Avaliação da dinâmica do piscar, dos movimentos palpebrais anômalos e do músculo Orbicular oculi em pacientes com espasmo hemifacial

• Autor(a) principal: Osaki, Midori Hentona [UNIFESP]
• Data de Publicação: 2021
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=11289370; https://repositorio.unifesp.br/handle/11600/68294
• topic: Hemifacial Spasm; Blink; Eyelid Spasms; Orbicularis Oculi; Espasmo Hemifacial; Piscar; Espasmos Palpebrais; Orbicular Oculi

Purposes: 1) To assess the dynamics of blinking and anomalous eyelid movements in patients with hemifacial spasm (HFS); 2) To objectively demonstrate the relieft of eyelid spasms after application of botulinum toxin type A (BTX-A) injections; 3) To determine whether there is an association between the energy generated during eyelid movements and two clinical scales to assess hemifacial spasm; 4) To evaluate samples of orbicularis oculi muscle from the affected and unaffected sides of patients with hemifacial spasm. Methods: Patients with hemifacial spasm from the Division of Oculoplastics, Department of Ophthalmology at the Federal University of São Paulo were evaluated. Spontaneous eyelid movements were recorded bilaterally using a highspeed video camera for 3 minutes, while patients watched a video containing nature landscapes, so that they maintaned their eyes in primary position of gaze. In addition, samples of orbicularis oculi from hemifacial spasm patients not previously treated with BTX-A (affected and unaffected sides) and normal patients were analyzed. The following outcomes were evaluated: 1) maximum velocity of eyelid closure and amplitude of eyelid movements in untreated patients; 2) energy generated during spontaneous eyelid movements before and after applications of botulinum toxin-A; 3) disease severity and frequency of eyelid spasms via the use of 2 clinical scales: Jankovic rating scale (JRS) and hemifacial spasm grading scale (HSGS) before and after BTX-A applications; 4) morphology of the orbicularis oculi samples using hematoxylin-eosin staining and a digital image software (Image J) for objective analysis. Results: 1) Regarding spontaneous blinking, no significant difference was observed in the amplitudes or velocities of eyelid closure between affected and unaffected eyes. Of the 28 patients evaluated, 23 (82%) presented anomalous eyelid spasms with a similar pattern to normal blink, but observed only on the affected side; in 17 (61%), anomalous high-frequency eyelid movements were also detected in the affected eye. Analysis of these anomalous movements demonstrated significantly lower amplitudes and velocities than in spontaneous blinking. 2) The energy generated by the upper eyelid movements was significantly reduced on the affected side after treatment with botulinum toxin. 3) Energy spectrum below 23,000 was associated with scores below 4 and 6.25 in JRS and HSGS, respectively (p <0.0001); 4) Histopathological analysis showed significantly greater connective tissue area on the affected side and significantly lower cell density on both sides of patients with hemifacial spasm when compared to the control group. Conclusions: 1) There was no significant interocular difference for amplitude and velocity of eyelid closure during spontaneous blinking in patients with HFS. Anomalous eyelid movements are characterized by lower amplitudes and reduced velocity when compared to spontaneous blinking. 2) The significant reduction in the energy generated during upper eyelid movements on the affected side after treatment with BTX-A has objectively demonstrated the effectiveness of treatment with this drug to relieve eyelid spasms. 3) An association between the energy generated during eyelid movements and clinical evaluations performed using the JRS and HSGS scales in patients with HFS was observed. 4) Significant morphological changes were observed in orbicularis oculi muscle samples from patients with hemifacial spasm, both on the affected and non-affected sides.