THE PROPERTIES AND LONGITUDINAL EXPERIENCE OF CHINESE TYPE A BOTULINUM TOXIN FOR THE TREATMENT OF FOCAL DYSTONIA AND HEMIFACIAL SPASM

Objective.To introduce the properties of Chinese type A botulinum toxin(CBTXA,made by Lanzhou Institute of Biological Products),and its long?term effect for focal dystonia and hemifacial spasm.Method.The purity and recovery of crude and crystalline toxin were tested.Long?term data from305patients with hemifacial spasm(HFS),blepharospasm(BS)and cervical dystonia(CD)were evalu-ated and subgroups of patients received CBTXA injections between1994and2000in at least six sepa-rate treatment sessions,with follow up for2～8years.The therapeutic results of the last session CBTXA injections were analyzed in comparison with the first session.Result.CBTXA purity was high[(2.55～2.60)×10 7 LD50/mgPr ,A260/A280≤0.55,high molecular substance accounted for99.2%of total proteins].Long term treatment with CBTXA in patients with focal dystonia and HFS was not associated with any decline in benefit,and efficacy may improve slightly with repeat treatments.CBTXA is an excellent long-term treatment of HFS,BS and CD.Conclusion.We conclude that Chinese type A botulinum toxin is of botulinum toxin therapy quality standard according to results obtained from the basic study and long?term clinical applications.The re?injection of CBTXA significantly improves the quality of life of most patients and is a safe,effective and comparatively economical treatment for patients with focal dystonia and HFS.

Sonographic Alteration of Basal Ganglia in Different Forms of Primary Focal Dystonia： A Cross-sectional Study

Background：Few studies have addressed whether abnormalities in the lenticular nucleus （LN） are characteristic transcranial sonography （TCS） echo features in patients with primary dystonia.This study aimed to explore alterations in the basal ganglia in different forms of primary focal dystonia.Methods：A cross-sectional observational study was performed between December 2013 and December 20 1 4 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects.TCS was performed in patients and control subjects.Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups.Results：Thirteen individuals were excluded due to poor temporal bone windows,and two subjects were excluded due to disagreement in evaluation by sonologists.Totally,70 patients （cervical dystonia,n =30;blepharospasm,n =30;oromandibular dystonia,n =10） and 50 normal controls were included in the final analysis.LN hyperechogenicity was observed in 51% （36/70） of patients with primary focal dystonia,compared with 12% （6/50） of controls （P 〈 0.001）.Substantia nigra hyperechogenicity did not differ between the two groups.LN hyperechogenicity was observed in 73% （22/30） of patients with cervical dystonia,a greater prevalence than in patients withblepharospasm （33%,10/30,P =0.002） and oromandibular dystonia （40%,4/10,P =0.126）.LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls （73% vs.12%,P 〈 0.001）;however,no significant difference was detected in patients with blepharospasm （33% vs.12%,P =0.021） or oromandibular dystonia （40% vs.12%,P =0.088）.Conclusions：LN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls.It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia.

Could Dystonia Be Initial Presentation of Corpus Callosum Infarction in Young Age Patients? A Case Report Study

Focal dystonia in young aged patients is considered to be the uncommon clinical presentation, unless a secondary cause is to be considered. Infarcts of the corpus callosum are rare and have not been well documented previously. As for a variety of signs and symptoms due to corpus callosum lesion, focal dystonia can be easily overlooked. The case is approved by ethical committee and explained to the patient with patient approval.

A型肉毒毒素治疗咀嚼肌群痉挛的远期疗效分析

目的分析A型肉毒毒素治疗咀嚼肌群痉挛的远期疗效。方法对17例经保守治疗无效的咀嚼肌群痉挛患者进行A型肉毒毒素肌肉注射治疗。受累咬肌和颞肌注射剂量分别为1ml（50U）和0．5ml（25U），未受累咬肌和颞肌注射剂量分别为0．5ml（25U）和0．25ml（12．5U）。观察治疗前后不同时期患者最大张口度和并发症发生情况。结果治疗后不同时期患者最大张口度明显大于治疗前（P〈0．001），而治疗后不同时期患者最大张口度相差不大（P〉0．05）。平均随访时间4～9年（6．5±1．6），患者无严重并发症发生。结论A型肉毒毒素治疗咀嚼肌群痉挛安全有效，可明显改善咀嚼肌功能，增大张口度。

重复局部注射A型肉毒毒素治疗局限性肌张力障碍长期疗效观察

目的研究重复局部注射A型肉毒毒素治疗偏侧面肌痉挛、眼睑痉挛、Meige's综合征、痉挛性斜颈的长期疗效及维持时间,有无剂量增加趋势。方法用A型肉毒毒素对241例患者重复小剂量局部多点注射,随访治疗10年,将6轮次治疗疗效以及剂量、疗效维持时间、不良反应进行比较分析。结果各轮次总有效率分别为98.7%、98.9%、99.3%、100%、100%、100%。作用持续(20±3)周,平均剂量40U,各轮间疗效、平均剂量、作用持续时间均无显著差异(P>0.05)。结论重复局部注射治疗局限性肌张力障碍长期疗效稳定,作用持续时间相似,维持疗效无需增加剂量,局部不良反应轻微短暂。

A型肉毒毒素联合安坦治疗Meige综合征的临床观察

目的观察A型肉毒毒素联合安坦治疗Meige综合征的疗效。方法将2009-2013年神经内科门诊确诊为Meige综合征的患者分为两组。2009年3月-2011年7月期间的14例病例为A组,2011年8月-2013年12月期间的17例病例为B组,A组单独使用肉毒毒素治疗,B组则在使用肉毒毒素注射基础上同时使用安坦片口服（2mg/片）1-2 mg,每日3次。两组患者均采取门诊定期复诊及电话询问的形式进行随访。对比观察两组患者临床疗效、注射剂量、疗效持续时间及副作用等。结果 B组的临床疗效显著优于A组,差异有统计学意义（P〈0.05）。两组治疗起效时间、注射剂量比较差异无统计学意义（P〉0.05）,B组的疗效持续时间长于A组,差异有统计学意义（P〈0.01）。两组患者注射A型肉毒毒素期间副作用均较为轻微,1.5-2周症状可自行缓解、消失。结论 A型肉毒毒素联合安坦治疗Meige综合征可以提高临床疗效,延长疗效持续时间,从而减少A型肉毒毒素的注射次数。

A型肉毒毒素治疗局限性肌张力障碍和肌肉痉挛

A型肉毒毒素(BTX-A)治疗多种以不自主或异常肌肉收缩为特征表现的运动障碍性疾病是近年神经科治疗领域的重要进展之一。本文综述肉毒毒素治疗应用的原理、适应证、远隔效应、免疫反应等问题,充分肯定其临床应用的发展前景。对其局限性也阐述了看法和建议。

重复经颅磁刺激对局灶型肌张力障碍治疗的疗效分析

目的探讨重复经颅磁刺激对局灶型肌张力障碍治疗的疗效。方法 2016年1~12月我院84例局灶型肌张力障碍患者分为两组各42例,对照组给予苯海索,观察组患者则加用重复经颅磁刺激治疗,比较两组患者书写痉挛程度、肌张力与痉挛性倾斜情况。结果观察组治疗后书写痉挛评分量表(WCRS)、Burke-Fahn-Marsden量表(BFM)与西多伦多痉挛性倾斜评分量表(TWSTRS)总分低于对照组(P<0.01)。结论重复经颅磁刺激对局灶型肌张力障碍治疗的疗效显著,具有借鉴意义。

重复经颅磁刺激联合苯海索治疗局灶型肌张力障碍的效果分析

目的探讨重复经颅磁刺激联合苯海索治疗局灶型肌张力障碍的临床效果。方法抽取2021年6月至2022年8月郑州大学附属郑州中心医院收治的局灶型肌张力障碍患者70例,按随机数字表法分为对照组与研究组,每组35例。对照组采用苯海索治疗,研究组采用重复经颅磁刺激联合苯海索治疗。比较两组书写痉挛评分量表(WCRS)评分、Burke-Fahn-Marsden(BFM)评分、西多伦多痉挛性倾斜(TWSTRS)评分、书写时间、视觉模拟评分法(VAS)评分、生活障碍评分及不良反应发生率。结果治疗前,两组WCRS、BFM、TWSTRS评分比较差异未见统计性意义(P>0.05);治疗后,研究组WCRS、BFM、TWSTRS评分低于对照组(P<0.05)。治疗前,两组书写时间比较差异未见统计学意义(P>0.05);治疗后,研究组书写时间短于对照组(P<0.05)。治疗前,两组VAS、生活障碍评分比较差异未见统计学意义(P>0.05);治疗后,研究组VAS、生活障碍评分低于对照组(P<0.05)。研究组不良反应发生率(2.86%,1/35)与对照组(8.57%,3/35)比较差异未见统计学意义(P>0.05)。结论重复经颅磁刺激联合苯海索治疗局灶型肌张力障碍可改善患者书写痉挛程度、肌张力情况及痉挛性倾斜,缓解疼痛程度,减轻生活障碍,存在安全性。