Correlation between blepharospasm and psychological diseases:the anxiety,depression and sleep disorder study

AIM:To investigate the relationship between benign essential blepharospasm(BEB)symptoms and depression/anxiety/sleep disorder in a prospective manner and to determine whether treatment the BEB with botulinum toxin type A(BoNT/A)can impact psychological symptoms.METHODS:This prospective interventional case series recruited 61 adults with evidence of BEB.Patients were administered the Jankovic Rating Scale(JRS),the Blepharospasm Disability Index(BSDI),Personal Health Questionnaire Depression Scale(PHQ-8),Generalized Anxiety Disorder 7-item scale(GAD-7)and the Athens insomnia scale(AIS)to evaluate the severity of BEB symptoms,depression,anxiety and sleep disorder before and 1wk,1,3mo after the BoNTA treatment.Statistical analysis was performed to assess the relationships between changes in the survey scores.RESULTS:The mean score for JRS,BSDI,PHQ-8,and GAD-7 improved significantly(P<0.0001),respectively,compared to the initial visit at follow-up.At baseline,worse BSDI scores were correlated with worse GAD-7 and PHQ-8,but not with worse AIS.At 1mo follow-up visit,there was no correlation between change in BSDI and PHQ-8/AIS,the change in GAD-7 showed a mild association with change in BSDI.The change in BSDI was correlated with the change in both PHQ-8 and GAD-7 in the subgroup of patients without a prior diagnosis of depression or anxiety.Patient satisfaction with BoNT/A treatment reached the highest at 1mo of follow-up(83.6%,51/61).CONCLUSION:BEB may lead to psychological diseases.BoNT/A can significantly improve motor and non-motor symptoms of BEB,which emphasize the effectiveness of BoNT/A and therefore pave the way for its use in the field of psychiatry.However,further research is needed to confirm these findings and understand the underlying mechanisms.

Clinical Observation on Treating Primary Blepharospasm with Acupuncture at Yinqiao and Yangqiao Meridians as Main Treatment Method

[Objectives]To observe the clinical effect of acupuncture on blepharospasm.[Methods]72 patients were randomly divided into treatment group and control group with 36 cases in each group.In the treatment group,Shenmai,Zhaohai,Fengchi,Taichong,Fuyang,Jiaoxin and Jingming were selected as the main acupoints,while in the control group,routine acupoints were selected.With 4 weeks as a course of treatment,the two groups were compared after a course of treatment.The clinical effect of primary blepharospasm,blepharospasm intensity and scores of Hamilton Depression Scale were compared between the two groups before and after treatment.[Results]After treatment,the clinical efficacy of the two groups were significantly improved compared with that before treatment,the effective rate of the control group was 75.00%,the effective rate of the treatment group was 88.89%,indicating that the effective rate of control group was lower than that of the treatment group(P<0.05);after treatment,the degree of blepharospasm in both groups was significantly lower than that before treatment(P<0.05),and the treatment group had better effect in improving primary blepharospasm;the score of Hamilton depression scale in control group was lower than that in observation group(P<0.05).[Conclusions]The clinical curative effect of acupuncture at Yinqiao and Yangqiao meridians was better than that of conventional acupoints selected in relieving mild and moderate blepharospasm;it could definitely reduce the intensity of blepharospasm and relieve anxiety and depression of patients,so it is worthy of clinical promotion.

Prospective observational study to assess the validity of the functional disability score in patients with blepharospasm,hemifacial spasm and synkinesis treated with botulinum toxin injection

Background:Benign essential blepharospasm(BEB),aberrant facial nerve degeneration and hemifacial spasm(HFS)are all examples dystonia which,though not life-threatening,can have a significant impact on patient quality of life.The need for reliable self-rating surveys to monitor functional disability is fundamental.The Blepharospasm Disability Index(BSDI)is already a widely utilised and validated selfrating score for blepharospasm whilst the functional disability score(FDS)requires further validation.The principle aim of this study is to repeat validation of the FDS against the BSDI,which has been validated by several groups since its original description but only in patients with BEB.Methods:A randomised blinded prospective cohort study was conducted at a single unit on 38 patients with BEB,aberrant facial nerve degeneration and HFS.Patients were blinded to complete the FDS followed by the BSDI or the BSDI followed by the FDS with a 30-minute interval.Results:Both the FDS and BSDI were found to be reliable with high internal consistency and test-retest reliability.Both scales were also found to be moderately correlated with the Jankovic disease severity score.Conclusions:This study is the first to use the FDS as a rating scale in patients with HFS and aberrant facial nerve degeneration.It is also the first study to formally validate the FDS as an acceptable rating scale for patients with dystonia and in particular it provides validation for its use in patients with HFS and aberrant facial nerve degeneration.

Efficacy of Carbamazepine Combined with Botulinum Toxin A in the Treatment of Blepharospasm and Hemifacial Spasm

Purpose:To observe the efficacy of the combined treatment of carbamazepine and botulinum toxin A for blepharospasm and hemifacial spasm. Methods:Fifty-eight patients with either blepharospasm or hemifacial spasm were randomly divided into treatment and control groups. In the treatment group, 30 patients were administered with local intramuscular injections of botulinum toxin A and oral carbamazepine 100 mg/time,3 times/day for 60 days. Twenty-eight subjects in the control group under-went local intramuscular injections of botulinum toxin A only. Results:After combined treatment, the complete remission rate was 90%, which was significantly higher than that of the of the control group (67.9% , P<0.05,χ2 =4.733). However, no statistical significance was noted regarding the duration of therapeutic effects between the treatment group (range 14～40 weeks; 19.2 weeks on average) and control group (range 12～36 weeks; 18 weeks on average). Conclusion:The combined therapy of carbamazepine and topical injections of botulinum toxin A had increased efficacy in the treatment of blepharospasm or hemifacial spasm, but had no significant effect in terms of the duration of the therapeutic effect.

眼睑痉挛患者治疗期间习得性无助感的影响因素

目的 分析眼睑痉挛患者治疗期间习得性无助感的影响因素。方法 采用纵向研究设计,于注射用A型肉毒素治疗前、治疗1周后、治疗4周后采用临床资料问卷、习得性无助感量表(LHS)对138例眼睑痉挛患者展开调查,运用重复测量方差分析、广义估计方程分析变化趋势及影响因素。结果 研究对象治疗前、治疗1周后、治疗4周后绝望感得分、无助感得分、LHS总分均呈降低趋势(P<0.05);治疗前后不同年龄、痉挛强度、病程、受教育程度、家庭月收入、性格特征、自我效能感、社会支持研究对象LHS总分呈降低趋势(P<0.05);广义估算方程显示,年龄(OR=0.569)、痉挛强度(OR=5.270)、受教育程度(OR=0.516)、家庭月收入(OR=0.522)、自我效能感(OR=0.576)、社会支持(OR=0.547)是眼睑痉挛患者治疗期间习得性无助感的影响因素(P<0.05)。结论 眼睑痉挛患者治疗期间习得性无助感呈下降趋势,医护人员应加强眼睑痉挛患者习得性无助感多时间点筛查,重点针对低自我效能感、低社会支持、内向、低受教育程度患者采取合理措施,满足患者身心需求,提高身心健康水平。

低频重复经颅磁刺激治疗眼睑痉挛的短期疗效观察

目的探讨低频重复经颅磁刺激(rTMS)治疗眼睑痉挛(BS)的短期疗效及安全性。方法纳入2019年11月至2020年7月眼睑痉挛患者共90例,根据随机数字表法分成三组,分别为低频重复经颅磁刺激组(rTMS组)、肉毒毒素组(BTX组)、肉毒毒素联合低频重复经颅磁刺激组(BTX+rTMS组)。分别给予三组不同的干预措施,随访12周,对比观察三组患者的起效时间,通过Jankovic评定量表(JRS)、眼睑痉挛残疾指数(BSDI)及改良TWSTRS疗效量表等综合评估疗效,并记录不良反应。结果rTMS组与BTX+rTMS组起效时间明显短于BTX组,差异有统计学意义(P<0.05)。三组患者在第1、4、12周JRS评分较治疗前均明显降低,差异有统计学意义(P<0.05)。第4、12周BTX组与BTX+rTMS组JRS评分均较rTMS组下降明显,差异有统计学意义(P<0.05)。第4、12周三组患者BSDI均较治疗前明显降低,差异有统计学意义(P<0.05)。第12周BTX组与BTX+rTMS组BSDI评分下降较rTMS组明显,差异有统计学意义(P<0.05)。第12周改良TWSTRS疗效评分≥3分者,BTX组7例(23.3%),BTX+rTMS组14例(46.67%),而rTMS组所有患者评分均<3分。结论眼睑痉挛经颅磁刺激治疗起效快,疗效维持时间短,不良反应少。低频rTMS联合肉毒毒素注射治疗能够缩短患者的起效时间,提高临床疗效。

微砭耳针联合A型肉毒毒素治疗伴焦虑抑郁症的特发性眼睑痉挛的疗效观察

目的观察微砭耳针联合A型肉毒毒素(BTX-A)治疗特发性眼睑痉挛(BEB合并焦虑抑郁的临床疗效。方法纳入2021年12月—2022年12月佛山市中医院眼科和神经内科门诊诊治的BEB合并焦虑抑郁的患者63例(126只眼)。采用随机数字表法分为肉毒素组、耳针组和联合组,每组21例(42只眼),依次予BTX-A、微砭耳针、微砭耳针联合BTX-A治疗。3组均观察6个月。记录3组患者的起效时间和疗效持续时间,治疗前后分别检测患者的焦虑自评量表(SAS)和抑郁自评量表(SDS)得分,记录数据进行统计分析。结果(1)BEB的起效时间及疗效持续时间:3组起效时间比较,差异有统计学意义(F=5.058,P=0.012)。与耳针组比较,肉毒素组、联合组起效时间均提前,差异均有统计学意义(t肉毒素=3.193,P=0.003;t联合组=3.835,P=0.000)。联合组与肉毒素组起效时间比较,差异无统计学意义(P>0.05)。3组疗效持续时间比较,差异有统计学意义(F=29.079,P=0.000)。与耳针组比较,肉毒素组和联合组疗效持续时间均延长,差异均有统计学意义(t_(肉毒素)=4.391、t_(联合组)=7.729,均P=0.000)。与肉毒素组比较,联合组疗效持续时间延长,差异有统计学意义(t=2.638,P=0.012)。(2)SDS评分:3组治疗后SDS评分均较治疗前降低,差异均有统计学意义(t_(耳针组)=4.498、t_(肉毒素组)=5.758、t_(联合组)=11.489,均P=0.000)。治疗后3组间比较,差异有统计学意义(F=5.343,P=0.007)。联合组SDS评分低于耳针组和肉毒素组,差异均有统计学意义(t_(耳针组)=3.284,P=0.002;t_(肉毒素组)=2.253,P=0.030),肉毒素组和耳针组SDS评分比较,差异无统计学意义(P>0.05)。(3)SAS评分:3组治疗后SAS评分均较治疗前降低,差异均有统计学意义(t_(耳针组)=4.603、t_(肉毒素组)=7.617、t_(联合组)=10.585,均P=0.000)。治疗后3组间比较,差异有统计学意义(F=14.845,P=0.000)。肉毒素组和联合组治疗后SAS评分均低于耳针组,差异均有统计学意义(t_(肉毒素组)=2.351,P=0.024;t_(联合组)=5.446,P=0.000)。联合组治疗后SAS评分低于肉毒素组,差异有统计学意义(t=3.070,P=0.004)。(4)BEB临床疗效:耳针组、肉毒素组、联合组的总有效率依次为66.7%、76.2%和95.2%,3组总有效率比较,差异有统计学意义(χ^(2)=10.855,P=0.004)。肉毒素组总有效率与耳针组比较,差异无统计学意义(P>0.05),联合组总有效率高于耳针组和肉毒素组,差异有统计学意义(χ_(耳针组)^(2)=11.118,P=0.001;χ_(肉毒素组)^(2)=6.222,P=0.013)。(5)不良反应发生率:3组不良反应率比较,差异无统计学意义(P>0.05)。结论微砭耳针联合BTX-A注射治疗BEB起效快,疗效维持时间长,不良反应少,并能明显改善抑郁焦虑症状,值得临床推广。

乌灵胶囊联合注射用A型肉毒毒素治疗良性特发性眼睑痉挛合并失眠的临床效果

目的 观察乌灵胶囊联合注射用A型肉毒毒素治疗良性特发性眼睑痉挛(BEB)合并失眠的临床效果及对睡眠质量的影响。方法 选择2018年2月—2021年5月徐州市第一人民医院收治的BEB合并失眠患者60例,采用随机数字表法分为观察者和对照组各30例。对照组给予注射用A型肉毒毒素治疗,观察组在对照组基础上给予乌灵胶囊治疗,治疗时间为6周。比较2组痉挛治疗效果,焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数(PSQI)、世界卫生组织生活质量简表(WHOQOL-BREF)评分及不良反应。结果 观察组总有效率与对照组比较差异无统计学意义(93.33%vs. 86.67%,χ^(2)=0.185,P=0.667)。治疗后4、8周,2组SAS、SDS、PSQI评分均低于治疗前,且观察组低于对照组(P<0.05或P<0.01);治疗后6周,2组WHOQOL-BREF评分均高于治疗前,且观察组高于对照组(P<0.05或P<0.01);观察组与对照组不良反应总发生率比较差异无统计学意义(16.67%vs. 13.33%,P=1.000)。结论 乌灵胶囊联合注射用A型肉毒毒素治疗BEB伴失眠安全有效,能显著改善患者焦虑抑郁程度,提高睡眠及生活质量。

A型肉毒素治疗特发性眼睑痉挛眼睑肌张力障碍的效果

目的 观察A型肉毒素注射液治疗特发性眼睑痉挛(blepharospasm,BSP)的效果。方法 选取收治的94例特发性BSP患者,使用随机抽签法分为对照组与研究组,每组47例。对照组予以针灸、抗精神病药物等治疗,研究组在对照组治疗的基础上予以A型肉毒素治疗。比较2组的疗效、不良反应、治疗前后疾病严重程度[Jankovic评定量表(Jankovic rating scale,JRS)]、眼睑肌张力障碍[肌张力障碍症状量表(Burke-Fahn-Marsden dystonia rating scale,BFMDRS)]、干眼症状[眼表疾病指数量表(ocular surface disease index,OSDI)、眼部症状视觉模拟量表(visual analogue scale,VAS)评分]和中枢感觉传导通路兴奋性(P19’/N30’、N13’/P19’、P19/N30和N13/P19峰峰幅度)。结果 研究组的总有效率(95.74%)明显高于对照组(80.85%),P<0.05;治疗后,研究组的JRS、BFMDRS、OSDI和VAS评分以及P19’/N30’、N13’/P19’、P19/N30和N13/P19峰峰幅度均较对照组低(P<0.05);对照组未出现不良反应,研究组出现2例轻度眼睑肿胀、2例眼睑发僵及1例上睑下垂,但均在注射4周内自动消失。结论 A型肉毒素注射液治疗特发性BSP效果显著,可缓解疾病症状,减轻眼睑肌张力障碍,降低中枢感觉传导通路兴奋性。治疗过程中出现一些不良反应,但未影响患者病情,且会自动消失。

Clinical Observation on Aligned Needling in Treating Idiopathic Blepharospasm

Objective:To observe the clinical effect of aligned needling method in treating idiopathic blepharospasm.Methods:Seventy-eight patients with idiopathic blepharospasm were randomized into two groups.Forty-six cases in the treatment group were treated with aligned needling method applied to orbicularis oculi muscles;32 cases in the control group were treated with anticonvulsants.Therapeutic effects were compared after 3 treatment courses.Results:The total effective rate was 93.5%in the treatment group versus75.0%in the control group,and the difference was statistically significant(P<0.05).Conclusion:Aligned needling method applied to orbicularis oculi muscle has better therapeutic effect than anticonvulsants in treating blepharospasm.

Clinical study of acupuncture plus Dang Gui Bu Xue Qu Feng Tang for benign essential blepharospasm

Objective:To evaluate the therapeutic efficacy of acupuncture plus Dang Gui Bu Xue Qu Feng Tang for benign essential blepharospasm(BEB).Methods:A prospective randomized controlled trial was performed.A total of 105 participants were randomized 1:1:1 into an acupuncture group,a herbal medicine group and an acupuncture plus herbal medicine group.Participants in the acupuncture group received manual acupuncture treatment,twice a week.Participants in the herbal medicine group received Dang Gui Bu Xue Qu Feng Tang,oral administration,once a day.Participants in the acupuncture plus herbal medicine group received both treatments.The therapeutic effects of the three groups were evaluated after four weeks of treatment.The primary outcome was the Jankovic rating scale(JRS)score,and the secondary outcome was the blepharospasm disability index(BSDI)score.Results:After four weeks of treatment,the JRS total scores significantly decreased in all three groups versus baseline(P<0.05).A greater reduction in the JRS total score was reported in participants in the acupuncture plus herbal medicine group(P<0.05),but there was no significant difference between the acupuncture group and the herbal medicine group(P>0.05).The acupuncture plus herbal medicine group had a greater decrease in the JRS severity score than the herbal medicine group(P<0.05).The reduction in the JRS frequency score was not significantly different among the three groups(P>0.05).The BSDI scores significantly decreased in all three groups versus baseline(P<0.05),but the reduction in the BSDI score was insignificantly different among the three groups(P>0.05).Conclusion:It is effective in the treatment of BEB either to use acupuncture and Dang Gui Bu Xue Qu Feng Tang alone or in combination.The combination therapy shows a more significant effect than either of the treatment alone.

Anatomical correlates of blepharospasm

Background:Focal dystonia is a neurological disorder characterized by unwanted muscle spasms.Blepharospasm is a focal dystonia producing an involuntary closure of the eyelid.Its etiology is unknown.Objective:To investigate if there are structural changes in the white and grey matter of blepharospasm patients,and if the changes are related to disease features.Methods:T1 and diffusion-weighted magnetic resonance imaging scans were collected from 14 female blepharospasm patients and 14 healthy matched controls.Grey matter volumes,fractional anisotropy(FA),and mean diffusivity maps were compared between the groups.Based on grey matter differences within the facial portion of the primary motor cortex,the corticobulbar tract was traced and compared between groups.Results:Changes in grey matter in patients included the facial portion of the sensorimotor area and anterior cingulate gyrus.These changes did not correlate with disease duration.Corticobulbar tract volume and peak tract connectivity were decreased in patients compared with controls.There were no significant differences in FA or mean diffusivity between groups.Conclusions:Grey matter changes within the primary sensorimotor and the anterior cingulate cortices in blepharospasm patients may help explain involuntary eyelid closure and the abnormal sensations often reported in this condition.

基于“肝藏血主筋”论治眼睑痉挛

总结基于“肝藏血主筋”理论辨证论治眼睑痉挛的体会。肝为罢极之本,肝其性如木,木曰曲直;人体的筋主屈伸,若筋之运动失常则出现震颤、抽搐等症状;眼睑痉挛中医属“目睛瞬动”范畴,初起多因外感六淫之邪,久而邪气耗伤阴血,阴虚风动,致使眼睑不自主抽动。基于“肝主藏血,肝主筋”的特点,主张治疗眼睑痉挛以养肝血,疏肝解痉法贯穿始末。通过养肝血、滋肝阴、息肝风、养肝筋诸法恢复眼周肌肉活动功能,以维持眼睑筋络气血调和,为眼睑痉挛的治疗提供新的思路。

眼周局部注射A型肉毒杆菌毒素联合干眼SPA治疗特发性眼睑痉挛的效果

目的探讨眼周局部注射A型肉毒杆菌毒素联合干眼SPA治疗特发性眼睑痉挛的效果。方法选择赣州爱尔眼科医院2020年1月至2021年8月就诊的特发性眼睑痉挛患者60例,使用随机数字表法将患者分为两组,每组各30例。对照组患者仅施以眼周局部注射A型肉毒杆菌毒素进行治疗,观察组在对照组治疗基础上联合使用干眼SPA进行治疗,两组均随访12个月,比较两组患者疗效、干眼指标变化情况、满意度。结果两组患者的治疗效果比较,差异无统计学意义(P>0.05)。治疗前,两组患者的泪液分泌量、泪膜破裂时间比较,差异无统计学意义(P>0.05);治疗后,两组患者的泪液分泌量多于治疗前,泪膜破裂时间长于治疗前,且观察组患者的泪液分泌量多于对照组,泪膜破裂时间长于对照组,差异有统计学意义(P<0.05)。观察组患者的总满意度高于对照组,差异有统计学意义(P<0.05)。结论使用A型肉毒杆菌毒素联合干眼SPA治疗特发性眼睑痉挛,治疗有效率较好,满意度较高,可改善患者干眼症状,值得在临床上推广和使用。

针刺联合A型肉毒素治疗特发性眼睑痉挛的临床观察

目的观察针刺联合A型肉毒杆菌毒素(BTX-A)治疗特发性眼睑痉挛(BES)的临床疗效。方法纳入2022年1月—2023年1月中国中医科学院眼科医院诊治的BES患者60例(120只眼),证属心脾两虚证。随机分为肉毒素组(A组)、针刺组(B组)和肉毒素联合针刺组(C组),每组各20例(40只眼)。A组予BTX-A眼睑注射治疗,B组予针刺治疗,C组予针刺联合BTX-A治疗。3组均观察7个月。分别于治疗前、治疗后7 d和治疗后7个月检测患者的肌肉痉挛等级及例数、起效时间和疗效持续时间并做统计分析。结果(1)痉挛等级:治疗前3组痉挛等级分布总体比较,差异无统计学意义(P>0.05)。治疗后7 d与治疗前比较,A组和C组痉挛等级分布总体均较前降低,差异均有统计学意义(ZA组=47.088,Z_(C组)=45.888,均P=0.000)。治疗后7 d 3组间痉挛等级分布总体比较,差异有统计学意义(Z=28.572,P=0.000)。A组和C组痉挛等级分布总体低于B组,差异均有统计学意义(ZA组=36.212,Z_(C组)=32.938,均P=0.000)。治疗后7个月与治疗前比较,B组和C组痉挛等级分布总体均较前降低,差异均有统计学意义(Z_(B组)=29.450,Z_(C组)=54.162,均P=0.000)。治疗后7个月3组间痉挛等级分布总体比较,差异有统计学意义(Z=38.878,P=0.000)。B组和C组痉挛等级分布总体均低于A组,差异均有统计学意义(Z_(B组)=19.788,P=0.026;Z_(C组)=46.850,P=0.000),C组痉挛等级分布总体低于B组,差异有统计学意义(Z=27.062,P=0.001)。(2)起效时间:3组起效时间比较,差异有统计学意义(Welch F=315.658,P=0.000)。与A组比较,B组起效时间均延后,差异有统计学意义(t=25.348,P=0.000);C组起效时间无明显变化,差异无统计学意义(P>0.05)。与B组比较,C组起效时间提前,差异有统计学意义(t=24.270,P=0.000)。(3)疗效持续时间:3组疗效持续时间比较,差异有统计学意义(Welch F=38.290,P=0.000)。B组和C组疗效持续时间均较A组长,差异均有统计学意义(tB组=3.441,P=0.004;tC组=7.751,P=0.000);C组疗效持续时间较B组长,差异有统计学意义(t=5.605,P=0.000)。(4)临床疗效:A组、B组和C组的总有效率依次为27.5%,77.5%和100.0%,差异有统计学意义(χ^(2)=50.911,P=0.000)。B组高于A组,差异有统计学意义(χ^(2)=18.095,P=0.000),C组高于A组和B组,差异均有统计学意义(χ^(2)A组=42.407,P=0.000;χ^(2)B组=8.013,P=0.005)。(5)不良反应:3组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论针刺联合BTX-A治疗BES起效快,疗效持续时间久,临床疗效可观,安全性高,值得临床推广。

眼睑痉挛型Meige综合征的治疗进展

Meige综合征是一种节段性的颅颈部肌张力障碍性的锥体外系疾病,属于成人多动症的一种。发病原因不明,常见于中老年女性,多与抑郁、外伤、药物、手术等危险因素相关,眼睑痉挛是Meige综合征最早也是最常见的临床症状,尽管有自发缓解的可能,但亦有致盲风险,临床上多因对此病认识不足而延误治疗影响预后,随着其发病率的增长,尤其以眼睑痉挛就诊于眼科的人数增长,全面认识Meige综合征有利于提高眼科医师诊治本病的能力以及指导临床合理用药。本文就眼睑痉挛型Meige综合征的治疗进展予以综述,总结了药物、手术和中医疗法的利弊,以期提高眼科医师对此类疾病的诊治水平。

针刺联合西药治疗原发性眼睑痉挛临床研究

目的:观察针刺联合西药治疗原发性眼睑痉挛(PBS)的疗效。方法:选取90例PBS患者,按随机数字表法分为观察组及西药组各45例。西药组行常规西药口服,观察组行针刺联合西药治疗。比较2组临床疗效、不良反应发生率、复发率,比较2组治疗前后睑痉挛强度(Cohen)评分、扬科维奇评定量表(JRS)评分的变化。结果:治疗后,2组Cohen评分均较治疗前下降(P<0.05),观察组Cohen评分低于对照组(P<0.05)。治疗后,2组JRS评分均较治疗前下降(P<0.05),观察组JRS评分低于西药组(P<0.05)。观察组临床疗效总有效率为88.89%,西药组为75.56%,2组经Ridit分析比较,差异有统计学意义(P<0.05)。治疗期间,观察组不良反应发生率为4.44%,西药组为20.00%,2组比较,差异有统计学意义(P<0.05)。观察组复发率为17.50%,西药组复发率为44.12%,2组比较,差异有统计学意义(P<0.05)。结论:针刺联合西药治疗PBS的疗效优于单一使用西药治疗,能缓解临床症状,降低复发率。

A型肉毒毒素对偏侧面肌痉挛和良性特发性眼睑痉挛患者焦虑/抑郁状态的影响

目的探讨偏侧面肌痉挛和良性特发性眼睑痉挛患者伴发焦虑/抑郁状态的情况,以及A型肉毒毒素局部注射治疗对患者焦虑/抑郁的影响。方法共纳入偏侧面肌痉挛(hemifacial spasm,HFS)患者90例和良性特发性眼睑痉挛(benign essential blepharospasm,BEB)患者90例,所有患者均进行BTX-A局部肌肉注射治疗,在注射前、注射后2个月采用焦虑自评量表(SAS)及抑郁自评量表(SDS)进行测评。比较HFS和BEB患者注射前后SAS和SDS分值的变化。结果(1)HFS患者治疗前SAS及SDS标准分的平均值分别为41.25±6.35、42.25±7.57,其中女性患者SAS评分比男性患者高(43.56±6.10、40.17±8.36,P=0.031),SDS评分比男性患者高(45.48±7.31、40.25±6.46,P=0.008),治疗后患者SAS及SDS评分分别为30.12±4.35(P=0.000)、30.58±4.89(P=0.000),与治疗前比具有统计学差异;(2)BEB患者治疗前SAS及SDS评分分别为58.90±10.61,58.78±9.89;其中女性患者SAS评分比男性患者高(60.89±9.11、56.45±8.75,P=0.017),SDS评分比男性高(60.12±8.35、57.90±7.93,P=0.011);治疗后SAS及SDS评分分别为38.17±3.67(P=0.000)、38.12±4.15(P=0.001),与治疗前比具有统计学差异。结论很多HFS和BEB患者伴发焦虑/抑郁状态,且女性较男性更明显,BTX-A治疗后可改善患者的焦虑/抑郁症状。

良性特发性眼睑痉挛的研究进展

良性特发性眼睑痉挛是以不自主双眼闭合并睁开费力为特征的局灶性肌张力障碍性疾病。目前病因及发病机制不清,多数成年起病,女性多发。症状通常是由压力、疲劳、强烈的光照或个人因素等引起的。通常病情进展缓慢,晚期患者可出现功能性盲影响生活,目前主要治疗方法包括:肉毒毒素注射、外科手术、系统性和眼部药物以及中医药治疗。肉毒菌素治疗是一种有效的治疗方法,外科手术效果较满意但有一定适应证,适用于对肉毒杆菌毒素治疗无效患者。药物治疗疗效甚微,中医药治疗有一定治疗效果,经颅磁刺激可改善患者症状。本文就该病的流行病学、解剖学、生理学、临床表现、鉴别诊断、发病机制以及治疗等方面进行系统综述。

眼睑肌阵挛失神综合征患者临床特点及视频脑电图特征分析

目的探讨眼睑肌阵挛失神综合征(EMA)患者的临床特点及视频脑电图特征。方法回顾性分析2006年1月—2012年8月我院确诊的8例EMA患者的临床及视频脑电图资料。结果 8例EMA患者中男1例,女7例;眼睑肌阵挛(EM)平均起病年龄(8.5±3.4)岁;1例仅有EM一种发作形式,3例伴有失神发作,6例伴有全面强直阵挛发作。8例患者第1次脑电图检查仅1例发现全导棘慢波,均未能确诊EMA。2例患者有高热惊厥病史;1例患者有高热惊厥家族史。所有患者EM以眼睑的节律性抽动为最突出症状,抽动频率为3～6次/s,每次发作持续1～8 s。3例患者伴有眼球上视及头后仰的强直成分,3例患者在眨眼发作>3 s后伴有不同程度的意识障碍,1例伴有双手抖动。脑电图特征:发作间歇期癫痫样放电主要表现为广泛性的3～6 Hz棘波节律、棘慢复合波或多棘慢复合波单发或节律性爆发;发作期脑电图主要表现广泛性高波幅3～6 Hz棘慢波或多棘慢波节律性爆发。所有患者在闭目异常放电增多,6例患者对间断闪光刺激敏感,3例过度换气诱发异常放电增多。结论眼睑肌阵挛失神综合征症状相对较轻、发作时间短暂,易被误诊,视频脑电图对于该综合征的正确诊断具有重要的临床意义。