Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China; Neurotoxin Research Center, Tongji University School of Medicine, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education of the People's Republic of China, 389 Xincun Road, Shanghai, 200065, China.
Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, China; Department of Neurology, Shanghai Xuhui Dahua Hospital, 901 Laohumin Road, Shanghai, 200232, China.
Toxicon. 2020 Sep;184:122-126. doi: 10.1016/j.toxicon.2020.06.004. Epub 2020 Jun 14.
Facial synkinesis can be present in both primary and postparalytic hemifacial spasm (HFS). The present retrospective study aimed to summarize the clinical features of synkinesis and explore an appropriate botulinum toxin A (BoNT-A) injection strategy to manage the synkinesis accompanying HFS. Video recordings of 234 patients with primary and postparalytic HFSs were analyzed. Improvements in the severity of spasm and synkinesis owing to BoNT-A treatment were monitored and compared among 36 primary and 12 postparalytic HFS patients with synkinesis and completed follow-up records. BoNT-A was injected into the voluntary facial region (VFR), the synkinetic facial region (SFR), or both VFR and SFR, and the efficacy of these strategies was evaluated and analyzed. Oral-ocular synkinesis in the primary group (32.8%) and ocular-oral synkinesis in the postparalytic group (81.0%) showed the highest incidence. Patients in both the primary and postparalytic groups exhibited a tremendous alleviation of spasm (97.2% vs. 91.7%, P > 0.05) following BoNT-A treatment. In both groups, coinjection and SFR injection were commonly used and effective in treatment of ocular and oral synkinesis, while VFR was frequently used but ineffective for frontal synkinesis. In addition, the improper muscle selection surrounding the mouth corner resulted in pattern change and treatment failure of oral synkinesis. Synkinesis mostly affected the ocular and oral regions. BoNT-A, via treatment of SFR, is effective against synkinesis accompanying HFS.
面部联动可发生于原发性和麻痹性半面痉挛（HFS）中。本回顾性研究旨在总结联动的临床特征，并探索一种合适的肉毒毒素 A（BoNT-A）注射策略来管理 HFS 伴发的联动。分析了 234 例原发性和麻痹性 HFS 患者的视频记录。对 36 例原发性和 12 例麻痹性 HFS 伴联动且完成随访记录的患者，监测并比较 BoNT-A 治疗对痉挛和联动严重程度的改善。BoNT-A 被注射至随意面区（VFR）、联动面区（SFR）或 VFR 和 SFR 两者，评估和分析这些策略的疗效。原发性组（32.8%）中出现口-眼联动，麻痹性组（81.0%）中出现眼-口联动，这两种联动的发生率最高。原发性和麻痹性两组患者痉挛均显著缓解（97.2% vs. 91.7%，P>0.05）。两组中，联合注射和 SFR 注射常用于治疗眼、口联动，且有效；而 VFR 常用于治疗额部联动，但无效。此外，口角周围不当的肌肉选择导致口联动的模式改变和治疗失败。联动主要影响眼和口区域。BoNT-A 通过治疗 SFR 对 HFS 伴发的联动有效。
