Botulinum A Toxin Injection as a Treatment for Blepharospasm

Scott, Alan B.; Kennedy, Ross A.; Stubbs, Harrison A.

doi:10.1001/archopht.1985.01050030043017

Cited by 393 publications

(158 citation statements)

References 4 publications

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“…12 Since then, BoNT-A has replaced eyelid surgery as the first-line therapy for BEB, [13][14][15][16][17] and has become the treatment of choice, as it is very successful in controlling eyelid spasms. [17][18][19][20][21][22][23][24][25][26][27][28][29] Although some authors have reported decreasing effectiveness with prolonged use, 23,30 others have not observed this in the majority of patients. 24,31 There is no evidence that prolonged treatment has any adverse effects related either to the chemodenervation of adjacent non-target muscle groups by the toxin or to the injection technique.…”

Section: Introductionmentioning

confidence: 41%

Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes

Cillino

Raimondi

Guépratte

et al. 2009

Eye

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Purpose To investigate the long-term effectiveness and safety of botulinum neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation index percentage' (BEI-%), in the dose-escalation evaluation. Methods All patients in this multicentre study were followed for at least 10 years and main outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and frequency of adverse events. Results BEB, HFS, and EN patients received a mean BoNT-A dose with a significant intergroup difference (Po0.0005, respectively). The mean ( ± SD) effect duration was statistically different (P ¼ 0.009) among three patient groups. Regarding the BoNT-A escalation indexes, the mean ( ± SD) values of BEI-U and BEI-% were statistically different (P ¼ 0.035 and 0.047, respectively) among the three groups. In BEB patients, the BEI-% was significantly increased in younger compared with older patients (P ¼ 0.008). The most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and localized bruising. Conclusions This long-term multicentre study supports a high efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB patients compared with HFS or EN patients and a significantly greater BEI-% in younger vs older BEB patients. These results confirm a greater efficacy in the elderly and provide a framework for long-term studies with a more flexible and reliable evaluation of drug-dose escalation.

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Section: Introductionmentioning

confidence: 41%

Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes

Cillino

Raimondi

Guépratte

et al. 2009

Eye

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“…The corrugator and procerus muscles are intramuscularly injected. The orbicularis oculi is commonly injected at five locations, with an initial total dose of approximately 12.5-20 U of Botox ® per eye (4,20). The standard treatment techniques involve injection into four sites around each eye with two in the upper lid, one medially, and one laterally near the canthus.…”

Section: B -P R E B -P O S T D -P O S T D -P R Esupporting

confidence: 39%

“…Currently, two of these seven serotypes are commercially available: type A (Botox ® , Dysport . BTX development has markedly altered BS treatment (4). When BTX is injected into overactive muscles, acetylcholine release is inhibited at the neuromuscular junction, which results in reduced contractions.…”

Section: Introductionmentioning

confidence: 39%

OnabotulinumtoxinA (Botox®) and AbobotulinumtoxinA (Dysport®) in Treating Essential Blepharospasm: Long Term Results

Nuhoglu¹,

Ozdemir²,

Karademir³

et al. 2016

JAREM

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Methods: A total of 100 eyes of 78 patients who were diagnosed with blepharospasm were evaluated during a retrospective, randomized, parallel group study. The severity of spasm, eyelid closing force, and functional visual status scores were used as quantitative measures of the change in clinical status. Side effects (ptosis, dry eye, ocular foreign body sensation, headache, eyelid edema, pain, and ocular irritation) were collected using a systematic questionnaire.

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“…5 A variety of treatments are available for facial dystonias: treatment of dry eye symptoms, referral to patient groups, 3 treatment with drugs including antidepressants, anxiolytics, anticonvulsants, anti-Parkinson drugs, and muscle relaxants, 6 and surgery including facial nerve avulsion, 7 orbicularis oculi myectomy, [8][9][10] and brow suspension. 11,12 Since the mid-1980s, the treatment of facial dystonias has been revolutionised following the introduction of botulinum toxin, 13 which has been shown to be very effective in the treatment of benign essential blepharospasm and hemifacial spasm. 14 However, difficulties remain; it is difficult to determine the appropriate dose for an individual patient, and also to manage refractory cases.…”

Section: Introductionmentioning

confidence: 99%

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

Ortisi

Henderson

Bunce

et al. 2006

Eye

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Purpose To evaluate a protocol for the treatment of facial dystonias. Method A retrospective noncomparative interventional case series of all patients who attended a specialised tertiary referral clinic between January 2000 and January 2003. At the start of treatment, patients were seen and treated at weekly intervals until their symptoms were controlled or they developed complications. The sum of the weekly doses was taken as the individual patient dose and then given at 3-4 monthly intervals as required for the individual patient. Refractory cases of spasm underwent orbicularis muscle reduction. Pretarsal spasm was treated with pretarsal botulinum toxin. If the spasm was relieved but the patient could not open their eyelids, a trial of ptosis props was undertaken and the toxin injections continued, before considering a brow suspension. If patients could not see because of a spastic Bell's phenomenon, they were given centrally acting systemic medication. Results Of 182 new patients, 63 (35%) required two or more sets of injections to titrate their optimum dose of toxin. Symptoms improved in 169 patients (93%). Of a total 332 new patients and follow-up patients, 47 (14%) underwent surgery during their management, 36 protractor myectomy, and 13 brow suspension. Protractor myectomy improved symptoms in 23 (64%). Brow suspension improved symptoms in 12 patients (92%). Conclusions The dose of botulinum toxin can be titrated to the individual patient, and the refractory cases managed satisfactorily if a logical protocol is followed. Eye (2006) 20, 916-922.

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Botulinum A Toxin Injection as a Treatment for Blepharospasm

Cited by 393 publications

References 4 publications

Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes

Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes

OnabotulinumtoxinA (Botox®) and AbobotulinumtoxinA (Dysport®) in Treating Essential Blepharospasm: Long Term Results

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

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