Quantitative changes in botulinum toxin a treatment over time in patients with essential blepharospasm and idiopathic hemifacial spasm

Background Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease. Objectives To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige’s Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies. Methods A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige’s syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted. Results A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 3.61 (±Standard deviation 0.50, range 3-4), 3.21 (±Standard deviation 0.63, range 2-4) and 3.67 (+- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 4.3 (± Standard deviation 1.6, range 2.0-6.5), 5.8 (±Standard deviation 1.4, range 3-8) and 4.5 (± Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications.Conclusions The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige’s syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6217 Kathmandu Univ Med J 2010;8(3):305-10

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Eight years experience with botulinum toxin A and eyelid surgery in the treatment of hemifacial spasm

International Eye Research ◽

10.18240/ier.2021.02.05 ◽

2021 ◽

Vol 2 (2) ◽

pp. 83-87

Author(s):

Kenneth K.H. Lai ◽

◽

Edwin Chan ◽

Simon T.C. Ko ◽

◽

...

Keyword(s):

Botulinum Toxin ◽

Hemifacial Spasm ◽

Complication Rate ◽

Botulinum Toxin A ◽

Onset Time ◽

Surgical Correction ◽

Toxin A ◽

Eyelid Surgery ◽

Therapeutic Outcomes ◽

Eyelid Diseases

AIM: To report the therapeutic outcomes of botulinum toxin A (Botox) and eyelid surgery in patients with hemifacial spasm (HFS). METHODS: Patients’ images and medical notes were retrospectively reviewed with subsequent analysis of both the therapeutic outcomes and complications of Botox injections. RESULTS: The information of 76 patients (female=58) with HFS who received a minimum of 4 Botox injections were included. The mean follow-up interval was 83±50 (20-112)mo with an average of 16±10 (4-34) injections. The peak incidence was between 55 and 64 years and the average age of onset was 66±11 (32-85)y. Up to 23% of patients with HFS had aberrant vascular structures (right=8, left=7) in close relationship to the facial nerve (MRI=14, CT=1), where the vertebral artery (n=6) was the most involved vessel followed by the anterior inferior cerebellum artery (n=5). Patients with primary HFS had a shorter effective duration (2.5 vs 3.1mo, P<0.05), a longer onset time (4.1 vs 3.8d, P=0.739) and a lower Subjective Spasm Alleviation score (SSAs; 1.7 vs 1.9, P=0.179) than those with secondary HFS. Twelve of the 19 patients with preexisting eyelid diseases underwent surgical correction including upper blepharoplasty (n=12), limited myectomy (n=7), browplasty (n=7) and advancement of levator aponeurosis (n=5). Five (41.7%) of those with surgical correction and suboptimal response to Botox showed improvement 6mo after surgery [onset time (P=0.0256), effective duration (P=0.374) and SSAs (P=0.0161)]. Those 12 patients with eyelid surgery had a lower complication rate than those without eyelid surgery (23% vs 42%, P≤0.05). CONCLUSION: Botox is an effective and safe treatment for HFS. Patients with primary HFS had a less favorable therapeutic outcome with Botox than those with secondary HFS. Eyelid surgery for patients with concurrent eyelid diseases can augment the effect of subsequent Botox injections by improving patient satisfaction and reducing complication rate.

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Low-Dose Botulinum Toxin A for Treatment of Blepharospasm and Hemifacial Spasm

Japanese Journal of Ophthalmology ◽

10.1007/s10384-005-0200-5 ◽

2005 ◽

Vol 49 (4) ◽

pp. 327-328 ◽

Cited By ~ 3

Author(s):

Anuchit Poonyathalang ◽

Pisit Preechawat ◽

Uraiwan Jamnansiri

Keyword(s):

Botulinum Toxin ◽

Hemifacial Spasm ◽

Low Dose ◽

Botulinum Toxin A ◽

Toxin A

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High Versus Low Concentration Botulinum Toxin A for Benign Essential Blepharospasm: Does Dilution Make a Difference?

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0b013e31819946c4 ◽

2009 ◽

Vol 25 (2) ◽

pp. 81-84 ◽

Cited By ~ 17

Author(s):

Michael H. Boyle ◽

Gerald McGwin ◽

Courtney E. Flanagan ◽

Matthew G. Vicinanzo ◽

John A. Long

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Toxin A ◽

Low Concentration ◽

Essential Blepharospasm

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Facial asymmetry in patients with hemifacial spasm before and after botulinum toxin A treatment

Neurological Sciences ◽

10.1007/s10072-016-2670-2 ◽

2016 ◽

Vol 37 (11) ◽

pp. 1807-1813 ◽

Cited By ~ 3

Author(s):

Libin Xiao ◽

Yougui Pan ◽

Xiaolong Zhang ◽

Yong Hu ◽

Li Cai ◽

...

Keyword(s):

Botulinum Toxin ◽

Hemifacial Spasm ◽

Botulinum Toxin A ◽

Facial Asymmetry ◽

Toxin A ◽

Before And After

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Differences in Corneal Parameters Between Affected and Normal Contralateral Eyes in Patients With Hemifacial Spasm Treated With Botulinum Toxin-A

Cornea ◽

10.1097/ico.0000000000000688 ◽

2016 ◽

Vol 35 (2) ◽

pp. 220-225 ◽

Cited By ~ 1

Author(s):

Teissy Osaki ◽

Midori H. Osaki ◽

Tammy H. Osaki ◽

Flavio E. Hirai ◽

Mauro Campos

Keyword(s):

Botulinum Toxin ◽

Hemifacial Spasm ◽

Botulinum Toxin A ◽

Toxin A

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The good toxin: 10 years of experience with botulinum toxin A in the treatment of benign essential blepharospasm

European Journal of Ophthalmology ◽

10.1177/1120672120925630 ◽

2020 ◽

pp. 112067212092563

Author(s):

Kenneth KH Lai ◽

Andrew KT Kuk ◽

Edwin Chan ◽

Simon TC Ko

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Onset Time ◽

Surgical Correction ◽

First Year ◽

Common Complication ◽

Toxin A ◽

Essential Blepharospasm ◽

Threatening Condition ◽

Life Threatening

Purpose: To describe the efficacy and safety of botulinum toxin A (Botox) in patients with benign essential blepharospasm. Methods: Retrospective review of operation, injection, and medical records. Results: Information of 29 patients (nine males) was reviewed, and the average age of benign essential blepharospasm onset was 59.1 years. The average number of injections per patient was 14.2 ± 8.2 (5–44) and the average follow-up was 75.8 ± 47.3 months (15–180). The average unit dose was 14.2 ± 8.2 (10–30) ipsilaterally in the patient’s first year and was 21.4 ± 5.0 (12.5–30) ipsilaterally in their last year (p = 0.00458). The average onset time was 3.8 ± 1.9 (1–7) days in a patient’s first year and was 3.6 ± 1.7 (2–7) days in their last year (p = 0.549). The average effective duration was 2.86 ± 1.1 months in a patient’s first year and was 2.53 ± 0.9 in their final year (p = 0.187). The Subjective Spasm Alleviation Scale was 1.72 ± 0.4 at the first year and was 1.79 ± 0.5 in the last year (p = 0.187). Ten (34.5%) patients with eyelid disease had surgical correction. The Subjective Spasm Alleviation Scale was 1.50 ± 0.5 before and was 2.0 ± 0 six months after the operation (p = 0.0268). Post-injection complications were experienced in eight (27.6%) patients. The most common complication was ptosis (n = 7), followed by diplopia (n = 1), dry eye (n = 1), and tearing (n = 1). No life-threatening complication was reported. Conclusion: Botox was a safe and effective treatment in benign essential blepharospasm which required an increased dosage over time. Ptosis was the most common complication and no life-threatening condition was reported. Surgical correction of those with eyelid diseases showed subjective improvement of subsequent Botox treatment.

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