Clinical Evaluation Of Riolan’s Muscle Injection Of Botulinum Toxin Type A In The Treatment Of Blepharospasm

Background:In this study, we increased injection site Riolan’s muscle when treatment of type Abotulinum toxin in patients with blepharospasm, research the injection method ofRiolan’s muscle in improving the clinical efficacy in patients with blepharospasm. Inorder to achieve the best therapeutic effect, minimal side effects and to explore thepossible pathogenesis of blepharospasm,we contrast classical injection method andRiolan’s injection method to explore more effective injection site and dose to therapyblepharospasm with botulinum toxin type A.MethodsWe select40cases diagnosed blepharospasm in the department of Neurology inthe First Affiliated Hospital of Dalian Medical University from June2010to March2013.40patients were assigned randomly to two different treatment groups (classicinjection group(groupⅠ), Riolan muscle injection group（groupⅡ）).Each group have20cases respectively.GroupⅠwere used botulinum toxin to inject classic sites,groupⅡwere used botulinum toxin to inject Riolan’s muscle on the base of classic sites.Wedecrease the dose of BTX-A in the pretarsal and lateral canthus,so there is nosignificance different cumulative total amount of BTX-A between groupⅠand groupⅡ.Then observe the onset time, the degree of recovery, clinical efficacy, effectiveduration and side effects after treatment one month, three months to one year.UsingJankovic Rating Scale (Jankovic Rating Scale, JRS) and improve TWSTRS toevaluate function and clinical efficacy by physician.Using Blepharospasm DisabilityIndex (Blepharospasm Disability Index, BSDI)to evaluate activities of daily livingbefore and after the treatment by patients.When relapse again,20cases of classical sitesinjection were assigned randomly into two grops. groupⅠ(n=10) continue to applyclassic sites injection,and groupⅡ apply botulinum toxin to inject Riolan’s muscle. Then,observe the clinical efficacy, effective duration, and side effects after treatmentone month, three months.Results:1.After treatment the JRS scale scores of20patients in groupⅡwas significantdifference lower than group Ⅰ(P＜0.001),the average BSDI score of20patientswere0.85±0.21.2.Compare groupⅠand groupⅡ,there was no significant difference betweengender, age,the course of the disease and the severity of the spasm (P＞0.05),Cumulative total dose of BTX-A injection was no significant difference (P＞0.05).According to JRS scale and improved TWSTRS Scale,there were13/20patientscompletely improve,4/20patients significantly improved,3/20patients moderateimprovement, no ineffective cases in groupⅡ.There were3/20patients completelyimprove,12/20patients significantly improved,5/20patients moderate improvement,no ineffective cases in groupⅠ.Between the two groups there were significantlydifferent (P＜0.05).There was a significant difference between JRS scale and BSDIscale assessment after treatment one month between the two groups (P＜0.05).Theonset time was much faster in groupⅡthan groupⅠ(P＜0.001),0.5to4days afterinjection,the symptoms were significantly improved,with an average of2.05±1.52days.The symptom of almost all patients of groupⅡ dramatic remission after24-48htreatment, and last for three months or longer,6cases are immediately effective in10-20minutes after injection with their eyes open easily.there is a significant differencebetween the two groups (P＜0.05)3.Compare side effects of the two sets after injection BTX-A: the side effectswere lighter in groupⅡ (40%of all patients performed side effects), including threecases of tears, two cases of dry eye, two cases of closed weak, one case of blurredvision,there was no patient performed with diplopia and ptosis. The side effects wereseverely in groupⅠ (55%of all patients performed side effects), including4cases ofmild ptosis, five cases of closed weak, one case of diplopia, one case of blurred vision.All these side reactions remission in2to5weeks after injection.4.Compare Group Ia with Ib group, there was no significant difference before thetreatment of the JRS Scale (P＞0.05).According to JRS scale and improved TWSTRSscale,there was significant difference after the treatment of the Ia group and Ib group (P＜0.05) And group Ib patients complained of significant pain in Riolan’s muscle’sinjection. Conclusion:1.In the application of botulinum toxin type A treatment for the blepharospasm,increase injection site into Riolan’s muscle can be more significantly improvement thesymptoms and a more effective treatment method.2.The symptom of the patients were rapidly improvement in Riolan’s muscleinjection group, and the effect last longer than classic group;3.Compare side effects of the two sets after injection BTX-A: the side effects werelighter in Riolan muscle injection group;4.Botulinum toxin injection into Riolan’s muscle at the same time not only amuscle relaxant but also a selectively change afferent input,which can adjust the sensorycortex, thus improving the symptoms.