Botulinum toxin therapy of hemifacial spasm: bilateral injections can reduce facial asymmetry
Botulinum toxin therapy of hemifacial spasm: bilateral injections can reduce facial asymmetry
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肉毒毒素治疗面肌痉挛：双侧注射可减少面部不对称
DOI：
10.1007/s00415-018-8960-2
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发表时间：
2018-09-01
影响因子：
6
通讯作者：
Jin, Lingjing
中科院分区：
文献类型：
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作者：
Xiao, Libin;Pan, Lizhen;Jin, Lingjing
肉毒杆菌毒素（BT）是面肌痉挛（HFS）的首选治疗方法。当 BT 注射到患侧时，患者可能会出现面部不对称现象增加。我们想要在一项前瞻性、随机、安慰剂对照研究中评估双侧 BT 注射是否可以减少这种面部不对称。为此，我们使用 CBTX-A（中国兰州兰州生物制品研究所）对 19 名 HFS 患者进行单侧 BT 治疗，24 名患者进行双侧 BT 治疗。受影响一侧的 BT 剂量为标准剂量，未受影响一侧的 BT 剂量为标准剂量的三分之一。使用 Sunnybrook 面部分级系统 (SFGS)、面部临床评估量表 (FaCE)、半面痉挛对称量表 (SSHS) 和自我评估量表对面部不对称进行研究。如 SFGS 和 SSHS 所示，双侧 BT 治疗可减少面部不对称性，而单侧 BT 治疗可增加面部不对称性。这两种效应在面部随意运动时比休息时更为明显。 BT效应延迟、BT效应持续时间、不良效应频率和严重程度不受影响。 FaCE总分、部分分项以及自评量表没有显示出效果。双侧 BT 治疗可以改善 HFS 的 BT 治疗结果，而不会产生额外的副作用。然而，这种策略增加了药品成本（约三分之一）。在未受影响的一侧使用更高的剂量可能会进一步增强改善效果。未来的研究还可能监测患者的生活质量以及天真的公众对患者面部表情的整体感知。
Botulinum toxin (BT) is the treatment of choice for hemifacial spasm (HFS). When BT is injected into the affected side, patients may experience increased facial asymmetry. We wanted to evaluate in a prospective, randomised, placebo-controlled study whether bilateral BT injections may reduce this facial asymmetry. For this, we treated 19 HFS patients with unilateral and 24 with bilateral BT therapy using CBTX-A (Lanzhou Biological Products Institute, Lanzhou, China). BT doses on the affected side were standard doses, on the non-affected side they were one-third of those. Facial asymmetry was studied with the Sunnybrook facial grading system (SFGS), the Facial Clinimetric Evaluation Scale (FaCE), the Symmetry Scale for Hemifacial Spasm (SSHS) and a self-assessment scale. As shown in SFGS and SSHS, bilateral BT therapy reduces facial asymmetry, whilst unilateral BT therapy increases it. Both effects are more pronounced during voluntary facial movements than at rest. BT effect delay, BT effect duration, adverse effect frequency and severity were not affected. FaCE total score, some of its subscores and the self-assessment scale did not show an effect. Bilateral BT therapy may improve the outcome of BT therapy for HFS without producing additional adverse effects. This strategy, however, raises drug costs (by about a third). Using even higher doses in the non-affected side may intensify the improvement even further. Future studies may also monitor the patient’s quality of life and the naïve public’s overall perception of the patient’s facial expression.