| Study on Botulinum A Toxin in the Treatment of Blepharospasm and Hemifacial SpasmBlepharospasm and hemifacial spasm diseases are chronic, progressive neuromuscular disorders often occurring in the middle-aged and the aged. Frequent and prolonged spasmodic contracture of the eyelids and facial muscles and involuntary closure of the eyelids may result in visual disturbance or even functional blindness, inconveniencing patients and distorting the facial appearance. Different treatments by using drugs, surgery, biofeedback, acupuncture and moxibustion have been prescribed with little avail. Since 1998 a crystaline botulinum A toxin developed in the Lanzhou Institute of Biological Products has been used for the treatment of eyelid and hemifacial spasms with satisfactory results.86 patients with blepharospasms, hemifacial spasm were treated with botulinum A toxin yielding satisfactory results. Rapid spasm relief was obtained. Only mild, transient and local side-effects occurred, and one case of allergic reaction happened in a thirdly-reinjected patient. The patients were followed up for 10-50 months.The clinical results show that local injection of a minute dose of botulinum A toxin in treating blepharospasm, hemifacial spasm is a safe, effective and simple method of nonsurgical therapy.Aims: To implore the optimal dosage of botulinum A toxin for the treatment of blepharospasm and hemifacial spasm diseases,and to study the suitable reinjection time for the reoccurred patients.A group of 86 patients, 36 male and 50 females, aged 42-71years, averaging 55.1 ± 7.2years, had histories of illness for 10 months to 15 years, averaging 4.4±2.7years. 65 patients had hemifacial spasm associated with unilateral blepharospasm, and 21 patients unilateral blepharospasm. 58 patients had undergone either medicinal, or acupuncture treatment without ideal effect.Blepharospasm and hemifacial spasm were graded in terms of intensity according to Cohen's standard as follows: 0=no spasm; 1 = increased blinking caused by external stimuli; 2=slight fluttering of eyelids and facial muscles without functional disturbance; 3 = moderate, marked spasm with mild functional disturbance; 4=severe spasm and functional disturbance, affecting such daily activities as walking, driving, reading, etc. In this study, there were 37 cases with Grade 3 spasm and 49 cases with Grade 4 spasm.All these 86 patients had undergone 507 times of botulinum A toxin treatment altogether, i.e.,there were altogether 507 casetimes treated with BTX-A, which were divided into group A and group B.Group A(totally 51cases or 294 case-times) were injected 2.5U of BTX-A(0.1ml) at each injection site, while group B(totally 35 cases 213 case-times) were injected 5U of BTX-A(also 0.1ml) at each site. According to the length of reinjection interval, all the reinjected cases were divided into group C(totally 222 case-times) and group D (totally 199 case-times), the former's interval was 3-4 months, whereas the later's 6-8months.Methods: Before and after treatments, the patients were examined for eyelid position and spasmodic intensity. Follow-up examination were given twice weekly in the first two weeks, once weekly in the next two weeks and once every 1 months.thereafter for a total 6 months.Dosage and administration: The crystaline botulinum A toxin, packed in ampoules of 100 units; was diluted in sterile normal saline to the appropriate concentration (2.5 units/ 0.1 ml or 5 units/0.1ml), used for local injection into eyelid, face muscles, at multiple sites, with 2.5 U or 5 U at each site. For eyelid spasm 5 sites were selected on the orbicularis oculi at the upper, lower eyelid and the outer canthus. For hemifacial spasm, 3 more sites were chosen at middle and lower face muscles and at cheek muscles in addition to the above sites. The total dosage was 12.5-45 U.RESULTS: In 86 patients with blepharospasm and hemifacial spasm, clinical observations showed marked improvement insymptoms starting 48 hours after t... |
PDF Full Text Request