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

Abstract

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. Key words: botulinum toxin, hemifacial spasm. toxina botulínica tipo A no tratamento do espasmo hemifacial: 11 anos de experiência resumo Para avaliar o efeito em longo prazo da toxina botulínica tipo A (TXB) no tratamento do espasmo hemifacial (EHF), foi feita uma análise retrospectiva de pacientes tratados no Ambulatório de Distúrbios do Movimento da Divisão de Clínica Neurológica -Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de 1993 a 2004. Um total de 808 aplicações de TXB foram administradas a 54 pacientes com EHF. A duração média de melhora foi de 3,46 meses e a taxa média de melhora segundo avaliação subjetiva do paciente foi de 83%. Efeitos adversos, em sua maioria menores, foram observados em 64,8% dos pacientes ao menos uma vez durante o seguimento e o mais freqüente foi paralisia do orbicular da boca (38,3%). Não se observou decremento na resposta quando se comparou a primeira com a última aplicação anotada. Palavras-chave: toxina botulínica, espasmo hemifacial.

Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated

“…These findings corroborate those published studies. 16,17,18,19,20,21,22,23,24 . The success rate in the present study was 94.73% when injections that did not produce any effect or produced a short-term or minor effect were excluded.…”

“…These data corroborate the findings of previously-published studies. 16,17 The high incidence of left HFS could be explained by congenital malformations in the vascular system located primarily on the HFS: hemifacial spasm; BTS-a: botulinum toxin type A. The results were compared with three clinical trials.…”

Evaluation of concentrations of botulinum toxin A for the treatment of hemifacial spasm: a randomized double-blind crossover trial

“…In 1980, Dr. Scott of the USA reported the application of BTX-A for the first time after successful treatment of strabismus using a local injection of BTX-A (Scott, 1980). Subsequently, this therapy was used for dystonia (Barbosa et al, 2010;Gill and Kraft, 2010;Wu et al, 2011;Van Der Walt et al, 2012;Czyz et al, 2013). Since the 1990s, local injection of BTX-A has been widely used in the treatment of hemifacial spasm in China and abroad and has shown good results, which was considered to be a major development in the field of neurological treatment (Simpson et al, 2008;Barbosa et al, 2010;Wu et al, 2011;Czyz et al, 2013).…”

“…Subsequently, this therapy was used for dystonia (Barbosa et al, 2010;Gill and Kraft, 2010;Wu et al, 2011;Van Der Walt et al, 2012;Czyz et al, 2013). Since the 1990s, local injection of BTX-A has been widely used in the treatment of hemifacial spasm in China and abroad and has shown good results, which was considered to be a major development in the field of neurological treatment (Simpson et al, 2008;Barbosa et al, 2010;Wu et al, 2011;Czyz et al, 2013). However, the concentrations used to treat hemifacial spasms are different at different institutions, and thus, consistent results about the efficacy and incidence of side effects have not been reported thus far (Simpson et al, 2008;Barbosa et al, 2010;Czyz et al, 2013;Mazlout et al, 2013).…”

“…Since the 1990s, local injection of BTX-A has been widely used in the treatment of hemifacial spasm in China and abroad and has shown good results, which was considered to be a major development in the field of neurological treatment (Simpson et al, 2008;Barbosa et al, 2010;Wu et al, 2011;Czyz et al, 2013). However, the concentrations used to treat hemifacial spasms are different at different institutions, and thus, consistent results about the efficacy and incidence of side effects have not been reported thus far (Simpson et al, 2008;Barbosa et al, 2010;Czyz et al, 2013;Mazlout et al, 2013). Majority of the previous clinical studies were retrospective and nonrandomized, with no control group and a low level of evidence; therefore, definite conclusions cannot be obtained (Simpson et al, 2008;Nestor and Ablon, 2011;Mazlout et al, 2013).…”