A型肉毒桿菌毒素治療半面痙攣：病例報告

半面痙攣是一間歇性單側臉部肌肉不自主的收縮，A型肉毒桿菌毒素治療是一有效而安全的方法，但眼瞼下垂是注射後可能的併發症。本文報告一位第三級半面痙攣的病例，以左顏面各點5單位之傳統注射方式治療一週後追蹤時，病人仍強烈要求治療其上眼瞼的抽動，因此我們以有別於不打上眼瞼的傳統治療方式，以低劑量3單位A型肉毒桿菌毒素皮下注射於上眼瞼處來治療上眼瞼痙攣，結果併發眼瞼下垂問題。經以Apraclonidine 0.5 %眼藥水治療眼瞼下垂，病人於三週後眼瞼即回復至日常生活所需程度。病人寧可眼皮不跳動及部份眼瞼下垂，而自行停用眼藥水，病人之眼瞼下垂在12週後恢復，而後其半面痙攣則停留在第一級。傳統上因注射在上眼瞼區域會導致眼瞼下垂而絕對禁止的觀念，在有眼藥水可改善眼瞼下垂的情形下，我們嘗試去達成病人對治療的期望。本病例的治療經過可以提供治療類似病患時做更多角度的考量，雖然經由減量注射肉毒桿菌素，仍然發生部份眼瞼下垂的副作用，但是病人眼皮跳動顯著改善，而且經由眼藥水的輔助，也使眼瞼下垂現象降低到不影響外觀及日常生活的程度。

關鍵字

半面痙攣； A型肉毒桿菌毒素；眼瞼下垂

並列摘要

Hemifacial spasm is an intermittent, synchronous contraction of ipsilateral facial muscles. Botulinum toxin A injection is an effective and safe symptomatic treatment for hemifacial spasm. In the traditional method, physicians omitted the central upper eyelid area to prevent the development of ptosis, but there may remain some twitches. Here we report a case of Botulinum toxin A injection for left hemifacial spasm with complication of ptosis. Apraclonidine 0.5% ophthalmic solution was used in this patient to facilitate the recovery of ptosis. A 53 y/o woman with Grade 3 left hemifacial spasm received first treatment with total dosage of 45 units of Botox, 5 units each was injected over the left lateral area of frontalis, eyebrow, upper and lower orbicularis oculi, the central area of the left lower orbicularis oculi, the left nasalis, mentalis and the left lateral upper and lower orbicularis oris. One week later, this patient wished to treat her remaining twitches over the left central upper eyelid, zygomatic muscle and the left lower face, not injected previously, so we reduced the Botox A injection dose to 3 units over the left central upper eyelid and 5 units over the left Zygomatic muscle and lower face. Indeed, we abolished the remaining twitch over the upper eyelid successfully but with the development of left ptosis 2 days later. We used apraclonidine 0.5% ophthalmic solution to treat ptosis. The ptosis improved and became not interfering her daily life 3 weeks later and totally recovered 3 months later. During treatment, she would rather accept the incomplete ptosis than tolerate the remaining eyelid twitches, so she decreased the dose of Apraclonidine by herself at the second week, and discontinued it by the end of 3rd week to avoid the twitches even with slight ptosis. Until now, she has first grade hemifacial spasm and doesn’t want Botulinum A toxin injection again. The choice of optimal treatment should be based on the individual patient’s need. By decreasing the dosage of Botulinum A toxin to minimal amount and using complementary Apraclonidine 0.5% ophthalmic eyedrops, severe upper eyelid twitches can be treated. We need further research to find if there are other better modalities to treat upper eyelid twitch without causing ptosis or having residual twitches.

並列關鍵字

hemifacial spasm ； botulinum toxin A ； ptosis

國際替代計量

A型肉毒桿菌毒素治療半面痙攣：病例報告

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