What is new in the era of focal dystonia treatment? Botulinum injections and more

Purpose To investigate the long-term effectiveness and safety of botulinum neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation index percentage' (BEI-%), in the dose-escalation evaluation. Methods All patients in this multicentre study were followed for at least 10 years and main outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and frequency of adverse events. Results BEB, HFS, and EN patients received a mean BoNT-A dose with a significant intergroup difference (Po0.0005, respectively). The mean ( ± SD) effect duration was statistically different (P ¼ 0.009) among three patient groups. Regarding the BoNT-A escalation indexes, the mean ( ± SD) values of BEI-U and BEI-% were statistically different (P ¼ 0.035 and 0.047, respectively) among the three groups. In BEB patients, the BEI-% was significantly increased in younger compared with older patients (P ¼ 0.008). The most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and localized bruising. Conclusions This long-term multicentre study supports a high efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB patients compared with HFS or EN patients and a significantly greater BEI-% in younger vs older BEB patients. These results confirm a greater efficacy in the elderly and provide a framework for long-term studies with a more flexible and reliable evaluation of drug-dose escalation.

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“…Although botulinum neurotoxin injections are currently the mainstay of therapy, other therapies are on the horizon. 17,38,46,63,64 …”

Section: Discussionmentioning

confidence: 99%

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

Cillino

Raimondi

Guépratte

et al. 2009

Eye

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“…This highlights the temporary nature of the treatment and the frequency with which patients must re‐attend. It has been reported in the literature that patients with HFS have a generalized facial weakness underlying the spasms, 10 which may account for the fewer BTX treatments required. Hall et al 6 .…”

Section: Discussionmentioning

confidence: 99%

Difference in response to botulinum toxin type A treatment between patients with benign essential blepharospasm and hemifacial spasm

Cannon

MacKenzie

Cook

et al. 2010

Clinical Exper Ophthalmology

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“…This aberrant cycle becomes self-perpetuating as the resultant eyelid spasms create further irritation of the eyes, which will act as sensory stimuli [3]. Sensory triggers for BEB include bright light and ocular irritation [3, 8, 16]. Both FL41-tinted and grey-tinted lenses can significantly improve blepharospasm [9, 11].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, just as in facial palsy-induced blepharospasm, where in an isolated case we first found the BOF to be effective, patients with HFS also tend not to be light-sensitive or photophobic [12]. Interestingly, prior facial-palsy has been recognised in up to 1 in 4 cases of HFS and perhaps electrophysiology may play a more valuable role in identifying such patients and possibly helping further understand the basis of occlusion-positivity [15, 16]. However, we have also anecdotally observed that some patients with HFS experience reduction in their lower facial as well as eyelid spasm from wearing FL-41 tinted spectacle lenses.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Bangerter Occlusion Foils on Blepharospasm and Hemifacial Spasm in Occlusion-Positive and Occlusion-Negative Patients

Malhotra

Then²,

Richards³

et al. 2010

TOOPHTJ

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Objective:To test the hypothesis that occlusion-positive (OP) patients with blepharospasm (BEB) or hemifacial spasm (HFS) will benefit from a Bangerter occlusion foil (BOF), compared to occlusion-negative (ON) patients. OP/ON was based on immediate improvement in spasm with placement of a hand in front of either eye.Design:Prospective non-randomised single-centre pilot study.Participants:Fifteen-patients (6 BEB, 9 HFS).Methods:Patients were identified as OP or ON and wore highest-density BOF tolerable over one spectacle lens for 1 month. Outcomes were assessed at 1 month.Main Outcome Measures:Validated quality-of-life questionnaire (CDQ-24), scores of blink-rate and spasm severity assessed by two observers from video-recordings.Results:OP group had mean improvement in all scores. There was no change or worsening of scores in the ON group. In both BEB and HFS, more OP patients reported subjective benefit from wearing a foil (2 of 4 BEB, and 2 of 2 HFS) compared to the ON group (0 of 2 BEB, and 1 of 7 HFS).Conclusion:OP patients with BEB and HFS are more likely to experience improvement in spasms from wearing a BOF compared to ON patients. The occlusion test should be considered on all patients with BEB or HFS.

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What is new in the era of focal dystonia treatment? Botulinum injections and more

Abstract: There have been recent therapeutic developments in the treatment of ocular dystonias.

Cited by 6 publications

References 58 publications

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

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

Difference in response to botulinum toxin type A treatment between patients with benign essential blepharospasm and hemifacial spasm

The Effect of Bangerter Occlusion Foils on Blepharospasm and Hemifacial Spasm in Occlusion-Positive and Occlusion-Negative Patients

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