Response and compliance of botulinum toxin with or without oral treatment in hemifacial spasm

Abstract

Hemifacial spasm (HFS) is the commonest presentation than any other movement disorder in Botulinum Toxin (BoNT) therapy clinic. Objective: To evaluate response and compliance of BoNT in HFS. To observe the BoNT duration of therapy effect with or without oral treatment in HFS. Materials and Methods: This is a retrospectively carried out study at government medical college, Kota, Rajasthan. Seventy eight patients of HFS were evaluated out of 142 cases from movement disorder clinic who received BoNT therapy from December 2012 to January 2019. Patients were eligible if they were older than 18 years and clinically confirmed diagnosis of HFS. Results: Mean age was 48.5 ±4.32 years. Forty seven (60.25%) were female. Left hemifacial spasm was seen in 71.7%. Seventy percent of patients were having an initial response with oral medication. Total numbers of injections were 304 and average applications per patient were 3.89. The average dose per patient given was 22± 3.2 units. Latency and duration of effect of BoNT therapy were 9±2 days and 4.3 months respectively. Mean interval between injection and average follow up was 5.3 and 12.6 months respectively. The overall success rate was 94.78%. Adverse effect on the total application was 11.68%. Most common adverse effect was ptosis and average recovery period of all adverse effect was 9±5 days. One patient developed vaso-vagal syncope which recovered immediately. Comparision of BoNT therapy with continued oral treatment group and BoNT therapy alone was insignificant (P=0.925); however the duration of effect was longer with combined treatment than BoNT therapy alone. Conclusion:We suggest that response of treatment in HFS with BoNT along with oral medication support may be more effective as compared to BoNT alone however large study trials are to be needed. Compliance to BoNT therapy depends upon side effect profile and pharmacoeconomic burden.