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目的:探讨A型肉毒毒素(Bo NT/A)注射治疗锥体外系疾病合并眼睑痉挛(伴或不伴睁眼性失用)的疗效。方法:30例锥体外系疾病(19例帕金森病、5例多系统萎缩、6例进行性核上性麻痹)合并眼睑痉挛的患者局部注射Bo NT/A,在治疗前和治疗后1个月采用Jankcovic评定量表(JRS)、眼睑痉挛残疾指数(BSDI)评估眼睑痉挛改善效果,视觉模拟评分法(VAS)让患者自评疗效,自评改善大于50%定义为治疗有效。结果:治疗后1个月患者JRS-F(1.43±0.68)分、JRS-S(1.23±0.94)分、JRS-T(2.53±1.46)分、BSDI(1.33±0.91)分,均较治疗前[JRS-F(2.47±0.90)分、JRSS(2.70±0.88)分、JRS-T(5.30±1.68)分、BSDI(1.95±0.83)分]明显降低,差异均有统计学意义(均P<0.001)。86.7%的患者治疗有效(VAS评分大于50%),治疗无效的13.3%患者均伴发睁眼性失用。结论:Bo NT/A能有效治疗锥体体外系疾病合并眼睑痉挛,但对伴发睁眼性失用的患者疗效有限。
Objective: To investigate the efficacy of botulinum toxin type A (Bo NT / A) in the treatment of extrapyramidal diseases with blepharospasm (with or without blindness). METHODS: Thirty BoNT / A patients with congenital extrapyramidal diseases (19 Parkinson’s disease, 5 multiple system atrophy and 6 progressive supranuclear palsy) with blepharospasm were injected locally with BoNT / A before and after treatment The JRS, JDS and BSDI were used to evaluate the improvement of blepharospasm. Visual analogue scale (VAS) was used to evaluate the efficacy of self-assessment and the improvement of more than 50% in self-evaluation was defined as effective. Results: The scores of JRS-F (1.43 ± 0.68), JRS-S (1.23 ± 0.94), JRS-T (2.53 ± 1.46) and BSDI (1.13 ± 0.91) (2.47 ± 0.90), JRSS (2.70 ± 0.88), JRS-T (5.30 ± 1.68) points and BSDI (1.95 ± 0.83) points were significantly decreased (all P < 0.001). 86.7% of patients were treated effectively (VAS score greater than 50%), 13.3% of patients with ineffective treatment were associated with open-eye disorders. CONCLUSION: BoNT / A is effective in the treatment of extrapyramidal diseases with blepharospasm, but has limited efficacy in patients with open eyes.