Long-term stable efficacy of botulinum toxin A in facial movement disorders with no need for increasing dose

Abstract

Botulinum toxin A is considered an effective treatment for involuntary facial movements. We examined whether treatment efficacy maintained or changed over time with two products, Botox and Dysport, in patients with hemifacial spasm, facial synkinesis and benign essential blepharospasm. We retrospectively investigated 87 consecutive patients (51 women, 36 men) who had undergone treatment for ≥6 years. Long-term effects, as well as side effects of Botox or Dysport local injections were evaluated. The first three treatments were considered the titration period and not taken into account when testing for dose changes. Mean treatment duration was 10 years (range 6–11, SD 1.0), 2441 treatments were administered, 1162 with Botox and 1279 with Dysport, the two brands were interchanged as needed. Good to full improvement was seen in 90% of patients both with both brands. Injection doses and treatment responses were consistent during the study with both drugs. No major side effects were reported, and relatively few minor adverse events were reported, with clear reduction from the titration period (6.1%), to the remainder of the study (3.9%). Botulinum toxin (BTX-A) is a satisfactory long-term treatment without need for dose increase over. Both Botox and Dysport were effective when used interchangeably.

Ultra-Long-Term Therapy of Benign Essential Blepharospasm with Botulinumtoxin A—30 Years of Experience in a Tertiary Care Center

“…Although some long-term studies are found in the literature, these analyses usually cover shorter observation periods and smaller patient collectives. A comparison with published studies demonstrates that the present study, with a total of 1940 patients treated for BEB with botulinum toxin A, of whom 234 received long-term treatment with onabotulinum toxin A, represents the largest patient population investigated, with the highest number of injections administered, and with the longest treatment period of up to 30 years (Table 2) [14,16,19,20]. Another publication on long-term use of BoNT-A by Badarny et al was not included in the table below because of a lack of comparability, as this analysis was performed only for a group of patients, which also included 42 patients with hemifacial spasm and 19 with facial synkinesis in addition to the 26 patients with BEB.…”

“…Furthermore, patients were treated with either Botox or Dysport, depending on availability. Only eight patients were treated with Botox alone, and no data on subjective duration were available [20]. Another important aspect of our study is the standardized documentation and uniform treatment of all patients following the same injection regimen over the entire course of treatment.…”

“…Double vision is described in the literature as a transient side effect after botulinum toxin injections [9,14,20,25], and we are not aware of any studies describing an increase in this adverse event in the (ultra-) long term. In addition, in our study, double vision remained stable at a low level over the course of up to 80 injections, with a marked increase only thereafter.…”

Botulinum Toxins and Zinc: From Theory to Practice—A Systematic Review

“…4 In 2002, BoNT was also approved for the treatment of glabellar lines. 4 Later, more indications for the use of BoNT emerged such as neuropathic pain, 5 depression, 6 facial movement disorders, 7 axillary bromhidrosis, 8 gummy smile, 9 and many dermatological conditions such as acantholytic disorders (Hailey-Hailey disease) 10 and Raynaud syndrome. 11 Recently, specialists and patients have noticed that closer sessions and more injections of BoNT were needed to obtain satisfactory results in both medical and esthetic fields.…”