Botulinumtoxin – Therapie des Spasmus hemifacialis: Ein Update

Abstract

ZusammenfassungDie Injektion von Botulinumtoxin gilt beim Spasmus hemifacialis (SHF) mittlerweile als Therapie der Wahl. Alle 3 Botulinumtoxin-A Präparate sind für diese Indikation zugelassen. Der SHF ist eine häufige Erkrankung, die gekennzeichnet ist durch unwillkürliche Kontraktionen der vom Nervus facialis innervierten Muskulatur einer Gesichtshälfte. Die Symptome können tonisch oder klonisch, intermittierend oder permanent auftreten. Die Diagnosestellung erfolgt klinisch. Zur Ausschlussdiagnostik sollte eine Magnetresonanztomografie des Schädels eingesetzt werden, die einen pathologischen Nerv-Gefäß-Kontakt nachweisen und alternative Ursachen ausschließen kann.

Clinical Application of Botulinum Toxin for Hemifacial Spasm

“…As nerve terminals regenerate and form new connections, muscle contractions gradually resume. BoNT is broken down enzymatically within the body, predominantly by proteases, and its metabolites are eliminated through regular metabolic pathways [ 2 , 10 , 11 ].…”

“…The dosage of BoNT varies depending on factors such as muscle size, severity of symptoms, and individual response. The initial dosage is often conservative, with subsequent adjustments made based on the patient’s response and tolerability, i.e., start with lower doses and gradually increase if necessary [ 2 , 3 , 11 , 12 ]. Currently, total doses recommended for HFS for each session should range accordingly: 10–34 unit for Onabotulinumtoxin A, 53–160 unit for Abobotulinumtoxin A, and 1250–9000 unit for Rimabotulinumtoxin B.…”

“…The therapeutic effect begins at about 3–6 days after treatment and can persist for 2–3 months. Intervals of 3 months between injections are generally recommended [ 2 , 3 , 11 , 12 ]. Usual doses of Botulinum toxin A per site are summarized in Table 1 .…”

“…Precise injection technique is crucial for optimal results, which requires identifying the specific muscles involved in the spasm and administering injections directly into those muscles. The dosage and injection sites may vary depending on individual needs, but commonly targeted muscles include the orbicularis oculi, zygomaticus, orbicularis oris muscles, and depressor anguli oris muscle [2,3,11,12] (Figure 1). Orbicularis oculi muscle: This muscle surrounds the eye and is responsible for eyelid closure.…”

“…Hemifacial spasm (HFS) is a neurological disorder characterized by involuntary contractions of muscles on one side of the face [ 1 , 2 , 3 , 4 ]. Its primary symptom involves repetitive, involuntary twitching or spasms of the facial muscles, typically initiating around the eye and potentially spreading to other muscles on the affected side.…”