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Study on Botulinum A Toxin in the Treatment of Blepharrospasm and Hemifacial Spasm

Author: YangZhongLiang
Tutor: HuangJianZheng
School: Zhejiang University
Course: Neurology
Keywords: Botulinum toxin type A ( BTX - A ) Hemifacial spasm Dose Efficacy Adverse Reaction
CLC: R745.12
Type: Master's thesis
Year: 2003
Downloads: 143
Quote: 0
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Abstract


Hemifacial spasm, also known as hemifacial spasm is usually limited to one side of the face, for involuntary clonic convulsions. Multi-primary case for no clear reason. In recent years, many authors found that the vast majority of normal vascular cross-compression, such as the posterior inferior cerebellar artery, anterior inferior cerebellar artery, vertebral artery oppression. Occasionally due to aneurysm, arteriovenous malformation or brain tumor and facial nerve roots of oppression. This mechanical compression can squeeze the nerve fibers together, then its demyelination, resulting in operating current short circuit between the axons, which is caused by the pathophysiology of hemifacial spasm. Clinical manifestations: onset in middle age, more women, early disease orbicularis muscle intermittent convulsions. The facial muscle gradually spread to the other side of the face, mouth muscles most likely involved in the severe cases involving the ipsilateral platysma. Convulsions exacerbated due to mental stress, fatigue and voluntary movement, facial spasm often can not control their own excitement increased, stop quiet or asleep. No other positive signs in the nervous system. Commonly used carbamazepine, stability and anti-epileptic drugs in the past, but more difficult to work. The arrest and decompression of the facial nerve more than a positive effect, but often accompanied by nerve damage, severe facial paralysis occurs, also quite a number of cases of recurrence. Carbamazepine: treatment of hemifacial spasm have a certain effect, but often require larger doses, long-term use can cause dizziness, drowsiness, ataxia, leukopenia and other side effects. Its mechanism of action may reduce the excitability of the facial nucleus, thereby reducing the abnormal discharge related. Microvascular decompression: Since the mastoid craniotomy microvascular decompression is high success rate, a gelatin sponge separated by the small blood vessels of the facial nerve root and nerve to relieve pressure stimulation, the cure rate of hemifacial spasm 99%, but complications include deafness, dizziness, transient facial paralysis, Zhejiang University, a master's degree thesis abducens nerve palsy, these complications are due to excessive backward extrusion, pulling the cerebellum and auditory nerve . This is a cure rate of the highest recurrence rate is very low cure, but the high cost of risk. In recent years, application of botulinum toxin type A (B-TX) injection therapy, to obtain better results. This drug for the treatment of a variety of focal dystonia disease, is considered to be one of the important progress in the recent years, the field of neurology treatment for localized muscle spasms opened a new therapeutic areas. B TX-A is composed of a single polypeptide chain, activated by proteolytic processing of the selected portion, and cleavage of the two fragments of the heavy chain (H) and light chain (L). H chain molecular weight of 100,000 daltons, L chain molecular weight of 50,000 daltons, the two chains connected by Mateo S-. H hydroxyl end with the cholinergic nerve endings of the presynaptic membrane receptor binding, the amino acid side-channel forming region, then L chain shift in the cells through inhibition of the phenone choline vesicles quantum release, reduced muscle contraction, eliminating symptoms of muscle spasms. Selected muscle endplate syringe of a very small amount of B TX-A can produce enough paralysis. The majority of patients symptoms will receive significantly improve the efficacy of an average duration of about three months, relapse, repeated injections may be re-efficacy, duration of symptoms one year by the lesser of 2 to 3 times after injection is expected to be cured. BTX. A most common complication of ptosis, exposure keratitis can occur, diplopia, increased tears or dry eyes, preterm medication during pregnancy. B TX-A is a safe and effective treatment of hemifacial spasm, simple method of treatment. In this paper, A botulinum toxin treatment of hemifacial spasm, to explore the optimal dose, onset time, efficient, average efficacy, adverse reactions, etc.. BTX-A treatment of hemifacial spasm disease 507 cases to take randomly divided into two groups, A group of 294 cases, each point of injection of BTX. A 2. The su / OLML to: B group 213 cases, each point of injection SU River. lml. Interval length by two injections of 421 cases of repeated injection treatment is divided into two three Zhejiang University, a master's degree thesis group: Group C, an interval of 3 to 4 months, a total of 222 cases; D group interval of 6 to 8 May, a total of 199 cases. Tip: Bu four groups of patients after BTX-A treatment, there is no significant difference in efficiency and partial remission rate. The total effective rate was 98%. Are ,3-8 days efficacy reached a peak within 48 hours of onset, recurrence repeated injections similar results. Adverse reactions: within a week after the injection of local swelling in 35 cases, the slightly drooping upper eyelid 22 cases, incomplete eyelid closure in 17 cases, shallow nasolabial fold 24 cases have disappeared within 3 weeks. 1 patient in the third retreatment, 1 hour after injection of BTX body itching, consider an allergic reaction to calcium gluconate needles and intravenous injection of dexamethasone pine needles symptoms. 3, the high-dose group u / sites) and low-dose group door. The SU / sites) in patients with similar efficacy, the effective duration of action no significant difference between the incidence of adverse reactions, but the high-dose group was significantly higher than the low-dose group. 4, repeat the dose is similar, but the short-interval group efficacy in patients with a shorter duration, that is, the effective duration of action is shorter than the long-interval group, there was no significant difference in the incidence of adverse reactions. In this paper, successfully applied botulinum toxin treatment of hemifacial spasm, the effect is significant, less side effects, easy to operate, the effective rate of 98%, is worthy of further promotion. But for retreatment, should be taken to prevent the emergence of an allergic reaction.

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CLC: > Medicine, health > Neurology and psychiatry > Neurology > Peripheral nerves and ganglia disease > Brain disease > Facial nerve disease
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