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      Tratamento cirúrgico do blefaroespasmo essencial: relato de dois pacientes Translated title: Surgical treatment of blepharospasm: report of two patients

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          Abstract

          Blefaroespasmo essencial pode ser tratado por diversas opções terapêuticas: clínicas em que se destaca entre outros o uso da toxina botulínica com suas vantagens e limitações, e algumas opções de tratamento cirúrgico. A técnica cirúrgica proposta por Gillum e Anderson oferece uma alternativa a pacientes resistentes ao tratamento clínico ou que durante a evolução da doença apresentem complicações secundárias. São analisados dois casos em que se indicou a miectomia dos músculos orbicular da pálpebra, prócero e corrugador do supercílio associados à blefaroplastia e ritidoplastia frontal por terem apresentado diminuição da resposta ao tratamento clínico. Ambos obtiveram bons resultados, retornando às suas atividades normais.

          Translated abstract

          Essential blepharospasm can be approached by several types of treatment: clinical in which the most important is the botulinum toxin with advantages and limitations; and some options of surgical treatment. The surgical technique described by Gillum and Anderson offers an alternative to patients resistant to the clinical treatment or with secondary complications. Two cases are analysed. Myectomy of all accessible orbicularis oculi, procerus and corrugator superciliaris muscle associated with blepharoplastic surgery and frontal lifting was indicated due to poor answer to clinical treatment. The results were satisfactory and both patients returned to their normal activities.

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          Most cited references25

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          Cranial dystonia, blepharospasm and hemifacial spasm: clinical features and treatment, including the use of botulinum toxin.

          Blepharospasm, the most frequent feature of cranial dystonia, and hemifacial spasm are two involuntary movement disorders that affect facial muscles. The cause of blepharospasm and other forms of cranial dystonia is not known. Hemifacial spasm is usually due to compression of the seventh cranial nerve at its exit from the brain stem. Cranial dystonia may result in severe disability. Hemifacial spasm tends to be much less disabling but may cause considerable distress and embarrassment. Patients affected with these disorders are often mistakenly considered to have psychiatric problems. Although the two disorders are quite distinct pathophysiologically, therapy with botulinum toxin has proven very effective in both. We review the clinical features, proposed pathophysiologic features, differential diagnosis and treatment, including the use of botulinum toxin, of cranial dystonia and hemifacial spasm.
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            Botulinum-A toxin in the treatment of craniocervical muscle spasms: Short- and long-term, local and systemic effects

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              Blepharospasm and hemifacial spasm. Randomized trial to determine the most appropriate location for botulinum toxin injections.

              The purpose of the study is to analyze the effectiveness and side effects of botulinum toxin using four different treatment site applications to determine the most successful treatment regime with the least side effects. In a prospective trial, 92 patients (50 blepharospasm and 42 hemifacial spasm) were assigned randomly to 1 of 4 different treatment groups (standard [S], brow [B], inner orbital [IO], or outer orbital [OO]). Each treatment group had a different pattern of injection sites in the orbicularis. A total of 285 treatments were given, and the mean follow-up time was 16.4 months. In the blepharospasm group, patients assigned to the standard group had a significantly longer duration of effect than for those in the brow, inner orbital, and outer orbital groups (8.1 weeks compared with 4.5, 4.2, and 3.1 weeks, respectively; P < 0.001). In the hemifacial spasm group, patients in the outer orbital group had significantly shorter duration of effect than those in standard, brow, or inner orbital group (7.2 weeks compared with 12.6, 12.8 and 10.4 weeks, respectively; P < 0.001). The four major complications of botulinum toxin treatment were epiphora, ocular irritation, ptosis, and diplopia. The inner orbital treatment produced significantly more episodes of ptosis (13% of treatments). However, the standard treatment produced the most epiphora and ocular irritation (18% of treatments). The position of the injection sites around the orbicularis influences the effectiveness and side effects of botulinum toxin treatment for patients with blepharospasm and hemifacial spasm. The further the treatment is away from the eyelid margin, the lower the risk of ocular side effects. The standard treatment produces the longest duration of effect in the blepharospasm group but with the most transient ocular irritation and epiphora. In the hemifacial spasm group, the brow treatment has an equally long duration of effect as that of the standard treatment with fewer side effects.
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                Author and article information

                Journal
                anp
                Arquivos de Neuro-Psiquiatria
                Arq. Neuro-Psiquiatr.
                Academia Brasileira de Neurologia - ABNEURO (São Paulo, SP, Brazil )
                0004-282X
                1678-4227
                June 1999
                : 57
                : 2B
                : 476-483
                Affiliations
                [01] orgnameUSP orgdiv1FM orgdiv2Hospital das Clínicas (HC)
                [02] orgnameUSP orgdiv1FM orgdiv2Hospital das Clínicas (HC)
                Article
                S0004-282X1999000300021 S0004-282X(99)05700221
                10.1590/S0004-282X1999000300021
                7b7297c4-7713-4cb0-8c29-0c8e6075847f

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

                History
                : 01 March 1999
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 8
                Product

                SciELO Brazil


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