The Efficacy And Safety Of Botulinum Toxin Type-A And Microvascular Decompression In The Treatment Of Hemifacial Spasm

OBJECTIVE: To investigate the clinical efficacy and safety of local injection of botulinum toxin type-a(BoNTA)and microvascular decompression(MVD)in the treatment of hemifacial spasm(HFS).DATA AND METHODS: A total of 83 patients diagnosed and treated in the department of neurology and neurosurgery of our hospital from august 2018 to august 2020 were retrospectively analyzed,including 58 cases in BoNTA treatment group and 25 cases in MVD group.In BoNTA group,there were 37 female patients and 21 male patients.There were 12 female patients and 13 male patients in MVD group.Some ways were applied to evaluate the degree of spasms,specific quality of life and treatment satisfaction of patients with HFS,such as HFS rating scale,five-point scoring scale,the measurement of the specific quality of life(HRQOL)questionnaire and five-point therapeutic effect scale.And the results were statistically analyzed to compare the efficacy,duration of efficacy,onset time of BoNTA and MVD in the treatment of HFS and so on.Results: In BoNTA group,female patients were dominant(male to female ratio was1:2).While in MVD group,the ratio was equal(male to female ratio was 1:2).In general,female patients were in the majority(male to female ratio was 1:3).The mean age of MVD group was lower than that of BoNTA group(BoNTA group:58.30±16.30 years old,MVD group: 48.92±8.93 years old);The course of diseases were long in two groups(BoNTA group: 73.78±59.62 months,MVD group: 47.16±28.27 months).The degree of spasticity of BoNTA group and MVD group was above severe(BoNTA group: 100%,MVD group: 100%).Sixty-four patients included in the study had completed magnetic resonance nerve root imaging examination,which showed a positive rate of 82.81%.Two patients in the MVD group did not show positive imaging signs,but intraoperative exploration found conflicts between facial nerves and blood vessels.The effective rates of BoNTA and MVD in the treatment of HFS were98.27% and 88% respectively,and no difference was found between two groups(P> 0.05),suggesting that both treatments were effective.No longer than 1 week,BoNTA treatment group and MVD group got the most effective time for HFS(88% in BoNTA group and 96% in MVD group).There was no difference in the effective time between this two schemes.91% of the patients in the operation group had a longer duration of curative effect,and only 2% of the patients in BoNTA group had a longer duration of curative effect(P< 0.05),indicating that the duration of surgical treatment for HFS was longer than that of BoNTA therapeutic scheme.Fewer side effects were found in BoNTA group than those in MVD group(34% vs.76%),but neither significant difference nor permanent side effect was found between BoNTA group and MVD group.Conclusion:Most of the patients with HFS are female.The course of disease is long in most HFS patients.The degree of spasm in most patients is more than severe.Both BoNTA and MVD surgery for HFS can significantly improve the spasticity of patients,and there is no difference in the efficacy rate between BoNTA group and MVD group,which is consistent with the conclusions of previous studies.However,the efficacy of MVD is longer,while BoNTA is more acceptable to patients due to its non-invasive,transient side effects and so on.No permanent side effects were found in two treatment regimens.Significance: At present,most domestic and foreign studies on HFS focus on the efficacy of MVD surgery,while there is relatively little experimental evidence on local BoNTA injection in the treatment of HFS.In particular,there is very limited literature on the comparison between local BoNTA injection and MVD surgery in the treatment of HFS.This paper compared local BoTNA injection and MVD surgery for HFS to provide practical suggestions for clinicians in providing treatment plans for patients,and to answer questions about the advantages and disadvantages of the two methods mentioned above.