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针对眼周面部肌张力障碍的缓解策略

Kilduff CL, Casswell EJ, Salam T, et al.

期刊名称:JAMA Ophthalmology

卷期:2016年第134卷第11期

关键词:
张力 面部 障碍

摘要

重要性:已知良性基本睑痉挛或半面痉挛患者采用肉毒杆菌毒素注射及缓解策略来帮助控制其症状。肉毒杆菌毒素注射和缓解策略之间的临床关联尚不完善。目的:为了决定良性基本睑痉挛或半面痉挛的缓解策略与疾病严重程度或者肉毒杆菌毒素治疗是否相关。设计、设置和参与者:一项前瞻性横断面观察研究(设计于20139月),本研究涵盖了良性基本睑痉挛74例患者和半面痉挛56例患者,这些人招募自Moorfields眼科医院(20141-6月)的附属诊所以完成一份问卷调查而且经过临床评估。201512月进行数据分析。主要结果和措施:用于睑痉挛和半面痉挛的缓解策略的患病率和类型,肌张力障碍严重程度,肉毒杆菌毒素注射的剂量和频率。结果:74例睑痉挛患者中,39人(52.7%)使用缓解策略(平均年龄70.4[9.1]岁);56例半面痉挛患者中,25人(44.6%)使用缓解策略(平均年龄66.5[12.7]岁)。最常用的策略是面部区域的接触(64例患者中有35[54.7%]),其它策略包括覆盖眼睛(64例中有6[9.4%]),唱歌(64例中有5[7.8%])和打哈欠(64例中有5[7.8%])。与未使用缓解策略的睑痉挛患者相比,使用缓解策略的睑痉挛患者Jankovic得分和(平均分值5 vs 4Hodges-Lehmann平均差1[95%可信区间0-2]P=0.01),睑痉挛残疾指数严重程度评分(平均得分11 vs 4Hodges-Lehmann平均差4[95%可信区间1-7]P=0.01)更高。与为使用缓解策略的半面痉挛患者相比,使用缓解策略的半面痉挛患者7条半面痉挛生活质量量化得分(平均7 vs 3Hodges-Lehmann平均差4[95%可信区间1-7]P=0.01),和SMC严重程度评分量表(平均得分2 vs 2Hodges-Lehmann平均差0[95%可信区间0-1]P=0.03)更高。肌张力障碍的严重程度与肉毒杆菌毒素治疗睑痉挛患者(r=0.23P=0.049)和半面痉挛患者(r=0.45P=0.001)有关。无论是睑痉挛组(150 vs 125Hodges-Lehmann平均差20[95%可信区间-10-70]P=0.15)还是半面痉挛组(58 vs 60Hodges-Lehmann平均差0[95%可信区间-15-20]P=0.83)使用缓解策略的患者和未使用缓解策略的患者之间肉毒杆菌毒素治疗的差异。结论和相关性:半数眼周面部张力障碍患者使用缓解策略。他们的使用与更严重的疾病有关而与肉毒杆菌毒素使用增加无关。这可能有助于指导未来的治疗,例如对策略增加或特定装置的建议。

Importance:Patients with benign essential blepharospasm or hemifacial spasm are known to use botulinum toxin injections and alleviating maneuvers to help control their symptoms. The clinical correlates between the use of botulinum toxin injections and the use of alleviating maneuvers are not well established.Objective:To determine whether the use of alleviating maneuvers for benign essential blepharospasm or hemifacial spasm correlates with disease severity or botulinum toxin treatment.Design, Setting, and Participants:A prospective cross-sectional observational study (designed in September 2013) of 74 patients with benign essential blepharospasm and 56 patients with hemifacial spasm who were consecutively recruited from adnexal clinics at Moorfields Eye Hospital (January-June 2014) to complete a questionnaire and undergo a clinical review. Data analysis was performed in December 2015.Main Outcomes and Measures:Prevalence and type of alleviating maneuvers used for blepharospasm and hemifacial spasm, dystonia severity, and dose and frequency of botulinum toxin injections.Results:Of the 74 patients with blepharospasm, 39 (52.7%) used alleviating maneuvers (mean [SD] age, 70.4 [9.1] years); of the 56 patients with hemifacial spasm, 25 (44.6%) used alleviating maneuvers (mean [SD] age, 66.5 [12.7] years). The most commonly used maneuver was the touching of facial areas (35 of 64 patients [54.7%]); other maneuvers included covering the eyes (6 of 64 patients [9.4%]), singing (5 of 64 patients [7.8%]), and yawning (5 of 64 patients [7.8%]). Patients with blepharospasm who used alleviating maneuvers scored higher on the Jankovic Rating Scale (median score, 5 vs 4; Hodges-Lehmann median difference, 1 [95% CI, 0-2]; P=.01) and the Blepharospasm Disability Index severity score (median score, 11 vs 4; Hodges-Lehmann median difference, 4 [95% CI, 1-7]; P=.01) than patients with blepharospasm who did not use alleviating maneuvers. Patients with hemifacial spasm who used alleviating maneuvers scored higher on the 7-item Hemifacial Spasm Quality of Life scale (median score, 7 vs 3; Hodges-Lehmann median difference, 4 [95% CI, 1-7]; P=.01) and the SMC Severity Grading Scale (median score, 2 vs 2; Hodges-Lehmann median difference, 0 [95% CI, 0-1]; P=.03) than patients with hemifacial spasm who did not use alleviating maneuver. The severity of dystonia correlated with botulinum toxin treatment for patients with blepharospasm (r=0.23; P=.049) and patients with hemifacial spasm (r=0.45; P=.001). There was no difference found in botulinum toxin treatment between patients who used alleviating maneuvers and those who did not, in either the blepharospasm group (150 vs 125 units; Hodges-Lehmann median difference, 20 units [95% CI, -10 to 70 units]; P=.15) or the hemifacial spasm group (58 vs 60 units; Hodges-Lehmann median difference, 0 units [95% CI, -15 to 20 units]; P=.83).Conclusions and Relevance:Half of the patients with periocular facial dystonias used alleviating maneuvers. Their use was associated with more severe disease but not with increased use of botulinum toxin. This may help to guide future therapies, such as advice on maneuver augmentation or tailored devices.


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