OBJECTIVE: To investigate the factors in first-time adrenocorticotropic hormone (ACTH) therapy and their influence on spasm control time in infants with infantile spasms. METHODS: A total of 72 infants with infantile spasms who were admitted from January 2008 to October 2013 were enrolled. Their clinical data were collected, and the exposure factors for infantile spasms were selected. A Cox proportional-hazards regression model analysis was performed for these factors to analyze their influence on spasm control time. RESULTS: Clarification of the etiology (known or unexplained etiology), frequency of spasms before treatment, and presence or absence of combination therapy (ACTH used alone or in combination with magnesium sulfate) had a significant influence on spasm control time in infants with infantile spasms. The infants with a known etiology had a significantly shorter spasm control time than those with unexplained etiology, and the infants with a low frequency of spasms before treatment and receiving ACTH combined with magnesium sulfate early had a significantly longer spasm control time than their counterparts (P<0.05). CONCLUSIONS For infants with infantile spasms at initial diagnosis, etiology should be clarified, which may helpful for evaluating prognosis. A combination of ACTH and magnesium sulfate should be given as soon as possible, which may improve their prognosis.
Adrenocorticotropic Hormone ; therapeutic use ; Anticonvulsants ; Humans ; Infant ; Proportional Hazards Models ; Spasm ; Spasms, Infantile ; drug therapy

OBJECTIVES: To study the factors influencing the short-term (28 days) efficacy of initial adrenocorticotropic hormone (ACTH) therapy for infantile epileptic spasms syndrome (IESS), as well as the factors influencing recurrence and prognosis. METHODS: The clinical data were collected from the children with IESS who received ACTH therapy for the first time in the Department of Pediatric Neurology, Xiangya Hospital of Central South University, from April 2008 to January 2018 and were followed up for ≥2 years. The multivariate logistic regression analysis was used to evaluate the factors influencing the short-term efficacy of ACTH therapy, recurrence, and long-term prognosis. RESULTS: ACTH therapy achieved a control rate of seizures of 55.5% (111/200) on day 28 of treatment. Of the 111 children, 75 (67.6%) had no recurrence of seizures within 12 months of follow-up. The possibility of seizure control on day 28 of ACTH therapy in the children without focal seizures was 2.463 times that in those with focal seizures (P<0.05). The possibility of seizure control on day 28 of ACTH therapy in the children without hypsarrhythmia on electroencephalography on day 14 of ACTH therapy was 2.415 times that in those with hypsarrhythmia (P<0.05). The possibility of recurrence within 12 months after treatment was increased by 11.8% for every 1-month increase in the course of the disease (P<0.05). The possibility of moderate or severe developmental retardation or death in the children without seizure control after 28 days of ACTH therapy was 8.314 times that in those with seizure control (P<0.05). The possibility of moderate or severe developmental retardation or death in the children with structural etiology was 14.448 times that in those with unknown etiology (P<0.05). CONCLUSIONS Presence or absence of focal seizures and whether hypsarrhythmia disappears after 14 days of treatment can be used as predictors for the short-term efficacy of ACTH therapy, while the course of disease before treatment can be used as the predictor for recurrence after seizure control by ACTH therapy. The prognosis of IESS children is associated with etiology, and early control of seizures after ACTH therapy can improve long-term prognosis.
Child ; Humans ; Infant ; Adrenocorticotropic Hormone/therapeutic use* ; Spasms, Infantile/drug therapy* ; Treatment Outcome ; Seizures ; Electroencephalography/adverse effects* ; Spasm/drug therapy*

The exact pathophysiologic mechanisms of spasmodic torticollis and other idiopathic torsion dystonias remain largely unknown. Thus, a variety of drugs have been used alone or in combination on an empirical basis to treat these disorders, but to date none have efficacy that is proven and consistent. The drugs in use include anticholinergics, benzodiazepines, dopaminergics and dopamine antagonists with variable degrees of clinical improvement. Botulinum toxin A injection treatment for spasmodic torticollis is safe and efficacious with minimal adverse effect. However, it is expensive and beneficial effects are short-lasting. Only when a spasmodic torticollis patient's symptoms are refractory to combined treatment, using various drugs and Botulinum toxin injections, should the patient be considered a candidate for neurosurgical procedures.
Benzodiazepines/therapeutic use ; Botulinum Toxins/*therapeutic use ; Dopamine Agents/therapeutic use ; Dopamine Antagonists ; Human ; Parasympatholytics/therapeutic use ; Spasm/*drug therapy ; Torticollis/*drug therapy

We studied the effects of botulinum A toxin in 101 patients with hemifacial spasm and 11 patients with blepharospasm in an open trial and double blind manner. All patients in the open trial and 6 patients in the double blind trial improved after the first injection of botulinum toxin. There was no improvement with placebo. The peak effect ranged from one to 6 days after injection and mean peak effect was 3.6 days in blepharospasm, and 4 days in hemifacial spasm. Of 144 treatments, 98.6% had excellent results, (below grade I). The duration of beneficial effect ranged 11 to 40 weeks (mean 16.5 weeks) in hemifacial spasm and 9 to 30 weeks (mean 14.2 weeks) in blepharospasm. Complications were encountered in 63.4% in hemifacial spasm and 72.7% in blepharospasm. The common side effects were dry eyes, mouth droop, ptosis and lid edema in order of frequency. These side effects were mild and resolved spontaneously in 1 to 3 weeks. Botulinum A toxin therapy is effective and convenient, and the treatment of choice for patients with hemifacial spasm and blepharospasm.
Adult ; Aged ; Blepharospasm/*drug therapy ; Botulinum Toxins/adverse effects/*therapeutic use ; Double-Blind Method ; *Facial Muscles ; Female ; Humans ; Male ; Middle Aged ; Spasm/*drug therapy

OBJECTIVETo investigate the patterns of spasmodic dysphonia and the outcome treated with botulinum toxin A injections.

METHODSAll subjects were studied with acoustic analysis, laryngostroboscopy and laryngeal electromyography (EMG) including motor unit potential measure (MUP), recruitment pattern analysis and evoked electromyography. All the patients with spasmodic dysphonia were received botulinum toxin A (BOTOX) injections in each affected muscles and mostly under electromyographic guidance.

RESULTSAmong 22 cases of spasmodic dysphonia, 18 cases of adductor dysphonic patients have strained, strangled voice with intermittent breaks in speech as a consequence of hyperadduction and spasm of the vocal folds during phonation. Two patients had synchronous pharyngeal, lingual and velar tremor. Amplitudes of MUP of thyroarytenoid muscle (TA) were greater in patients group than in normal group (P < 0.01); The recruitment activity was increased and the amplitudes were greater than normal group (700-2500 microV) and the duration of activity of the TA during phonation was also notably greater in patients group than in normal group. Four cases of abductor dysphonic patients have a breathy, effortful hypophonic voice with abrupt termination of voicing. Amplitudes of MUP of posterior cricoarytenoid muscle (PCA) in patients group were increased up to 374 to 538 microV. The recruitment activity was increased and the amplitude was greater than normal(3000-5000 microV). In the adductor dysphonic group, patients who were treated with unilateral toxin injection had good results with 2.5 U or more. The average onset of toxin effect in all adductor dysphonic patients was at 6 hours to 2 days (1.4+/-0. 8) days (x +/- s), with a peak effect at 2 weeks and the follow-up EMG showed fibrillation potentials or electric silence in injected muscle. Duration of benefit was 8 to 24 weeks (15.2 +/- 4.9) weeks. The side-effect of toxin injection were including breathy voice or occasional dysphagia and aspiration. The patients with abductor spasms were less well controlled after PCA injections.

CONCLUSIONSSpasmodic dysphonia was regarded as a neuromuscular diseases, so its diagnosis, classification, treatment and follow-up should depend on not only clinical manifestation but also EMG. Presently, for controlling the dystonic symptoms, the most effective therapy for most of those patients is local BOTOX injections. Repeated injections are required to have a stable results.

Adult ; Botulinum Toxins ; therapeutic use ; Botulinum Toxins, Type A ; therapeutic use ; Case-Control Studies ; Dysphonia ; diagnosis ; drug therapy ; Electromyography ; Female ; Humans ; Middle Aged ; Spasm ; diagnosis ; drug therapy ; Young Adult

Adult ; Anxiety ; diagnosis ; drug therapy ; psychology ; Botulinum Toxins, Type A ; therapeutic use ; Dystonia ; diagnosis ; drug therapy ; etiology ; Hemifacial Spasm ; diagnosis ; drug therapy ; etiology ; Humans ; Male ; Mastication ; Neuromuscular Agents ; therapeutic use ; Risk Factors

BACKGROUNDHemifacial spasm (HFS) is a facial nerve disorder characterized by episodic involuntary ipsilateral facial muscle contraction. Information on Chinese patients with HFS has not been well-characterized. This study aimed to evaluate the clinical feature and the treatment status of HFS across China.

METHODSA cross-sectional study including 1003 primary HFS patients had been carried out in 15 movement disorder clinics in China in 2012. The investigated information was acquired from questionnaires and medical records including demographic data, site of onset, aggravating and relieving factors, treatments prior to the investigation, etc.

RESULTSIn this study, the ratio of male to female was 1.0:1.8, the mean age at onset was (46.6 ± 11.5) years. About 1.0% patients were bilaterally affected. The most often site of initial onset was the orbicularis oculi muscle. The most often affected sites were orbicularis oculi, zygomatic, and orbicularis oris muscles. Stress/anxiety and relaxation were most often aggravating and relieving factors, respectively; 2.3% patients had family history, 28.4% cases were combined with hypertension, and 1.4% patients were with trigeminal neuralgia. Botulinum toxin type A (BTX-A) injection was the most commonly used treatment, followed by acupuncture and oral medication. BTX-A maintained the highest repeat treatment ratio (68.7%), while 98.4% patients gave up acupuncture. The mean latency of BTX-A effect was (5.0 ± 4.7) days, the mean total duration of the effect was (19.5 ± 11.7) weeks, and 95.9% patients developed improvements no worse than moderate in both severity and function. The most common side effect was droopy mouth.

CONCLUSIONSThe onset age of HFS in China is earlier than that in western countries. The most often used two treatments are BTX-A injection and acupuncture, while the latter kept the poor repeat treatment ratio because of dissatisfactory therapeutic effect.

Adult ; Botulinum Toxins, Type A ; therapeutic use ; China ; Cross-Sectional Studies ; Female ; Hemifacial Spasm ; diagnosis ; drug therapy ; Humans ; Male ; Middle Aged ; Neuromuscular Agents ; therapeutic use

OBJECTIVE: To investigate the clinical effect of Shenfu injection combined with glucocorticoid in the treatment of acute left heart failure complicated with bronchospasm. METHODS: A prospective study was conducted.Ninety patients with acute left heart failure complicated with bronchospasm admitted to Huai'an Second People's Hospital from January 2021 to July 2022 were selected and divided into conventional treatment group, hormone therapy group and combined treatment group according to random number table method, with 30 cases in each group. All patients in the 3 groups received basic Western medicine treatment. On this basis, the conventional treatment group was given 0.25-0.50 g aminophylline injection plus 5% glucose injection or 0.9% sodium chloride injection (diabetes patients) 100 mL slow intravenous infusion, 1-2 times a day. In the hormone treatment group, 1 mg of budesonide suspension for inhalation was diluted to 2 mL by 0.9% sodium chloride injection, twice a day, and applied until 48 hours after the pulmonary wheezing disappeared. The combined treatment group was given glucocorticoid combined with Shenfu injection 80 mL plus 5% glucose injection or 0.9% sodium chloride injection (diabetes patients) 250 mL intravenously, once a day. All treated for 1 week. The general data, traditional Chinese medicine (TCM) syndrome score, TCM syndrone efficacy index, acute left heart failure efficacy, bronchospasm efficacy, systolic blood pressure (SBP), mean arterial pressure (MAP), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level and safety of the 3 groups were compared. The patients were followed up for 6 months, and the mortality and re-hospitalization rate of the 3 groups were recorded. RESULTS: Among the 90 patients, a total of 83 patients completed the study, excluding the cases dropped due to death and other reasons. There were 29 cases in the combined treatment group, 25 cases in the hormone therapy group and 29 cases in the conventional treatment group. There were no significant differences in age, gender, course of disease, and previous history (history of diabetes, history of hypertension, history of hyperlipidemia) among the 3 groups. Therefore, they were comparable. The difference of TCM syndrome score before and after treatment, TCM syndrome efficacy index of combined treatment group and hormone therapy group were higher than those of conventional treatment group [difference of TCM syndrome score: 15.14±5.74, 13.24±5.75 vs. 10.62±5.87, TCM syndrome efficacy index: (67.84±14.31)%, (59.94±14.26)% vs. (48.92±16.74)%, all P < 0.05], and the difference of TCM syndrome score and TCM syndrome efficacy index of combined treatment group were higher than those of hormone treatment group (both P < 0.05). The total effective rate of acute left heart failure and bronchospasm in the combined treatment group was significantly higher than that in the conventional treatment group (total effective rate of acute left heart failure: 96.55% vs. 75.86%, total effective rate of bronchospasm: 93.10% vs. 65.52%, both P < 0.05). The difference of serum NT-proBNP before and after treatment in combination therapy group and hormone therapy group was significantly higher than that in conventional treatment group (ng/L: 7 922.86±5 220.31, 7 314.92±4 450.28 vs. 4 644.79±3 388.23, all P < 0.05), and the difference of serum NT-proBNP before and after treatment in the combined treatment group was significantly higher than that in the hormone treatment group (P < 0.05). There were no significant differences in SBP difference, MAP difference, mortality and re-hospitalization rate among the 3 groups. No adverse reactions occurred in the 3 groups during treatment. CONCLUSIONS Shenfu injection combined with glucocorticoid is effective in the treatment of patients with acute left heart failure complicated with bronchospasm. It is superior to glucocorticoid and aminophylline in relieving bronchospasm, reducing NT-proBNP level and improving total effective rate, and has good prognosis and safety.
Humans ; Glucocorticoids/therapeutic use* ; Bronchial Spasm ; Prospective Studies ; Aminophylline/therapeutic use* ; Sodium Chloride/therapeutic use* ; Natriuretic Peptide, Brain ; Peptide Fragments ; Heart Failure/drug therapy* ; Diabetes Mellitus ; Glucose

OBJECTIVETo investigate the protective effect of Mailuoning on the facial nerve demyelination of Hemifacial spasm and provide the data for therapy of Hemifacial spasm.

METHOD24 New Zealand white rabbits were divided into control group, Saline group and Mailuoning group, on the latter two groups the models of Hemifacial spasm were made by the temporal superficial artery closely contacting the main trunk of facial nerve at stylomastoid foramen. From the 5th week, the Saline and Mailuoning were injected intravenously into ear margin for 2 weeks on Saline and Mailuoning group respectively. At the 7th week, the MDA and SOD in serum were measured, mean while the microstructure and ultrastructure of facial nerve were observed on 3 animal groups.

RESULTThe MDA decreased obviously (P < 0.05) and SOD increased significantly (P < 0.01) in Mailuoning group comparing with that of Saline group, while the MDA and SOD showed insignificant changes of Mailuoning group and control group. The facial nerve severely demyelinated and axons retrogressively changed in Saline group but mild in Mailuoning group.

CONCLUSIONMailuoning injection has a significant protective effect on the facial nerve demyelination of Hemifacial spasm and the very important applied value for therapy of Hemifacial spasm.

Animals ; Demyelinating Diseases ; drug therapy ; pathology ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; pharmacology ; Facial Nerve ; pathology ; ultrastructure ; Female ; Hemifacial Spasm ; drug therapy ; pathology ; Injections, Intravenous ; Male ; Neuroprotective Agents ; administration & dosage ; pharmacology ; Plants, Medicinal ; chemistry ; Rabbits

OBJECTIVETo evaluate the efficacy of tolterodine on bladder spasm caused by the indwelling catheter after prostate operation.

METHODSEighty-two patients with bladder spasm caused by the indwelling catheter after prostate operation received tolterodine (2 mg twice daily), until 24 hours before the removal of the catheter.

RESULTSAfter 24 hours of treatment, bladder spasm was alleviated totally in 21 patients (25.6%), partially in 45 (54.9%), and unrelieved in 16 (19.5%). After 72 hours of treatment, bladder spasm was alleviated totally in 45 patients (54.9%), partially in 30 (36.6%), and unrelieved in 7 (8.5%). No severe adverse events occurred during the treatment.

CONCLUSIONThe tolterodine therapy for patients with bladder spasm caused by the indwelling catheter after prostate operations is rapid, effective, persistent and safe.

Aged ; Aged, 80 and over ; Benzhydryl Compounds ; therapeutic use ; Catheters, Indwelling ; adverse effects ; Cresols ; therapeutic use ; Humans ; Male ; Middle Aged ; Phenylpropanolamine ; Spasm ; drug therapy ; Tolterodine Tartrate ; Transurethral Resection of Prostate ; Urinary Bladder Diseases ; drug therapy ; Urinary Catheterization ; adverse effects