A型肉毒毒素治疗头颈部肌张力障碍的临床观察

Clinical observation on treatment of cranio-cevical dystonia with botulinum toxin A

目的观察A型肉毒毒素(BTXA)治疗偏侧面肌痉孪、睑痉孪、Meige’s综合征、痉孪性斜颈的疗效。方法治疗组(A组)用BTXA对86例患者进行头颈部肌肉多点注射,对照组(B组)50例根据诊断选用不同的药物或/和针灸、理疗、中医药治疗。观察两组疗效及副作用。结果A组治疗后当日至3d内开始见效,7～15d达高峰,疗效维持2～6月。总有效率为100%,疗效明显高于B组(P<0.001)。BTXA重复注射疗效无下降,1例HFS患者第三次注射产生耐药性,少数患者有轻微的局部副反应,未见全身副作用。B组62%(31例)的患者疗效维持5～15月后减退,需逐渐增加剂量,少数患者出现白细胞减少、肝功能损害、皮疹、共济失调等不良反应。结论A型肉毒毒素局部注射是治疗头颈部肌张力障碍的一种安全、有效、简便的方法。

Objective To study the efficacy of botulinum toxin A (BTXA) injection for the treatment of hemifacial spasm, blepharospasm, Meige's syndrome and spasmodic torticollis. Methods 86 patients in treatment group (group A) were injected with BTXA into multifocal cranio-cervical muscles. 50 patients in control group (group B) were treated with various medicines, acupuncture, physical treatment and traditional Chinese medicine according to the diagnosis of each patient. The therapeutic efficacy and the side effects of two groups were evaluated comparatively. Results In group A the efficacy was demonstrated within 1~3 days after the injection, the effective duration was 2～6 months. 100 % of the patients experienced relief from spasm. The efficacy in group A was more obvious than group B (P<0.001). Reinjection for recurrence had the similar effects. 1 with hemifacial spasm got drug-resistance after the third injection. The minority of patients had mild local side effects, no systemic adverse. The efficacy of 31 patients (62 %) in group B decreased within 5~15 months after treatment. It was necessary that the dosage of the medicines should be increased gradually. The minority of patients in group B had aftereffects such as white blood cells reduction, hepatic dysfunction, skin rash, ataxia and so on. Conclusion BTXA local injection is a safe, effective, simple means for treating cranio-cervical dystonia.