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

Abstract

Hemifacial spasm (HFS) is a craniofacial movement disorder characterized by involuntary contractions of the muscles on one side of the face 1 . The most common site for the contractures is the orbicularis oculi muscle, but the corrugator supercilii, frontalis muscle, orbicularis oris, zygomaticus major and platysma can also be affected 2 . The condition is believed to be mainly due to a peripheral dysfunction of the facial nerve, occasionally associated with nerve compression by a blood vessel or tumor 3,4 . The pathophysiology, however, has yet to be fully elucidated as the condition can occur in the absence of structural alterations 3 . In a recent study, Wilkinson and Kaufmann 5 showed that HFS may be associated with central nervous system changes. Accordingly, one previous study from our group found similar profiles of obsessive and psychiatric symptoms in cases of HFS and blepharospasm, which is recognized as a movement disorders of A total of 550 BTX-A injections were administered to 100 HFS patients. Results: Mean duration of improvement following each injection session was 3.1 months, mean latency to detection of improvement was 7.1 days and mean success rate was 94.7%. Patients were evaluated at an interval of 5.8 months after each application. Adverse effects, which were mostly minor, were observed in 37% of the patients at least once during follow-up. The most frequent was ptosis (35.1%). Conclusion: Treatment of HFS with BTX-A was effective, sustainable and safe and had minimal, well-tolerated side effects.

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

“…Response to the treatment was similar to the earlier studies published in the various literature. 5,6,7 Success rate per injection in the present study was 94.78% which was comparable with a study done by J P M Batistti et al 8 and Pandey S et al 9 this reflects a high degree of patient satisfaction in the present study. Female preponderance with left sided lateralization was similar to other studies.…”

“…Mean latency of effect to appear was 9± 2 days while other studies showing lower (7.1 days) and some was having more mean latency (11.63days). [11][12][13] In the present study the average duration of effect was 4.3 months which was higher than the study performed by Batisti et al 8 Barbosa et al 10 and defazzio et al 14 Possible cause of longer duration was a continuation of oral treatment along with BoNT therapy. Although there was a similar duration of effect between first and last BoNT injection it endorsed the previous study 10,14 .…”

Botulinum Toxin in Movement Disorders: An Update

“…In another series, 98% of 130 patients with HFS patients experienced relief of symptoms after BoNT injection [ 182 ]. In a retrospective review of 100 HFS patients who were treated with a mean dose of 28 U of onabotulinumtoxinA and were followed for 4 years, showed a mean duration of effect of around 3.1 months and latency to onset of effect of 7.1 days [ 183 ]. There are numerous prospective and retrospective trial which evaluated the use of BoNTA injections that showed safety and benefit in patients with HFS [ 184 , 185 , 186 , 187 , 188 , 189 ].…”

Botulinum toxin type A therapy for hemifacial spasm

“…In all these studies, BtA was considered highly e ective, with a success rate of 76% to 100%. The mean duration of improvement ranged between 2.6 and four months (Batisti 2017). The most common adverse e ects reported…”