Long-term therapy of benign essential blepharospasm and facial hemispasm with botulinum toxin A: retrospective assessment of the clinical and quality of life impact in patients treated for more than 15 years

Abstract

Botulinum toxin type A (BoNT-A) is recognized as the treatment of choice for patients with blepharospasm and facial hemispasm. We report the results of long-term BoNT-A therapy (15-20 years) in a group of patients with blepharospasm (9 patients) and hemifacial spasm (18 patients). We evaluated the number of treatment sessions, duration of therapeutic effects, side effects and their frequency during long-term therapy, and the differences between these two groups of patients. We used patient self-assessment and a patient questionnaire to evaluate the influence of the treatment on their quality of life. We have concluded that BoNT-A is an effective and safe long-term treatment of these facial dyskinesias. Despite the different pathophysiology of blepharospasm and facial hemispasm, the therapy effectiveness is comparable. The only differences were in the side effects. In patients with blepharospasm, the side effect frequency was higher and manifested by double vision or eyelid ptosis. In patients with facial hemispasm, the most frequent side effect was lower facial weakness. No association between therapy duration and side effect frequency was determined. Based on patient questionnaires, all patients believed that the treatment was safe and effective with a positive impact on their quality of life, especially in social communication.

Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated

“…These findings corroborate those published studies. 16,17,18,19,20,21,22,23,24 . The success rate in the present study was 94.73% when injections that did not produce any effect or produced a short-term or minor effect were excluded.…”

Blepharospasm 40 years later

“…Botulinum neurotoxin type A is considered the first‐line drug in the treatment of blepharospasm . Side effects such as transient ptosis, blurring of vision, or diplopia are relatively uncommon and usually improve spontaneously in a few weeks; long‐term efficacy of botulinum neurotoxin type A treatment in blepharospasm has also been documented . Despite apparently very good motor responses, however, several patients did not show satisfaction and consistent changes in quality of life .…”

Applications of Botulinum Toxin at a Neurology Clinic: An Eleven-year Experience

“…HFS is a chronic condition that rarely remits spontaneously. It significantly disfigures the face and thereby causes an important social handicap for patients and complicates social fulfillment and communication (12). BoNT type A plays an important role in the treatment of HFS because the recommended drugs usually have poor, brief, or no effect, and frequent adverse effects.…”

“…BPS substantially limits work capability, results in functional blindness, reduces a patient's quality of life, and requires long-term treatment. BoNT is currently the most common treatment modality in BPS (12). Silveira-Moriyama et al (18) analyzed a total of 379 treatments with BoNT type A in 30 patients with BPS.…”