以A型肉毒桿菌毒素長期治療半面痙攣症

Long-term Treatment of Hemifacial Spasm with Type A Botulinum Toxin

林裕晴(Yu-Ching lLin)

《台灣復健醫學雜誌》 32卷1期 (2004/03) Pp. 33-38

https://doi.org/10.6315/2004.32(1)05

摘要

半面痙攣症是一種少見的局部動作障礙症，在美國的盛行率約為萬分之一。此病的症狀為單側顏面神經支配的肌肉群會產生不自主的痙攣或陣攣性收縮，進而影響病人的外觀及功能。傳統的口服抗癲癇葯物效果不佳，而外科手術有其潛在的危險性，近年來的西方臨床研究顯示肉毒桿菌毒素可以有效地改善半面痙攣症患者的症狀且副作用極小。本回溯性研究的目的在評估長期肉毒桿菌毒素注射治療半面痙攣症的劑量、效果及副作用。
自民國88年11月至91年12月間，共有14位(48次)半面痙攣症患者至本院復健科門診接受單次或多次的肉毒桿菌毒素注射治療，患者的平均年齡為59歲，男性與女性各有3位及11位，右側及左側半面痙攣症各有8位及6位，注射次數最少的有1次，最多的有7次。治療的方法是依據病人的痙攣症狀，針對特定的肌肉群給予肌肉內注射肉毒桿菌毒素，注射的總劑量最少是15 unit，最多的是50 unit，平均25 unit。結果顯示，葯效的作用平均在注射後4天出現，約可持續5.5個月，大多數病人接受肉毒桿菌毒素注射後有痙攣嚴重度量表兩級以上的改善，治療及追蹤期間並未發現嚴重的副作用，所有患者皆滿意注射的效果且願意持續接受治療。由本研究的結果，我們認為長期肉毒桿菌毒素注射治療台灣人的半面痙攣症是個有效且副作用少的方式。

關鍵字

肉毒桿菌毒素 ； 半面痙攣症 ； 顏面神經

並列摘要

Hemifacial spasm is a rare movement disorder. It is characterized by recurrent, involuntary tonic or clonic contraction of the muscles innervated by unilateral facial nerve. It may affect patient’s vision and has great cosmetic or psychological impacts. Oral drugs including anticonvulsants, baclofen and benzodiazepines often have little effect. Surgery has potentially serious complications. After numerous clinical studies, botulinum toxin is now recommended as the primary treatment of choice for most hemifacial spasm cases.
The purpose of this study is to retrospectively evaluate the dose, effect and side effects of long-term treatment of hemifacial spasm with type A botulinum toxin. Between November 1999 and December 2002, 14 patients with hemifacial spasm receiving a total of 48 times of botulinum toxin injection were enrolled from outpatient PMR clinic. Type A botulinum toxin was administered intramuscularly according to the severity of symptoms and involved muscles. Patients were asked to record the onset and the duration of spasm-free period, and to report any side effect. Hemifacial spasm intensity scale was used as an assessment tool.
The total injection doses varied from 15 units to 50 units. The effect of drug lasted 3 to 9 months, with an average of 5.5 months. After each injection, the majority of patients had at least two-grade improvement in spasm intensity scale. There is no serious side effect in the period of treatment and follow-up for 3 years. Every patient was satisfied with the result.
Sustained effect of botulinum toxin after each injection was noted for 3 years in our cases, in accordance with western series of 7-year follow-up. This study suggested that botulinum toxin is a safe and effective treatment option in long-term management of hemifacial spasm in Taiwanese.

並列關鍵字

botulinum toxin ； hemifacial spasm ； facial nerve