Outcome of Injection Botulinum Toxin in Blepharospasm

Introduction: Blepharospasm is a condition of involuntary spasm of the orbicularis oculi muscle which leads to intermittent or complete closure of the eyelids. Botulinum toxin is the currently recommended first line treatment for such blepharospasm. This study aims to find out the outcome of injection Botulinum toxin Type A in Blepharospasm. Materials and methods: It was a hospital based, prospective, interventional study conducted on patients diagnosed as Benign essential blepharospasm (BEB), Meige syndrome (MS) and Hemifacial spasm (HFS) by oculoplastic surgeon at Oculoplasty department OPD, Tilganga Institute of Ophthalmology, from December 2018 to November 2019. After taking all standard precautions for botulinum toxin injections, 6 to 8 sites for injecting 2.5 to 5 IU of the toxin were given. All the patients were evaluated before and after injections according to Jankovic spasm grading and improvement in functional impairment scale and followed on one week, one month, three month and when the symptoms reappeared. Results: A total of 43 cases which included 32 cases of Benign essential Blepharospasm, 9 Hemifacial spasm and 2 Meige syndrome. The mean Jankovic severity score was 3.51 ± 0.51 (range 3-4). The mean improvement in functional score was 2.60 ± 0.54 (range 1-3), was statistically significant (p-value <0.001).The effective period of injection was 130 ± 20.82 (93 – 189) days.38 patients had repeated injections after reappearance of symptoms. 4 patients had side effects of redness and hematoma at one site. Conclusion: This study concludes that Botulinum toxin type A is effective in the management of Benign essential blepharospasm, Hemifacial spasm and Meige syndrome. This along with a good safety profile justifies its role as a first line treatment therapy in blepharospasm. However, it is a temporary treatment option where the effect lasts for a short period of time and repeated injections are required.

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Botulinum toxin type A for the first-line treatment of Hailey-Hailey disease

Australasian Journal of Dermatology ◽

10.1111/ajd.12852 ◽

2018 ◽

Vol 60 (1) ◽

pp. 73-74 ◽

Cited By ~ 3

Author(s):

Anita Kothapalli ◽

Tony Caccetta

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Line Treatment ◽

First Line ◽

First Line Treatment

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Long-Term Efficacy of Botulinum A Toxin for Blepharospasm and Hemifacial Spasm

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100010817 ◽

2010 ◽

Vol 37 (5) ◽

pp. 631-636 ◽

Cited By ~ 22

Author(s):

Harmeet S. Gill ◽

Stephen P. Kraft

Keyword(s):

Hemifacial Spasm ◽

Repeated Measures ◽

Outcome Measure ◽

Botulinum Toxin Type A ◽

Botulinum Toxin Type ◽

Essential Blepharospasm ◽

The Mean ◽

Symptoms And Signs ◽

Facial Dyskinesia

Objective:To determine whether the duration of relief from symptoms in patients with essential blepharospasm (EB) or hemifacial spasm (HFS) who receive serial treatments with botulinum toxin type A (BtA) changes over the long-term.Methods:Retrospective longitudinal comparative analysis. The main outcome measure is the mean duration of relief from symptoms after an injection with BtA. Participants included 34 patients who received 30 or more serial BtA treatments for facial dyskinesia (EB or HFS). Repeated measures and linear regression analyses were used to determine trends and the mean duration of relief from symptoms was compared between early (first ten effective treatments) and late (last ten treatments) sessions in each group.Results:In the EB group (18 patients), the mean duration of relief was 13.5 weeks for the early and 11.4 weeks for the late sessions (P=0.04). In the HFS group (16 patients) the mean duration of relief was 12.4 weeks in both treatment periods (P=0.91). The duration of relief had a small negative correlation with mean late session BtA dose in the EB group (P=0.03) but no correlation in the HFS group (P=0.12).Conclusions:There was a trend towards a decreased duration of relief from symptoms in patients with EB over the long-term, but no changes for HFS. The treatment remains effective in relieving symptoms and signs for both conditions.

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The Effect of Botulinum TOxin Application if Neuro-Ophthalmological Indications on the Results of Schirmer’s Test and Tear Osmolarity

Czech and Slovak Ophthalmology ◽

10.31348/2019/2/3 ◽

2019 ◽

Vol 75 (2) ◽

pp. 74-77

Author(s):

Peter Žiak ◽

Juraj Halička ◽

Karolína Kapitánová ◽

Peter Mojžíš

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin Type A ◽

Botulinum Toxin Type ◽

Orbicularis Oculi Muscle ◽

Schirmer’S Test ◽

Essential Blepharospasm ◽

Long Term Effect ◽

Significant Difference ◽

The Mean

Botulinum toxin type A (BT-A) is used in the treatment of neuroophthalmologic disorders such as essential blepharospasm and facial hemispasm for more than 20 years. Although the long-term effect of repeated application of the BT-A was confirmed, the BT-A effect on tears production and retention is not clear. In our work we investigated whether applied BT-A in patients with blepharospasm and hemifacial spasm affect tears production. Tears quality was measured with Schirmer’s and tear osmolarity test during neuro-ophthalmologic diseases treatment, which was evaluated before and 14 days after application of BT-A (Botox inj, Allergan, Irvine, USA) into the orbicularis oculi muscle. BT-A doses of 16-18 U with unilateral and 32 to 36 U bilateral applications were used. The mean tear production in Schirmer’s test before BT-A application was 8.38 ± 0.63 mm, and 2 weeks after BT-A application was 7.12 ± 0,6 mm (n = 50). Tear osmolarity was 305.4 ± 9.2 mOsm before BT-A application, and 2 weeks after BT-A application it was 305.2 ± 8,6 mOsm (n = 13). We found significant difference between two groups in tear quantity (p < 0.012), but not quality (p > 0.05). Application of the BT-A reduced the amount of tears measured by Schirmer’s test. These results confirm rational basis of the empirical clinical experience where an artificial tears substitution is recommended for patients with neuro-ophthalmologic disorders treated by BT-A.

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Botulinum toxin type A in the treatment of hemifacial spasm: an 11-year experience

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2010000400006 ◽

2010 ◽

Vol 68 (4) ◽

pp. 502-505 ◽

Cited By ~ 14

Author(s):

Egberto Reis Barbosa ◽

Leonel Tadao Takada ◽

Lilian Regina Gonçalves ◽

Rose Mary Paulo do Nascimento Costa ◽

Laura Silveira-Moriyama ◽

...

Keyword(s):

Botulinum Toxin ◽

Hemifacial Spasm ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

School Of Medicine ◽

Long Term Effect ◽

Subjective Judgement ◽

The Mean

In order to evaluate the long-term effect of botulinum toxin type A (BTX) in the treatment of hemifacial spasm (HFS), a retrospective analysis of patients treated at the Movement Disorders Unit of the Division of Neurology, Clinical Hospital, University of São Paulo, School of Medicine from 1993 to 2004 was made. A total of 808 injections with BTX were administered to 54 patients with HFS. The mean duration of improvement per application was 3.46 months and the mean rate of improvement using subjective judgement by the patient was of 83%. Adverse effects, mostly minor, were observed in 64.8% of patients at least once along the period of follow-up and the most frequent of them was orbicularis oris paralysis (38.8%). There was no decrement in response when compared the first and the last injection recorded.

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Difference in response to botulinum toxin type A treatment between patients with benign essential blepharospasm and hemifacial spasm

Clinical and Experimental Ophthalmology ◽

10.1111/j.1442-9071.2010.02303.x ◽

2010 ◽

Vol 38 (7) ◽

pp. 688-691 ◽

Cited By ~ 6

Author(s):

Paul S Cannon ◽

Kenneth R MacKenzie ◽

Anne E Cook ◽

Brian Leatherbarrow

Keyword(s):

Botulinum Toxin ◽

Hemifacial Spasm ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Essential Blepharospasm

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Assessment of the effectiveness of botulinum toxin type A in a comprehensive approach to treatment of patients with hemifacial spasm

Toxicon ◽

10.1016/j.toxicon.2020.11.380 ◽

2021 ◽

Vol 190 ◽

pp. S20

Author(s):

Guzhina Elizaveta ◽

Vadim Gusev ◽

Olga Lvova

Keyword(s):

Botulinum Toxin ◽

Hemifacial Spasm ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Comprehensive Approach

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Long-term treatment with botulinum toxin type A in hemifacial spasm

Toxicon ◽

10.1016/j.toxicon.2008.04.093 ◽

2008 ◽

Vol 51 ◽

pp. 30-31

Author(s):

Kollewe Katja ◽

Krampfl Klaus ◽

Bigalke Hans ◽

Dengler Reinahrd ◽

Mohammadi Bahram

Keyword(s):

Botulinum Toxin ◽

Hemifacial Spasm ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Term Treatment ◽

Long Term Treatment

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PS01.095: BENIGN ESOPHAGEAL STRICTURE: A RECAP OF OUR EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.095 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 76-76

Author(s):

Keat How Teoh ◽

Kelvin Voon ◽

Shyang Yee Lim ◽

Premnath Nagalingam

Keyword(s):

Endoscopic Treatment ◽

Esophageal Stricture ◽

Endoscopic Dilatation ◽

Line Treatment ◽

First Line ◽

Benign Esophageal Stricture ◽

Anastomotic Strictures ◽

Esophageal Strictures ◽

The Mean ◽

First Line Treatment

Abstract Background Caustic injury remains the commonest cause of benign esophageal strictures in Asia. Others include gastroesophageal reflux, iatrogenic, radiation, autoimmune or idiopathic causes. Treatment goals are relief of dysphagia and prevention of recurrence. This study aims to evaluate the experience with benign esophageal stricture in Penang Hospital, a tertiary hospital in Northern region of Malaysia. Methods A retrospective review of 12 patients with benign esophageal strictures between year 2012 - 2017. Results The mean age was 53.5 and two thirds were female. Half of these patients were of Chinese ethnicity while the other half were Indian. The commonest cause was caustic ingestion (41.7%), followed by reflux stricture (25%) and anastomotic stricture (25%). There was one case of dystrophic epidermolysis bullosa. More than half of the patients had complex and multiple strictures. 41.7% of patients had proximal strictures that were located within 20cm from the incisors. Endoscopic dilatation was the first line treatment with either Savary Gilliard or balloon dilators. A total of 97 dilatation sessions were done with a mean dilatation frequency of 2.3 ± 1.5 times for anastomotic strictures, 8 ± 8.2 times for reflux strictures and 8.0 ± 6.6 times for corrosive strictures. The mean dilatation interval was 2.5 ± 1.2 weeks. 58.3% of patients had successful endoscopic treatment. The success rate was higher in non-corrosive stricture (83% vs 40%). There was one dilatation related complication in which the patient had pneumomediastinum without overt mediastinitis. This however, resolved with conservative management. 41.7% of patients had refractory strictures that failed endoscopic dilatation. Surgery including esophagectomy (40%), revision of anastomosis (20%) and gastrostomy (40%) were done for this group of patients. Proximal strictures, complex strictures and multiple strictures were associated with failed endoscopic dilatation (P < 0.05). Conclusion Endoscopic dilatation is the first line treatment for benign esophageal strictures. Surgery is reserved for refractory strictures with failed endoscopic treatment. Predictor scoring systems for refractory stricture and individualized approaches are the key to success. Disclosure All authors have declared no conflicts of interest.

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