Eficácia, durabilidade e segurança da descompressão micro-vascular versus infiltração de toxina botulínica no tratamento do espasmo hemifacial: revisão sistemática e metanálise
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Data
2022-07-12
Autores
Santos Filho, Carlos Alberto dos
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Espasmo hemifacial (EHF) é um distúrbio motor facial manifesto por movimentos paroxísticos involuntários unilateralmente, que se inicia tipicamente com contrações no múscu-lo orbicular do olho e progride com envolvimento de outros músculos da face e do pescoço, co-mo os músculos orbicular da bloca e platisma, o que acarreta prejuízo estético e funcional, com importante impacto na vida social do indivíduo afetado. Objetivos: Sistematicamente identifi-car, avaliar e sumarizar as evidências disponíveis sobre os efeitos de eficácia e segurança da microcirurgia para descompressão neurovascular (MDV) em comparação com a infiltração de neurotoxina botulínica (BoNT) no tratamento do espasmo hemifacial primário. Métodos: Revi-são sistemática com buscas realizadas nas bases PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE e COCHRANE em 07 de outubro de 2021. Resultados: Foram identificados um ensaio clínico não randomizado (ECNR) com qualidade metodológica boa a moderada comparando a microcirurgia para descompressão neurovascular, em comparação com a infiltração de neuro-toxina botulínica, e três com qualidade mais baixa comparando estas diferentes técnicas no tratamento do espasmo hemifacial. Conclusões: A MDV apresentou expressivamente maior probabilidade de cura para o EHF primário em comparação à BoNT, assim como também se mostrou ser um fator de proteção para doença com redução importante da recorrência dos sin-tomas. Contudo, ainda faltam evidências de qualidade em relação à melhora parcial dos sinto-mas e quanto ao aparecimento de eventos adversos.
Background: Hemifacial spasm (HS) is a facial motor disorder manifested by unilateral involuntary paroxysmal movements, which typically begins with contractions in the orbicularis oculi muscle and progresses to involvement of other muscles of the face and neck, such as the orbicularis oris and platysma, which causes aesthetic and functional damage, with an important impact on the social life of the affected individual. Objectives: Systematically identify, evaluate, and summarize the available evidence on the efficacy and safety effects of microsurgery for neurovascular decompression (MVD) compared with botulinum neurotoxin infiltration (BoNT) in the treatment of primary hemifacial spasm. Methods: Systematic review with searches performed in PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE on October 7, 2021. Results: One non-randomized clinical trial with good to moderate quality comparing microsurgery for neurovascular decompression compared to botulinum neurotoxin infiltration and three with lower quality comparing these different techniques in the treatment of hemifacial spasm were identified. Conclusions: MVD had a significantly higher probability of cure for primary HS compared to BoNT, as well as being a protective factor for the disease with a significant reduction in the recurrence of symptoms. However, there is still a lack of quality evidence regarding the partial improvement of symptoms and the appearance of adverse events.
Background: Hemifacial spasm (HS) is a facial motor disorder manifested by unilateral involuntary paroxysmal movements, which typically begins with contractions in the orbicularis oculi muscle and progresses to involvement of other muscles of the face and neck, such as the orbicularis oris and platysma, which causes aesthetic and functional damage, with an important impact on the social life of the affected individual. Objectives: Systematically identify, evaluate, and summarize the available evidence on the efficacy and safety effects of microsurgery for neurovascular decompression (MVD) compared with botulinum neurotoxin infiltration (BoNT) in the treatment of primary hemifacial spasm. Methods: Systematic review with searches performed in PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE on October 7, 2021. Results: One non-randomized clinical trial with good to moderate quality comparing microsurgery for neurovascular decompression compared to botulinum neurotoxin infiltration and three with lower quality comparing these different techniques in the treatment of hemifacial spasm were identified. Conclusions: MVD had a significantly higher probability of cure for primary HS compared to BoNT, as well as being a protective factor for the disease with a significant reduction in the recurrence of symptoms. However, there is still a lack of quality evidence regarding the partial improvement of symptoms and the appearance of adverse events.
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Palavras-chave
Espasmo hemifacial, Microcirurgia para descompressão neurovascular, Revisão sistemática, Metanálise, Toxinas botulínicas, Microcirurgia para descompressão neurovascular