Long term results of botulinum toxin type A (Dysport) in the treatment of hemifacial spasm: a report of 175 cases

Abstract

Objective-To describe the long term eYcacy and side eVects of the treatment of hemifacial spasm with Dysport and to evaluate two diVerent sites of injection to hopefully reduce side eVects. Methods-This study was designed as a prospective descriptive study. Injections were made subcutaneously around the eye. Peak improvement was subjectively assessed by using a visual analogue scale and reported in percentages (0-100%). Duration of improvement was assessed subjectively and reported in months. Results-Of 175 cases, 17 were lost to follow up and were excluded. 855 treatments were injected in the remaining 158 patients with a median of 4 treatments. The response rate was 97%. Of 855 treatments, the adjusted mean peak and duration of improvement was 77.2 (95% confidence interval (95%CI) 74.7-79.4)% and 3.4 (95%CI 3.2-3.6) months respectively. In 158 patients (complete group), the long term results from the first to the 12th treatment showed that the mean peak improvement ranged from 72.70 to 80.10% and the duration of improvement was 2.60 to 3.71 months. It remained constant throughout (p=0.40, p=0.87 respectively). The most common side eVect was ptosis. Of the 158 patients, 21 completed 12 treatments (subgroup). A separate analysis of this group disclosed a mean peak and duration of improvement from the first to 12th treatments ranging from 70.00 to 78.10% and 2.65 to 4.31 months respectively. Analysis of variance with repeated measures showed no significant variation of peak and duration of improvement over the first to the 12th treatments (p=0.38, p=0.38 respectively). Only 3% of the treatments were unsuccessful but responded to subsequent treatments. The incidence of ptosis was reduced from 27.17% to 9.68% by moving the injection site to the lateral part of orbital orbicularis oculi without any loss of eYcacy. The yearly cost of Dysport is considerably less than Botox. Conclusion-This study is the first to show, in detail, the long term results of treatments of hemifacial spasm with Dysport. The eYcacy is constant throughout the first to 12th treatments in both the complete group and subgroup. Ptosis can be reduced by moving the injection site further up to the lateral part of the orbital orbicularis oculi. The eYcacy of Dysport is comparable with Botox ® in long term follow up. (J Neurol Neurosurg Psychiatry 1998;64:751-757)

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

“…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.…”

Toxina botulínica no tratamento de distonias faciais: avaliação da eficácia e da satisfação dos pacientes ao longo do tratamento

“…Existem dúvidas se a aplicação repetida de TBA poderia causar tolerância no indivíduo ao longo do tempo. Alguns autores (8) relatam em seu estudo que foi necessário aumentar a dose da TBA em 50% para manter os 3 a 4 meses de alívio dos sintomas ao longo de injeções repetidas. Uma das hipóteses para esse declínio da eficácia seria devido à produção de anticorpos contra a TBA (9) .…”

“…Methods: Retrospective study of 42 facial dystonia cases followed at the Oculoplastic Surgery Department of the "Hospital das Clínicas" of the University of São Paulo. Results: Following the first injections, 45.2% of the patients scored the improvement of the spasms between 9-10, 35.7% scored between [7][8]16.7% between 5-6 and only one patient scored the improvement of the spasm as 4. According to the remission time of the symptoms, 4.8% of the patients reported between 5-6 months, 64.2% between 3-4 months and 31% reported the need for a new injection after 1-2 months of the previous injection.…”

Espasmo hemifacial bilateral: relato de caso

“…O tratamento sintomático não invasivo mais eficaz do espasmo hemifacial consiste em injeções de toxina botulínica tipo A em intervalos de três a quatro meses conforme a resposta clínica 1,8,20,21 . A melhora sintomática dura em média 12 semanas 20,21 .…”

“…A melhora sintomática dura em média 12 semanas 20,21 . Efeitos colaterais como ptose, lagoftalmo e inversão do lábio superior são transitórios e estão relacionados com maior difusão da droga para áreas pró-ximas e com a dose utilizada.…”