Botulinum Toxin: Preferred Treatment for Hemifacial Spasm

Abstract

This paper retrospectively analyses the clinical data of 65 consecutive cases of hemifacial spasm. A benign etiology was clinically evident in the majority of cases. Neuroradiologic investigation ruled out serious intracranial pathology in atypical cases. Trials of oral medication in 26 patients were consistently unsuccessful. Fifty-one patients had repeated lid and facial muscle injections of botulinum toxin during a period of 8 years. The mean duration of effective relief from spasm following an initial treatment was 18.9 weeks. This effect did not diminish with repeated injections.

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

“…Although neurosurgical treatment is available, the potential complications and relatively high recurrence rate have made botulinum toxin A the preferred symptomatic treatment for HFS. [34][35][36][37][38][39] As HFS rarely remits spontaneously, 40 most patients need to continue BoNT-A treatment for many years, if not for the rest of their lives. The long-term efficacy and safety of BoNT-A are, therefore, increasingly important questions.…”

“…The long-term efficacy and safety of BoNT-A are, therefore, increasingly important questions. Few of the numerous published studies assessing BoNT-A treatment for HFS 34,36,37,40,41 included patients with serial treatment spanning several years and none had follow-up past 5 years.…”

Hemifacial spasm: Clinical findings and treatment

“…2,24,30,80 Some patients report immediate improvement after the injection, 30 but the average latency is 5 days. 55 The average duration of improvement following BTX-A was slightly over 4 months, consistent with the 12-20-week benefit duration reported in other series.…”

Is It Always Necessary to Apply Botulinum Toxin into the Lower Facial Muscles in Hemifacial Spasm? A Randomized, Single-Blind, Crossover Trial

“…Since 1985, when Elston [12] first tried BTX for HFS, it has consistently been reported in subsequent large series that BTX is clinically very effective in HFS, with a success rate of 76–100% [2,10,13]. Currently, BTX injections are regarded as the first choice in the medical treatment of HFS, but it is still debated whether BTX treatment of lower facial muscles should be performed or not.…”

“…Typically, the spasms begin in the orbicularis oculi muscle and may spread to the brow, mid and lower face, and platysma over several years [1]. Botulinum toxin (BTX) injections are accepted as a safe and efficacious modality for the treatment of HFS [2,3,4]. Nevertheless, there are controversies on lower facial applications of BTX.…”