Although the beneficial effect of subcutaneous injections of botulinum toxin type A (BTX-A) is well known in both blepharospasm and hemifacial spasm, the position of the injection sites around the orbicularis oculi may influence the effectiveness and side effects. Here we report results of preseptal and pretarsal BTX-A injections in 53 patients (25 blepharospasm and 28 hemifacial spasm) in whom we used both injection techniques successively. Pretarsal injections were used in 102 out of 186 treatments in blepharospasm group and in 84 out of 202 treatments in hemifacial spasm group. Pretarsal BTX-A treatment produced significantly higher response rate and longer duration of maximum response in both patient groups. This technique was also associated with a lower frequency of major side effects such asptosis. We concluded that injections of BTX-A into the pretarsal, rather than the preseptal portion of the orbicularis oculiis more effective for treatment of involuntary eyelid closure due to contractions of this muscle.

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Background: Botulinum toxin (BTX) injections are accepted as safe and efficacious in the treatment of hemifacial spasm (HFS), but it is still debated whether BTX treatment of lower facial muscles should be performed or not. Objective: The study aims to evaluate the necessity of BTX administration into lower facial muscles in patients with HFS. Methods: A randomized, single-blind, crossover, clinical trial was conducted. Twenty-three HFS patients were randomly allocated to two different application methods. The patients were administered BTX type A into both the orbicularis oculi and perioral muscles in the first method and BTX type A into the orbicularis oculi but placebo into the perioral muscles in the second method. Subjects were crossed over to the alternate method when they needed BTX injection with a minimum of 3 months’ duration. All the patients underwent both methods with no change in the total dose of BTX. Results: All the patients benefited from BTX treatment regardless of the methods. However, in the patients with severe lower facial muscle involvement, the application of BTX into both orbicularis oculi and lower facial muscles led to better results. Conclusion: Our data suggest that BTX application to lower facial muscles might not be necessary in patients with mild lower facial involvement.

We investigated many of the effects of multiple sclerosis (MS) on patients in the Aegean District of Turkey who have had the disease for longer than one year to establish their social and occupational needs. Questions covered income, marital status, employment status of patient and spouse, housing, employment status of children, special care needs, and what changes had occurred in any of the preceding areas due to the illness. Our survey questionnaire yielded responses from 246 MS patients (ages 16–65; 87 men, 159 women) from the outpatient departments of six centers in Izmir, Turkey. The survey was conducted from March 2, 1998, to March 5, 1999. Survey results were tabulated and analyzed statistically for correlations between factors and were similar to other reports from western countries. Men reported reduced income and higher unemployment than women, many of whom were housewives. First-degree relatives carried the burden of caregiving. Disease duration and higher Expanded Disability Status Scale (EDSS) scores were strongly correlated with changes in employment, marital status, and housing. Higher EDSS scores had a negative impact on the spouse's work and the patient's need for care. Among disease types, secondary progressive MS (SPMS) also negatively affected the family structure. The disease had little effect on children's employment status.