Jilin Province Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, Changchun, 130021, China.
Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, 130021, China.
BMC Neurol. 2024 Oct 29;24(1):420. doi: 10.1186/s12883-024-03883-x.
Hemifacial spasm (HFS) is a neuromuscular disorder characterized by unilateral facial muscle spasms, negatively impacts quality of life due to social embarrassment. Botulinum Neurotoxin (BoNT) injections have emerged as a viable therapeutic approach. This systematic review evaluated the efficacy and safety of BoNT injections for HFS management, along with effects on patients' quality of life and mental health.
A systematic search for studies on BoNT treatment for HFS published between January 1, 2000, and May 1, 2024, was performed across major databases. Study quality was evaluated using Cochrane and Joanna Briggs Institute (JBI) tools, with data management handled by EndNote X9 and statistical analyses conducted via Review Manager (RevMan 5.4) and STATA 14.0.
Thirty-five studies met the inclusion criteria: 2 RCTs comprising 83 HFS patients compared the efficacy of perioral injections of botulinum toxin and placebo, while 33 single-arm studies reported outcomes for 2786 patients post-BoNT injection. The selection of 17 single-arm studies focused on the effectiveness rate as the key outcome metric. Pooled estimate signified a remarkably high effectiveness (ES: 0.882, 95% CI: 0.830, 0.926, P < 0.001). Analysis of depression scale (SMD: -0.85, 95% CI: -1.34, -0.35, P < 0.001), anxiety scale (SMD: -1.50, 95% CI: -2.19, -0.80, P < 0.001) and total scale of quality of life (SMD: -0.64, 95% CI: -0.87, -0.41, P = 0.766) showed that BoNT therapy worked well especially in improving mental state and quality of life. Ptosis was considered as the most common adverse reaction during BoNT injections (OR: 0.30, 95% CI: 0.11, 0.81, P = 0.843).
BoNT injection showed validity and clinical safety in the treatment of HFS, particular for depression relief. Injections around the mouth were only effective for HFS cases with severe symptoms. A standardized strategy for BoNT injections in managing HFS, detailing parameters such as injection sites, doses, and frequencies, remained elusive. Additional RCTs are necessary to further elucidate the interplay between efficacy and these components.
面肌痉挛（HFS）是一种以单侧面部肌肉痉挛为特征的神经肌肉疾病，由于社交尴尬会对生活质量产生负面影响。肉毒毒素（BoNT）注射已成为一种可行的治疗方法。本系统评价评估了 BoNT 注射治疗 HFS 的疗效和安全性，以及对患者生活质量和心理健康的影响。
对 2000 年 1 月 1 日至 2024 年 5 月 1 日期间发表的关于 BoNT 治疗 HFS 的研究进行了系统搜索，检索了主要数据库。使用 Cochrane 和 Joanna Briggs 研究所（JBI）工具评估研究质量，使用 EndNote X9 进行数据管理，并通过 Review Manager（RevMan 5.4）和 STATA 14.0 进行统计分析。
35 项研究符合纳入标准：2 项 RCT 比较了口周注射肉毒毒素和安慰剂治疗 HFS 的疗效，33 项单臂研究报告了 2786 例患者接受 BoNT 注射后的结局。17 项单臂研究的选择侧重于有效率作为关键结局指标。汇总估计表明，有效性非常高（ES：0.882，95%CI：0.830，0.926，P<0.001）。对抑郁量表（SMD：-0.85，95%CI：-1.34，-0.35，P<0.001）、焦虑量表（SMD：-1.50，95%CI：-2.19，-0.80，P<0.001）和生活质量综合量表（SMD：-0.64，95%CI：-0.87，-0.41，P=0.766）的分析表明，BoNT 治疗在改善精神状态和生活质量方面效果显著。眼睑下垂被认为是 BoNT 注射最常见的不良反应（OR：0.30，95%CI：0.11，0.81，P=0.843）。
BoNT 注射治疗 HFS 有效且具有临床安全性，尤其可缓解抑郁症状。口周注射仅对症状严重的 HFS 病例有效。BoNT 治疗 HFS 的标准化策略，包括注射部位、剂量和频率等参数，仍不明确。需要进一步的 RCT 来进一步阐明疗效与这些因素之间的相互作用。
