the changes of BR in 42 cases was recorded before and after the injection. Results Of totally 134 treated cases, 60 (44 8%) cases were completely relieved and the rest 74 (55 2%) cases were obviously improved after treatment, with an effective duration of 16 5±5 7 weeks.In 42 patients with determination of BR value,before injection the latency of R 1, R 2, R' 2 of the affected side showed within normal limit.The interval of R 2 was shorter and the amplitudes of R 1,R 2,R' 2 were higher .After injection , the R 1 disappeared in 7 patients,and R 1,R 2,R' 2 all disappeared in 5 patients,for the rest 30 patients,the latency of R 1,R 2,R' 2 was prolonged slightly,but showing no apparent differences The amplitudes of R 1,R 2 and R' 2 were lowered significantly ( P <0 05). Conclusion The treatment on HFS with local injection of BTXA is very effective and may be considered the best choice. The determination of double stimulation of BR reveals the increase of excitability of intermittent neuron in brain stem of patients