Arthurs B, Flanders M, Codère F, Gauthier S, Dresner S, Stone L
Can J Ophthalmol. 1987 Feb;22(1):24-8.
A total of 39 patients with essential blepharospasm and 2 patients with hemifacial spasm were treated with one or more forms of therapy. All patients underwent neurologic and ophthalmic assessment to rule out ocular causes of blepharospasm. Thirty-six patients were given a trial of various medications. Only one patient was successfully treated: her condition was markedly improved with pimozide after benztropine mesylate, clonazepam and amantadine hydrochloride had failed to help. Patients who did not respond to drug therapy were offered the option of undergoing eyebrow-eyelid muscle stripping surgery. The six patients who underwent surgery showed considerable improvement; however, side effects such as frontal anesthesia, exposure keratitis, lagophthalmus, scarring and eyelid malposition occurred, and three of the six had residual spasm. At this point type A botulinum toxin became available. A total of 27 patients (26 who did not respond to drug therapy, including the 3 with residual spasm after surgery, and 1 previously untreated patient) received type A botulinum toxin injections. Most experienced rapid relief from their spasms. The beneficial effects lasted weeks to months, and there were no major side effects. Treatment with type A botulinum toxin appears to be a safe and effective means of temporarily relieving blepharospasm. The long-term results with repeated injections are yet to be determined.
共有39例特发性睑痉挛患者和2例半面痉挛患者接受了一种或多种治疗。所有患者均接受了神经科和眼科评估，以排除睑痉挛的眼部病因。36例患者试用了各种药物。只有1例患者得到成功治疗：在甲磺酸苯扎托品、氯硝西泮和盐酸金刚烷胺治疗无效后，匹莫齐特使她的病情明显改善。对药物治疗无反应的患者可选择接受眉睑肌剥离手术。接受手术的6例患者有明显改善；然而，出现了诸如额部麻醉、暴露性角膜炎、兔眼、瘢痕形成和眼睑位置异常等副作用，6例中有3例仍有残余痉挛。此时A型肉毒毒素可供使用。共有27例患者（26例对药物治疗无反应，包括3例术后有残余痉挛的患者，以及1例先前未治疗的患者）接受了A型肉毒毒素注射。大多数患者的痉挛迅速缓解。有益效果持续数周至数月，且无重大副作用。A型肉毒毒素治疗似乎是暂时缓解睑痉挛的一种安全有效的方法。重复注射的长期效果尚待确定。
