Toxina botulínica no blefaroespasmo, no espasmo hemifacial e na distonia cervical: resultados em 33 pacientes

Novis, Sérgio Ap.; Mattos, James Pitágoras de; Rosso, Ana Lúcia Zuma de

doi:10.1590/S0004-282X1995000300006

Resumos

Avaliamos os resultados terapêuticos obtidos com o emprego de toxina botulínica do tipo A em 33 pacientes com distonia (12 com blefaroespamo; 10 com espasmo hemifacial e 11 com torcicolo espasmódico). Utilizamos uma escala de pontuação de gravidade antes de cada aplicação, sendo reavaliados duas semanas após, seguindo a mesma escala. Entre os com blefaroespasmo, oito eram mulheres e quatro homens; a média de idade foi 57,7 anos; a média do tempo de doença de quatro anos; três tinham história similar na família; nove eram essenciais e três fizeram uso de neurolépticos (distonia tardia). A dose média empregada ficou em 51,3 U, com a duração média do efeito benéfico de 2,8 meses. Do total de 22 aplicações (injeções e reinjeções), 14 (63,7%) tiveram resultado ótimo, 5 (22,7%) bom e três (13,6%) nulo. Naqueles com espasmo hemifacial, oito eram mulheres e dois homens; a média de idade foi 52,6 anos; a média do tempo de doença 7,4 anos; oito eram essenciais e dois pós-páralíticos. A dose média empregada ficou em 32 U. Do total de 15 aplicações, todos (100%) tiveram resultado ótimo, com a duração média do efeito benéfico de 3,4 meses. Nos pacientes com distonia cervical, oito eram homens e três mulheres; a média de idade foi 44,2 anos; a média do tempo de doença 12,2 anos; seis eram essenciais, três fizeram uso de neuroléptico e dois tinham história familiar. A dose média empregada ficou em 238,6 U, com a duração média do efeito benéfico de 4,7 meses. Do total de 20 aplicações, 18 (90%) tiveram resultado bom, 1 (5%) regular e 1 (5%) nulo. Ptose palpebral, paresia facial e disfagia foram os efeitos colaterais mais encontrados. Concluímos que a toxina botulínica revelou-se eficaz no tratamento destas condições.

toxina botulínica; distonia; blefaroespasmo; espasmo hemifacial; distonia cervical

The effects of botulinum toxin type A were studied in 33 patients with dystonia (12 blepharospasms, 10 hemifacial spasms and 11 spasmodic torticollis). A rate scale was used to evaluate the severity of the dystonic movements, before and two weeks after each injection. Among blepharospasm patients, eight were female and four were male; the mean age was 57.7 years; the mean time of the disease duration was four years. Three had familial history for similar disease; nine were essential and three had used neuroleptic drugs (tardive dystonia). The mean dose used was 51.3 U, with a mean time of benefical effects of 2.8 months. For 22 injections and reinjections, 14 (63.7%) showed an excellent result, five (22.7%) good and three (13.6%) null. In the hemifacial spasm group, eight were female and two male; the mean age was 52.6 years; the mean time of the disease duration was 7.4 years; eight were essential and two post-paralytic. The mean dose used was 32 U. From the total of 15 injections and reinjections, all of them (100%) had an excellent result, with a mean time of benefical effect of 3.4 months. Among the cervical dystonic patients, eight were male and three female; the mean age was 44.2 years; the mean time of the disease duration was 12.2 years; six had essential dystonia, three had used neuroleptic drugs and two had familial history for similar disease. The mean dose used was 238.6 U, with the mean duration of effect of 3.5 months. From the total of 20 injections and reinjections, 18 (90%) had good result, one (5%) mild and one (5%) null. Ptosis, facial palsy and dysphagia were the most common side effects seen. We conclude that botulinum toxin is effective for the treatment of such disorders.

botulinum toxin; dystonia; blepharospasm; hemifacial spasm; cervical dystonia

Sérgio Ap. Novis^I; James Pitágoras De Mattos^II; Ana Lúcia Zuma De Rosso^III

^IProfessor Titular

^IIProfessor Adjunto, Chefe do Setor de Doenças Extrapiramidais

^IIIMédica Neurologista

RESUMO

Avaliamos os resultados terapêuticos obtidos com o emprego de toxina botulínica do tipo A em 33 pacientes com distonia (12 com blefaroespamo; 10 com espasmo hemifacial e 11 com torcicolo espasmódico). Utilizamos uma escala de pontuação de gravidade antes de cada aplicação, sendo reavaliados duas semanas após, seguindo a mesma escala. Entre os com blefaroespasmo, oito eram mulheres e quatro homens; a média de idade foi 57,7 anos; a média do tempo de doença de quatro anos; três tinham história similar na família; nove eram essenciais e três fizeram uso de neurolépticos (distonia tardia). A dose média empregada ficou em 51,3 U, com a duração média do efeito benéfico de 2,8 meses. Do total de 22 aplicações (injeções e reinjeções), 14 (63,7%) tiveram resultado ótimo, 5 (22,7%) bom e três (13,6%) nulo. Naqueles com espasmo hemifacial, oito eram mulheres e dois homens; a média de idade foi 52,6 anos; a média do tempo de doença 7,4 anos; oito eram essenciais e dois pós-páralíticos. A dose média empregada ficou em 32 U. Do total de 15 aplicações, todos (100%) tiveram resultado ótimo, com a duração média do efeito benéfico de 3,4 meses. Nos pacientes com distonia cervical, oito eram homens e três mulheres; a média de idade foi 44,2 anos; a média do tempo de doença 12,2 anos; seis eram essenciais, três fizeram uso de neuroléptico e dois tinham história familiar. A dose média empregada ficou em 238,6 U, com a duração média do efeito benéfico de 4,7 meses. Do total de 20 aplicações, 18 (90%) tiveram resultado bom, 1 (5%) regular e 1 (5%) nulo. Ptose palpebral, paresia facial e disfagia foram os efeitos colaterais mais encontrados. Concluímos que a toxina botulínica revelou-se eficaz no tratamento destas condições.

Palavras-chave: toxina botulínica, distonia, blefaroespasmo, espasmo hemifacial, distonia cervical.

SUMMARY

The effects of botulinum toxin type A were studied in 33 patients with dystonia (12 blepharospasms, 10 hemifacial spasms and 11 spasmodic torticollis). A rate scale was used to evaluate the severity of the dystonic movements, before and two weeks after each injection. Among blepharospasm patients, eight were female and four were male; the mean age was 57.7 years; the mean time of the disease duration was four years. Three had familial history for similar disease; nine were essential and three had used neuroleptic drugs (tardive dystonia). The mean dose used was 51.3 U, with a mean time of benefical effects of 2.8 months. For 22 injections and reinjections, 14 (63.7%) showed an excellent result, five (22.7%) good and three (13.6%) null. In the hemifacial spasm group, eight were female and two male; the mean age was 52.6 years; the mean time of the disease duration was 7.4 years; eight were essential and two post-paralytic. The mean dose used was 32 U. From the total of 15 injections and reinjections, all of them (100%) had an excellent result, with a mean time of benefical effect of 3.4 months. Among the cervical dystonic patients, eight were male and three female; the mean age was 44.2 years; the mean time of the disease duration was 12.2 years; six had essential dystonia, three had used neuroleptic drugs and two had familial history for similar disease. The mean dose used was 238.6 U, with the mean duration of effect of 3.5 months. From the total of 20 injections and reinjections, 18 (90%) had good result, one (5%) mild and one (5%) null. Ptosis, facial palsy and dysphagia were the most common side effects seen. We conclude that botulinum toxin is effective for the treatment of such disorders.

Key words:botulinum toxin, dystonia, blepharospasm, hemifacial spasm, cervical dystonia.

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Aceite:28-janeiro-1995.

Serviço de Neurologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro;

Dr. Sérgio A.P. Novis - Rua Visconde de Pirajá 330/513 - 22410-000 Rio de Janeiro RJ - Brasil.

1. American Academy of Neurology Therapeutics and Technology Assessment Subcommitee. Assessment: The clinical usefulness of botulinum toxin A in treating neurologic disorders. Neurology 1990, 40:1332-1336.
2. Barbosa ER, Haddad MS, Silva HCA, Carvalho MJ, Bittar MS. Espasmo hemifacial: tratamento com toxina botulínica. Arq Bras Neurocirurg 1994, 13:119-122.
3. Clarke CE. Therapeutic potential of botulinum toxin in neurological disorders. Q J Med 1992, 82:197-205.
4. Cohen LG, Hallett M, Geller BD, Hochberg F. Treatment of focal dystonias of the hand with botulinum toxin injections. J Neurol Neurosurg Psychiatry 1989, 52:355-363.
5. Dykstra D, Ellingham C, Belfie A, Baxter T, Lee M, Voelker A. Quantitative measurement of cervical range of motion in patients with torticollis treated with botulinum A toxin. Mov Disord 1993, 8:38-42.
6. Gamer CG, Straube A, Witt TN, Gasser T, Oertel WH. Time course of distant effects of local injections of botulinum toxin. Mov Disord 1993, 8:33-37.
7. Girlanda P, Vita G, Nicolosi C, Milone S, Messina C. Botulinum toxin therapy: distant effects on neuromuscular transmission and autonomic nervous system. J Neurol Neurosurg Psychiatry 1992, 55:844-845.
8. Greene P, Fahn S. Use of botulinum toxin type F injections to treat torticollis in patients with immunity to botulinum toxin type A. Mov Disord 1993, 8:479-483.
9. Greene P, Fahn S, Diamond B. Development of resistance to botulinum toxin type A in patients with torticollis. Mov Disord 1994, 9:213-217.
10. Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. New Engl J Med 1991, 324:1186-1194.
11. Lees AJ. Botulinum toxin - useful in adult onset focal dystonias.Br Med J 1992, 305:1169-1170.
12. Lees AJ, Turjanski N, Rivest J, Whurr R, Lorch M, Brookes G. Treatment of cervical dystonia hand spasms and laryngeal dystonia with botulinum toxin. J Neurol 1992, 239:1-4.
13. Lorentz IT, Subramaniam SS, Yiannikas C. Treatment of idiopathic spasmodic torticollis with botulinum toxin A: a double-blind study on twenty-three patients. Mov Disord 1991, 6:145-150.
14. Savino PJ, Maus M. Botulinum toxin therapy. Neurol Clin 1991, 9:205-224.
15. Scott AB. Botulinum toxin injection of eye muscle to correct trabism. Trans Am Ophthalm Soc 1981, 79:734-770.
16. Zuber M, Sebald M, Bathien N, De Recondo J, Rondot P. Botulinum antibodies in dystonic patients treated with type A botulinum toxin: frequency and significance. Neurology 1993, 43:1715:1718.

Toxina botulínica no blefaroespasmo, no espasmo hemifacial e na distonia cervical: resultados em 33 pacientes

Botulinum toxin in blepharospasm, hemifacial spasm and cervical dystonia: results in 33 patients

Datas de Publicação

Publicação nesta coleção
09 Dez 2010
Data do Fascículo
Set 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. American Academy of Neurology Therapeutics and Technology Assessment Subcommitee. Assessment: The clinical usefulness of botulinum toxin A in treating neurologic disorders. Neurology 1990, 40:1332-1336.

[2] 2. Barbosa ER, Haddad MS, Silva HCA, Carvalho MJ, Bittar MS. Espasmo hemifacial: tratamento com toxina botulínica. Arq Bras Neurocirurg 1994, 13:119-122.

[3] 3. Clarke CE. Therapeutic potential of botulinum toxin in neurological disorders. Q J Med 1992, 82:197-205.

[4] 4. Cohen LG, Hallett M, Geller BD, Hochberg F. Treatment of focal dystonias of the hand with botulinum toxin injections. J Neurol Neurosurg Psychiatry 1989, 52:355-363.

[5] 5. Dykstra D, Ellingham C, Belfie A, Baxter T, Lee M, Voelker A. Quantitative measurement of cervical range of motion in patients with torticollis treated with botulinum A toxin. Mov Disord 1993, 8:38-42.

[6] 6. Gamer CG, Straube A, Witt TN, Gasser T, Oertel WH. Time course of distant effects of local injections of botulinum toxin. Mov Disord 1993, 8:33-37.

[7] 7. Girlanda P, Vita G, Nicolosi C, Milone S, Messina C. Botulinum toxin therapy: distant effects on neuromuscular transmission and autonomic nervous system. J Neurol Neurosurg Psychiatry 1992, 55:844-845.

[8] 8. Greene P, Fahn S. Use of botulinum toxin type F injections to treat torticollis in patients with immunity to botulinum toxin type A. Mov Disord 1993, 8:479-483.

[9] 9. Greene P, Fahn S, Diamond B. Development of resistance to botulinum toxin type A in patients with torticollis. Mov Disord 1994, 9:213-217.

[10] 10. Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. New Engl J Med 1991, 324:1186-1194.

[11] 11. Lees AJ. Botulinum toxin - useful in adult onset focal dystonias.Br Med J 1992, 305:1169-1170.

[12] 12. Lees AJ, Turjanski N, Rivest J, Whurr R, Lorch M, Brookes G. Treatment of cervical dystonia hand spasms and laryngeal dystonia with botulinum toxin. J Neurol 1992, 239:1-4.

[13] 13. Lorentz IT, Subramaniam SS, Yiannikas C. Treatment of idiopathic spasmodic torticollis with botulinum toxin A: a double-blind study on twenty-three patients. Mov Disord 1991, 6:145-150.

[14] 14. Savino PJ, Maus M. Botulinum toxin therapy. Neurol Clin 1991, 9:205-224.

[15] 15. Scott AB. Botulinum toxin injection of eye muscle to correct trabism. Trans Am Ophthalm Soc 1981, 79:734-770.

[16] 16. Zuber M, Sebald M, Bathien N, De Recondo J, Rondot P. Botulinum antibodies in dystonic patients treated with type A botulinum toxin: frequency and significance. Neurology 1993, 43:1715:1718.