Botulinum Toxin for the Treatment of Hemifacial Spasm: An Update on Clinical Studies

Tambasco, Nicola; Filidei, Marta; Nigro, Pasquale; Parnetti, Lucilla; Simoni, Simone

doi:10.3390/toxins13120881

Cited by 22 publications

(17 citation statements)

References 63 publications

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“…The muscles affected by hemifacial spasm include the orbicularis oculi, zygomaticus major, zygomaticus minor, corrugator supercilli, levator labii superioris alaeque nasi, orbicularis oris, risorius depressor anguli oris, mentalis, and platysma. Guidance with electromyography (EMG) is required to ensure accurate injection placement in facial muscles, and dosages are typically increased based on the response to therapy [54].…”

Section: Hemifacial Spasmmentioning

confidence: 99%

Mechanism and clinical use of botulinum neurotoxin in head and facial region

et al. 2023

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Food-borne botulism, derived from the Latin term "botulus," which means "sausage," was first described in the 18 th century. The term was used to define a fatal condition characterized by muscular paralysis resulting in respiratory arrest upon the consumption of raw sausages [1]. Botulinum neurotoxins (BoNTs), which cause botulism, are zinc-dependent metalloproteases produced by an anaerobic, spore-forming, Gram-positive bacterium, Clostridium botulinum, and are classified into seven serotypes (BoNT/A-G) based on their antigenic properties. Apart from the seven distinct BoNTs, an additional serotype has been reported; however, further validation is required for confirmation [2,3].Naturally produced BoNTs are non-covalently associated with one or several non-toxic neurotoxin-associated proteins (NAPs) and form high molecular weight (up to ~900kDa) progenitor toxin complexes (PTCs) at an acidic pH. The PTCs dissociate into BoNTs and NAPs at neutral or alkaline pH. NAPs play a vital role in protecting fragile BoNTs from the harsh environment of the gastrointestinal tract and in facilitating the passage of BoNTs through the intestinal epithelial barrier. BoNT is released from PTCs after absorption from the intestinal epithelial barrier. Free BoNTs are transported to neuromuscular junctions (NMJs) via general circulation, subsequently inhibiting acetylcholine exocytosis and resulting in flaccid paralysis [4]. BoNTs are potent toxins and are currently being extensively researched, not only for their lethality but also for their potential use in therapeutic interventions owing to their safety, efficacy, and long duration of action. BoNT/A and BoNT/B are widely used in clinical practice [5].In the early 19 th century, the first toxin of BoNT (BoNT/A) was identified. Immediately after its discovery, it was widely used for developing biological weapons, given its effects on the nervous system, and it was studied extensively during the Second World War. The therapeutic use of BoNT in the medical field began in the late 19 th century [6,7]. Human use of BoNT was first attempted to treat strabismus (crossed eyes) in 1977 by Scott [6]. Since then, many medical practitioners have used BoNT to treat eyelid twitching and muscle spasms [8]. BoNT/A has also been used to treat neurological J Prosthodont Res. 2023; **(**):

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Section: Hemifacial Spasmmentioning

confidence: 99%

Mechanism and clinical use of botulinum neurotoxin in head and facial region

et al. 2023

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“…11 For palatal myoclonus and hemifacial spasm, botulinum toxin injections can be beneficial. 23,24 In some cases of hemifacial spasm, surgical decompression of cranial nerve VII may also be of benefit. 25 In cases of spinal segmental myoclonus that are not due to a structural lesion or where the structural lesion cannot be safely removed, levetiracetam and clonazepam may be beneficial.…”

Section: Treatmentmentioning

confidence: 99%

Assessment and Treatment of Myoclonus: A Review

Burton¹,

Dalrymple²,

Figari³

2022

Neurology

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Myoclonus is defined as sudden, brief, shock-like contractions of muscles, and it can be a challenging diagnosis for the clinician to face. The number of aetiologies can make it difficult to determine the appropriate diagnostic workup for each individual patient without ordering a broad array of diagnostic studies from the start. As with other neurological conditions, a comprehensive history and physical examination are paramount in generating and ordering the initial differential diagnosis. Neurophysiological classification of myoclonus, using both electroencephalogram and electromyography, can be very helpful in elucidating the underlying aetiology. Treatment of myoclonus is often symptomatic, unless a clear treatable underlying cause can be found. This article aims to help providers navigate the assessment and treatment of myoclonus, focusing on neurophysiological classification as a guide. By the end of this article, providers should have a good understanding of how to approach the workup and treatment of myoclonus of various aetiologies.

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“…For example, carbamazepine and clonazepam may be effective in some mild patients, but there are some side reactions, such as drowsiness, headaches, and dizziness ( 4 ). The botulinum toxin type A is another therapy to reduce the symptoms of HFS, but its effect can only last up to 3–6 months and long-term use requires increased doses ( 5 , 6 ). Previous studies reported that botulinum toxin type A can paralyze facial nerves and cause artificial facial paralysis ( 7 , 8 ), leading to a main long-term side effect of facial asymmetry ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Electroacupuncture on Hemifacial Spasm and Temporomandibular Joint Pain Co-Morbidity: A Case Report

et al. 2022

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Hemifacial spasm (HFS) and temporomandibular joint (TMJ) pain are common facial diseases which cause depression, anxiety, insomnia, and poor quality of life. However, currently there are still no effective therapies to treat HFS and TMJ. Electroacupuncture (EA) has advantages of safety, rapid work, easy operation and convenience. Here, we reported a case of a 50-year-old woman who presented with irregular spasm of eyelids and facial muscles on the left side, and TMJ pain on the right side. The patient had been treated with carbamazepine (20mg per day) and alternative therapies for a year, but still not much improvement in the symptoms. The scores of the Jankovic Rating Scale (JRS), global rating scale (GRS), and visual analog scale (VAS) were 7, 60, and 7 points, respectively. The EMG test showed that the spastic side had higher R1 amplitude, longer R2 duration, and larger R2 area than the non-spasmodic side, and the occurrence rate of the lateral spread responses (LSR) in the Orbicularis oris and the Orbicularis oculi muscle was 60% and 40%, respectively. We considered this patient had left HFS and right TMJ pain. EA was successfully undertaken for two periods over 30 weeks. After EA, JRS and VAS were reduced sharply, and the symptoms of HFS were stable without recurrence. However, the frequency of the lower eyelid increased gradually during the 6-month follow-up. These findings reveal that EA with the frequency of 2 Hz and intensity of ~ 1–2 mA may be a benefit for alleviating symptoms of HFS and TMJ pain without adverse reaction. The potential mechanisms of EA in HFS and TMJ pain co-morbidity involve brain stem mechanism and DNIC mechanism for distal acupuncture and segmental mechanism for local acupuncture analgesia.

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Botulinum Toxin for the Treatment of Hemifacial Spasm: An Update on Clinical Studies

Cited by 22 publications

References 63 publications

Mechanism and clinical use of botulinum neurotoxin in head and facial region

Mechanism and clinical use of botulinum neurotoxin in head and facial region

Assessment and Treatment of Myoclonus: A Review

Electroacupuncture on Hemifacial Spasm and Temporomandibular Joint Pain Co-Morbidity: A Case Report

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