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Rehabilitation Practice and Science

Translated Title

A型肉毒桿菌毒素治療半面痙攣：病例報告

Abstract

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.

Language

Traditional Chinese

First Page

147

Last Page

152

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