Jamison Aaron, Favor Maribel, Malhotra Raman
From the Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom.
From the Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom.
Can J Ophthalmol. 2024 Feb;59(1):e41-e45. doi: 10.1016/j.jcjo.2022.10.017. Epub 2022 Nov 1.
To evaluate the effect of a break in botulinum toxin treatment, necessitated by the COVID-19 pandemic, on patients' quality of life.
Prospective cohort study of all patients undergoing incobotulinumtoxinA treatment in our department-for benign essential blepharospasm (BEB), hemifacial spasm (HFS), aberrant facial regeneration (AFR), or crocodile tears-who were affected by the break in service (March 18, 2020-June 17, 2020). All patients who received treatment both before and after the break in service were included. Data gathered included subjective patient-reported measure of "time until treatment failure" and disease rating scale scores: Blepharospasm-Dystonia Functional Disability Assessment Scale (BDFDAS; for BEB, HFS, and AFR); Jankovic Rating Scale (JRS; for BEB and HFS); and TEARS Epiphora Grading Scale (for crocodile tears).
Across 72 patients, there was a mean treatment delay of 3.9 months (range, 0-9.8 months). After a period of effect, treatment failed in all patients, with a mean time until treatment failure of 3.9 months (range, 0.5-12.0 months). All patient-reported outcome measurements increased, with greatest effect seen in AFR (178% increase in BDFDAS) and BEB (41% increase in JRS). At least 2 patients sought and underwent retreatment elsewhere in the private sector because of their symptom severity.
Patients with AFR and BEB are likely to tolerate a break in service least, whereas patients with crocodile tears appear to be less affected. This real-world snapshot allows quantification of the harm caused by a break in botulinum toxin service or a treatment delay. This study provides valuable information should further breaks in service or treatment delay be considered in the future due to a further wave of COVID-19 or other reasons.
评估因新冠疫情导致肉毒毒素治疗中断对患者生活质量的影响。
对在我科接受A型肉毒毒素治疗的所有患者进行前瞻性队列研究，这些患者因服务中断（2020年3月18日至2020年6月17日）而受到影响，治疗的疾病包括良性原发性睑痉挛（BEB）、面肌痉挛（HFS）、异常面部再生（AFR）或鳄鱼泪综合征。纳入所有在服务中断前后均接受治疗的患者。收集的数据包括患者主观报告的“直至治疗失败的时间”测量值和疾病评定量表评分：睑痉挛-肌张力障碍功能残疾评估量表（BDFDAS；用于BEB、HFS和AFR）；扬科维奇评定量表（JRS；用于BEB和HFS）；以及泪溢分级量表（用于鳄鱼泪综合征）。
72例患者的平均治疗延迟为3.9个月（范围为0至9.8个月）。经过一段时间的疗效期后，所有患者的治疗均失败，直至治疗失败的平均时间为3.9个月（范围为0.5至12.0个月）。所有患者报告的结局测量值均增加，其中AFR（BDFDAS增加178%）和BEB（JRS增加41%）的影响最大。至少有2例患者因症状严重而在私立部门寻求并接受了再次治疗。
AFR和BEB患者可能最难以耐受服务中断，而鳄鱼泪综合征患者似乎受影响较小。这一真实世界的情况量化了肉毒毒素服务中断或治疗延迟所造成的危害。本研究提供了有价值的信息，以备未来因新冠疫情再次暴发或其他原因而考虑进一步的服务中断或治疗延迟时参考。
