1.Medication
Haloperidol is a drug for the treatment of psychosis, the drug has a strong central inhibitory effect, if long-term medication can cause patients to appear depressive symptoms. Clonazepam and alprazolam are sedative and hypnotic drugs, long-term use of the drug can be addictive, although it can reduce the frequency of HFS seizures, but can not be cured, and the side effects of drowsiness, fatigue and other symptoms.
Carbamazepine is a drug for epilepsy. Taking this drug can reduce the frequency of HFS, but long-term use can cause nausea and vomiting, dizziness, allergy, white blood cell drop and other adverse symptoms. There are also anticholinergic drugs, such as o-methylphenidate and baclofen, which also have some therapeutic effects. The disadvantage of drug therapy is that it cannot completely cure HFS from the root, and it requires long-term medication, which has more serious side effects on health.
Zhong et al. retrospectively analyzed 431 patients with HFS through follow-up. All HFS cases were treated with medication at the beginning of the disease, with drugs such as carbamazepine, phenytoin sodium, clonazepam and diazepam. Among them, 21 cases had rash and other allergic phenomena during the course of medication, 139 patients had dizziness, weakness, drowsiness and unstable walking after taking medication, and none of them agreed that the medication could produce significant therapeutic effects, so the patients could not adhere to the medication for HFS.
2. Psychologically guided treatment
Tell patients that HFS does not cause serious complications and that a relaxed mood can reduce the number of episodes and not to focus too much on facial twitching. Zhang Yuankui et al. believe that allowing HFS patients to relax psychologically and giving some placebo, sedative drugs, especially tricyclic drugs, can relieve depression, worry, insomnia, and fear, and therefore have some effect in reducing HFS attacks.
3.Botulinum toxin local treatment of HFS
Botulinum toxin type A local injection treatment of HFS, because the type A botulinum toxin can prevent the release of acetylcholine nerve endings, acetylcholine is the nerve mediator of the facial nerve, acetylcholine release is inhibited, then the nerve conduction is terminated, and therefore can make the HFS attack disappear, in 1984 Frueh first use of botulinum toxin type A began to treat HFS, and achieved a very shocking therapeutic effect. Botulinum toxin type A is a large protein toxin produced by the bacterium Clostridium botulinum. When injected into the subcutaneous tissue, botulinum toxin type A acts on acetylcholinergic motor nerve endings, causing inactivation of calcium channels by antagonizing and blocking calcium channels in cell membranes, thus causing inability of innervated muscle fibers to contract normally, resulting in localized paralysis of muscle tissue.
In human studies using light microscopy, electron microscopy, and immunochemical techniques, it was found that the paralysis of muscle tissue after botulinum toxin type A injection was temporary and recoverable because it did not cause damage to the muscle or motor nerve endings, and it was possible for the nerve and neuromuscular junction sites to reappear with plastic changes, including the initiation of germination of new nerve axon terminals to establish extensive synapses with the entering nerve-muscle junction The process of botulinum toxin action on the target organ is divided into 3 processes.
The process of botulinum toxin action on target organs is divided into 3 phases.
(i) Binding phase: Botulinum toxin selectively binds tightly to the presynaptic membrane of acetylcholinergic nerve endings.
(2) Localization phase: Botulinum toxin is guided by the specific receptors on the cell surface and enters the cell by phagocytosis.
(iii) Paralysis phase: The light chain portion of botulinum toxin enters the cytoplasm and causes inactivation of the calcium channels in that cell, causing symptoms of cytotoxicity . Botulinum toxin treatment for HFS is characterized by complete and total elimination of HFS episodes after injection treatment, and the risk of toxicity is very low, so Botulinum toxin has become a common and effective drug for the treatment of HFS. However, botulinum toxin can only relieve the facial twitching symptoms of HFS patients for 3-6 months, and those with recurrent HFS will need to be re-injected with botulinum toxin, and the effect of re-injection will become less effective and shorter in duration.
Sankhla concluded that there is no significant correlation between the resistance of muscle tissue to botulinum toxin and the duration of treatment, but there is a significant correlation between the dose of the drug and the duration of the interval, therefore, the time to release HFS and the degree of release of spasm are positively correlated with the degree of complication of eyelid ptosis and nasolabial folds when botulinum toxin type A is used intermittently for HFS. Although it can block the normal nerve conduction between peripheral nerves and muscles and reduce the intensity of muscle spasm, it does not block pathological abnormal nerve impulses, and if the effect of Botox drug wears off, then muscle spasm recurs, and then Botox must be injected again.
Botulinum toxin type A is a very strong bacterial toxin and users should strictly control the indications to avoid serious complications caused by overdose. After subcutaneous injection, the patients usually lasted for 1-6 months. After botulinum toxin injection, the patients would develop: droopy eyelids, symptomatic dry eyes, exposure keratitis, lacrimation, shyness, diplopia, and different degrees of facial palsy, the incidence of which was as high as 76%, and after repeated injections of botulinum toxin, there would be permanent residual eyelid weakness, shallow nasolabial folds, crooked corners of the mouth, facial stiffness, and other signs.
4.Nerve block
It is the use of destructive solvents such as anhydrous alcohol or carbolic acid injected into the subcutaneous nerve trunk, causing chemical degeneration of the nerve, thus causing short-term paralysis or destruction of the nerve, the patient has short-term facial paralysis and HFS disappears, but the patient usually relapses in 3-10 months as the nerve regenerates and HFS recurs.
5.Thermal coagulation radiofrequency treatment
If eyelid and facial twitches are found, local destruction of the facial nerve fibers by heating the electrode will cause local paralysis of the facial muscles and HFS will disappear, but the patient can also have a recurrence of HFS due to nerve regeneration, and permanent facial paralysis can occur in severe patients.
6.Other treatments
Including Chinese medicine, acupuncture, massage and other treatments, but often the effect is not obvious.