Drugs for treating hemifacial spasm, 2 tables make it clear!

*It is only for medical professionals to read and refer to the characteristics of commonly used treatment drugs for hemifacial spasm and precautions for use.
Recurrent paroxysmal and involuntary twitches of the muscles, expression muscles, orbicularis oris muscles), which are aggravated when emotional or tense.
In severe cases, there may be difficulty in opening eyes, crooked mouth corners, and twitch-like noises in the ears
.

Source: Ruijing Gallery.
Hemifacial spasm includes two types: typical hemifacial spasm and atypical hemifacial spasm: 1) Typical hemifacial spasm means that the symptoms of hemifacial spasm start from the eyelids and gradually develop and involve the lower part of facial expression muscles.
Facial muscles; 2) Atypical hemifacial spasm means that the spasm starts from the lower facial muscles and gradually progresses upwards and finally involves the eyelids and frontal muscles
.

Clinically, there are few atypical hemifacial spasms, and most of them are typical hemifacial spasms
.

Hemifacial spasm tends to occur in middle-aged and elderly people, and women are slightly more than men, but the age of onset tends to be younger
.

Although hemifacial spasms are mostly located on one side, bilateral facial spasms are not uncommon
.

Diagnosis of hemifacial spasm The diagnosis of hemifacial spasm mainly depends on the characteristic clinical manifestations
.

Patients who lack characteristic clinical manifestations need to be clarified by auxiliary examinations, including electrophysiological examinations, imaging examinations, and carbamazepine treatment trials
.

The main treatment methods include drugs, botulinum toxin injections, and surgery (microvascular decompression)
.

1 Drug therapy for hemifacial spasm Drug therapy is often used in the early stage of onset, those who cannot tolerate surgery or who refuse surgery, and as an adjuvant treatment for those who cannot relieve their symptoms after surgery
.

Medication can reduce the symptoms of facial muscle twitching in some patients
.

It can be used for a long time for patients with mild clinical symptoms, significant drug efficacy, and no adverse drug reactions
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Commonly used drugs for the treatment of hemifacial spasm include carbamazepine, oxcarbazepine, and diazepam
.

Alternative drugs are phenytoin, clonazepam, baclofen, topiramate, gabapentin and haloperidol
.

The characteristics of commonly used drugs and the precautions for clinical use are summarized as follows: In addition, it should be noted that carbamazepine and oxcarbazepine have an effect on liver cytochrome P450 enzymes during clinical use, so they may be related to a variety of cytochrome P450 enzymes.
There are drug interactions
.

The common drugs that can interact with each other are summarized as follows
.

2 Commonly used drugs for botulinum toxin injection are botulinum toxin A for injection
.

①It is mainly used in adult patients who cannot tolerate surgery, refuse surgery, fail to operate or relapse after surgery, do not respond to medication, or are allergic to medications
.

②It should be used with caution when there is a decrease in efficacy or serious adverse reactions
.

③ People with allergies and those who are allergic to this product are prohibited from using it
.

Usage and dosage of type A botulinum toxin: Multi-point injection of upper and lower eyelid muscles is used, that is, 4 or 5 points of the inner and outer side of the upper and lower eyelids or the temporal subcutaneous orbicularis oculi muscle of the lateral canthus
.

If it is accompanied by twitching of the face and corners of the mouth, 3 intramuscular injections are required in the middle, lower and buccal parts of the face
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According to the needs of the disease, injections can also be given to the inner and outer eyebrows, upper lip or mandibular muscles
.

The starting volume per point is 2.
5U/0.
1ml
.

One week after the injection, patients with residual cramps can be given additional injections; those with recurrence can be given the original dose or doubled (5.
0U/0.
1ml) injection
.

However, the total dose of one injection should not be higher than 55U, and the total dose used within one month should not be higher than 200U
.

About 90% of patients are effective for the initial injection of botulinum toxin.
After one injection, the time for complete relief and obvious improvement of the cramps is 1 to 8 months, mostly concentrated in 3 to 4 months, and with the prolongation of the disease course and the number of injections The increase, the effect gradually diminishes
.

The interval between two treatments should not be less than 3 months.
If the treatment fails or the efficacy gradually decreases after repeated injections, other treatment methods should be considered
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Therefore, botulinum toxin injection cannot be used as a long-term treatment for hemifacial spasm
.

It should be pointed out that the effect after each injection is closely related to factors such as the choice of injection site, the size of the injection dose, and the proficiency of the injection technique
.

Adverse reactions of botulinum toxin type A: 1) A small number of patients may have transient symptomatic dry eyes, exposure keratitis, tearing, photophobia, diplopia, drooping eyes, reduced blinking, incomplete blepharoplasty, and various degrees of facial paralysis, etc.
, And usually recover naturally within 3 to 8 weeks
.

2) Patients with repeated injections of botulinum toxin will have permanent eyelid weakness, shallow nasolabial folds, crooked mouth corners, and facial stiffness
.

Precautions for using type A botulinum toxin: 1) Use with caution for people with fever, acute infectious diseases, pregnant women and children under 12 years of age; 2) Disable aminoglycoside antibiotics during the use of type A botulinum toxin (such drugs have neuromuscular junctions) Blocking effect can aggravate adverse drug reactions); 3) 1:1000 adrenaline should be prepared for emergency treatment in case of allergic reactions, and should be kept in the hospital for short-term observation after injection
.

3 Microvascular decompression surgery The currently accepted view is that the cause of hemifacial spasm is vascular compression.
Microvascular decompression surgery is to relieve the facial nerve root vascular neck compression of the facial nerve and repair the local influence of the facial nerve
.

Microvascular decompression is a treatment for the cause, so it is currently the most effective surgical method for the treatment of hemifacial spasm
.

However, postoperative ineffectiveness, recurrence, facial paralysis, hearing impairment and other complications are still problems that plague doctors and patients
.

References: [1] Chinese expert consensus on diagnosis and treatment of hemifacial spasm[J].
Chinese Journal of Minimally Invasive Neurosurgery,2014,v.
19;No.
174(11):528-532.
[2] Cheng Yapeng, Li Tao.
Facial Muscles Research progress in the etiology and pathogenesis of spasm[J].
Journal of Integrated Traditional Chinese and Western Medicine Cardio-Cerebrovascular Disease,2017,15(17):2128-2131.
[3],.
Diagnosis and treatment of hemifacial spasm[J].
Chinese Journal of Neurosurgical Disease Research, 2011,10(06):481-484.
[4] Instructions for carbamazepine tablets [5] Instructions for oxcarbazepine tablets [6] Instructions for diazepam tablets