Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA.
Department of Neurology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA.
Mov Disord Clin Pract. 2024 Aug;11(8):966-972. doi: 10.1002/mdc3.14064. Epub 2024 May 23.
Botulinum toxin is an effective treatment for hemifacial spasm in elderly patients. However, some patients do not tolerate the side effects and frequency of botulinum toxin treatments.
The purpose of this study was to evaluate the characteristics and outcomes of a cohort of elderly patients referred by neurologists for surgical decompression of the facial nerve following botulinum toxin treatment.
In a prospective cohort study, logistic regression was used to detect potential predictors of spasm-freedom after surgical decompression of the facial nerve in elderly patients that received ≤8 and >8 botulinum toxin treatments for hemifacial spasm before surgery. Age, sex, side, preoperative symptom duration, and preoperative botulinum toxin treatment were assessed as potential predictors of spasm-freedom at last follow-up.
Of 76 elderly patients with hemifacial spasm treated with botulinum toxin and microvascular decompression, with at least 2-years of follow-up (median, 44.5 months), 84.2% were spasm-free at last follow-up. Age (P = 0.38), sex (P = 0.59), side (P = 0.15), preoperative symptom duration (P = 0.7), and number of preoperative botulinum toxin treatments (P = 0.3) were not predictors of long-term spasm-freedom. Permanent ipsilateral hearing loss was the most frequent complication (3.9%).
This study provides evidence that elderly patients can undergo botulinum toxin treatment for hemifacial spasm without compromising their likelihood of achieving spasm-freedom with future surgical decompression. Therefore, surgical decompression of the facial nerve is an effective therapy for elderly patients with hemifacial spasm refractory to botulinum toxin.
肉毒毒素是治疗老年患者面肌痉挛的有效方法。然而，一些患者不能耐受肉毒毒素的副作用和治疗频率。
本研究旨在评估一组因肉毒毒素治疗后面肌痉挛而由神经科医生转诊行面神经减压手术的老年患者的特征和结果。
在一项前瞻性队列研究中，使用逻辑回归来检测在接受手术减压治疗之前接受 ≤8 次和 >8 次肉毒毒素治疗的老年患者中，面神经减压后无痉挛的潜在预测因素。年龄、性别、侧别、术前症状持续时间和术前肉毒毒素治疗被评估为手术减压后最后随访时无痉挛的潜在预测因素。
76 例接受肉毒毒素和微血管减压治疗的老年面肌痉挛患者，至少随访 2 年（中位数为 44.5 个月），最后随访时 84.2%的患者无痉挛。年龄（P=0.38）、性别（P=0.59）、侧别（P=0.15）、术前症状持续时间（P=0.7）和术前肉毒毒素治疗次数（P=0.3）均不是长期无痉挛的预测因素。永久性同侧听力损失是最常见的并发症（3.9%）。
本研究表明，老年患者可以接受肉毒毒素治疗面肌痉挛，而不会影响他们未来接受手术减压后实现无痉挛的可能性。因此，面神经减压是治疗肉毒毒素治疗无效的老年面肌痉挛患者的有效方法。
