Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
J Neurol. 2018 Sep;265(9):2097-2105. doi: 10.1007/s00415-018-8960-2. Epub 2018 Jul 9.
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.
肉毒毒素（BT）是治疗半面痉挛（HFS）的首选方法。当 BT 注射到受影响的一侧时，患者可能会出现面部不对称加重。我们希望在一项前瞻性、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，我们用 CBTX-A（兰州生物制品研究所，兰州，中国）治疗了 19 例单侧 HFS 患者和 24 例双侧 HFS 患者。受影响侧的 BT 剂量为标准剂量，非受影响侧的 BT 剂量为其三分之一。使用 Sunnybrook 面部分级系统（SFGS）、面部临床计量评估量表（FaCE）、半面痉挛对称量表（SSHS）和自我评估量表来研究面部不对称。如 SFGS 和 SSHS 所示，双侧 BT 治疗可减轻面部不对称，而单侧 BT 治疗则加重面部不对称。这两种影响在自愿面部运动时比休息时更为明显。BT 效应延迟、BT 效应持续时间、不良反应频率和严重程度不受影响。FaCE 总分、其一些子评分和自我评估量表没有显示出效果。双侧 BT 治疗可能会改善 BT 治疗 HFS 的效果，而不会产生额外的不良反应。然而，这种策略会增加药物成本（约三分之一）。在非受影响侧使用更高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和未接受过治疗的公众对患者面部表情的整体感知。
