Corneo Plastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK.
Eye (Lond). 2019 Mar;33(3):349-352. doi: 10.1038/s41433-018-0203-3. Epub 2018 Sep 10.
The purpose of this study was to assess the long-term outcome of onabotulinum used to treat facial dystonia and compare a flexible and fixed treatment regimen.
This was a retrospective comparative study looking at benign essential blepharospasm (BEB), hemifacial spasm (HFS) and aberrant facial nerve regeneration synkinesis (AFR) treatment with onabotulinum toxin A (Botox®) over a minimum of 10 years. Fifty-one patients were recruited into the study, with each dystonia subgroup having 17 patients. Blepharospasm disability score (BDS), subjective improvement score (SIS), duration of maximal effect (DME) and complications were recorded at each visit.
The mean age was 63 years and gender predominately female. Thirty-seven patients underwent flexible treatment intervals compared to 14 fixed treatment intervals, averaging 3.4 and 4 per annum, respectively. Mean BDS significantly improved from 6 to 3 at last review across all 3 groups, with the highest effect on BEB. BDS improvement was greater in flexible intervals. SIS remained similar for all three conditions during follow-up, but in those undergoing flexible intervals, SIS increased by a small margin compared to fixed interval. Mean DME was 10.5 weeks across all dystonias, but increased progressively only in the flexible interval group. Complications included ptosis (30%), dry eye (14%) and lagophthalmos (8%).
Flexible onabotulinum provided better long-term relief on BDS for facial dystonia than a fixed regimen. Flexible interval treatment may also provide better patient satisfaction and longer DME compared to fixed treatment. Both have similar complication rates. With flexible treatment however, fewer injections were required over 10 years, leading to cost saving.
本研究旨在评估用于治疗面部肌张力障碍的肉毒毒素 A（Botox®）的长期疗效，并比较灵活和固定治疗方案。
这是一项回顾性比较研究，观察了肉毒毒素 A 治疗良性特发性眼睑痉挛（BEB）、半面痉挛（HFS）和异常面神经再生协同运动（AFR）的至少 10 年的结果。该研究纳入了 51 例患者，每组肌张力障碍患者 17 例。在每次就诊时记录眼睑痉挛残疾评分（BDS）、主观改善评分（SIS）、最大疗效持续时间（DME）和并发症。
患者的平均年龄为 63 岁，以女性为主。37 例患者采用灵活的治疗间隔，14 例患者采用固定的治疗间隔，分别平均每年 3.4 次和 4 次。所有 3 组的平均 BDS 均从治疗前的 6 分显著改善至治疗后的 3 分，对 BEB 的疗效最高。在灵活间隔组中，BDS 的改善更为显著。在随访期间，所有 3 种情况的 SIS 均保持相似，但在接受灵活间隔治疗的患者中，与固定间隔相比，SIS 略有增加。所有肌张力障碍患者的平均 DME 为 10.5 周，但仅在灵活间隔组中逐渐增加。并发症包括上睑下垂（30%）、干眼症（14%）和兔眼（8%）。
与固定方案相比，肉毒毒素 A 的灵活治疗方案可为面部肌张力障碍患者提供更好的长期 BDS 缓解。与固定治疗相比，灵活间隔治疗可能还会提供更好的患者满意度和更长的 DME。两种方案的并发症发生率相似。然而，在 10 年内，灵活治疗需要的注射次数更少，从而节省了成本。
