片側顔面攣縮のボツリヌストキシン治療—神経内科クリニック外来での実践的臨床経験から

Botulinum Toxin Treatment for Hemifacial Spasm:Based on the Practical Clinical Experience in the Neurology Outpatient Clinic

Point

・片側顔面攣縮のボツリヌストキシン（BTX）治療は，第一選択的神経内科的治療法である．

・BTX治療は，圧迫性片側顔面攣縮患者では，神経減圧術の非適応，非選択，手術待機長期間の場合に適応となる．

・BTX治療は，麻痺後片側顔面攣縮患者では，連合運動を含め適応となるが，潜在性顔面神経麻痺のため，注射量を少なめにする．

・BTX治療は，神経内科外来診療中に容易に行えるが，手際よく，安全かつ迅速に行うことが肝要である．

　Botulinum toxin（BTX）treatment is the first-line neurological treatment for hemifacial spasm（HFS）. In my neurology clinic, Clinique Kita Neurologique（CKN）, I have provided a cumulative total of approximately 400 BTX treatments for approximately 50 HFS patients for 23 years. Based on my own practical clinical experience, I have demonstrated the efficacy of BTX treatment. In compressive HFS, BTX treatment is indicated in patients who are not indicated or unwilling to undergo neurodecompression surgery. This is also indicated in the case of a long waiting period before surgery. In postparetic HFS, BTX treatment is indicated in patients with spasm and synkinesia. The amount of each BTX injection in postparetic HFS should be less than that in compressive HFS because of latent facial paresis. Although BTX injections can be easily administered in neurology outpatient clinics, it is important to perform the procedure safely and promptly.