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Duarte A, Coutinho L, Germiniani FMB, Teive HAG. Effects of onabotulinum toxin type A injections in patients with Meige's syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-7. [PMID: 38641339 PMCID: PMC11031253 DOI: 10.1055/s-0044-1785691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/07/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Meige's syndrome is a type of facial dystonia characterized by the simultaneous occurrence of blepharospasm and oromandibular dystonia. Although botulinum toxin type A (OBTA) injections are the standard treatment, evidence of their effectiveness and safety in this scenario is still lacking. OBJECTIVE Our research aimed to evaluate the improvement and occurrence of side effects following injections of onabotulinum toxin type A (OBTA) in patients with Meige's syndrome. METHODS Patients with Meige's syndrome undergoing botulinum toxin injections were enrolled in this study. We assessed dystonia intensity before and 14 days after OBTA injection using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) to measure the response of symptoms in the eyes (blepharospasm) and mouth (oromandibular dystonia). Other variables, such as dosage, side effects, and demographic data, were also recorded. RESULTS The study included 41 participants, with a mean age of 67.7 years and a female-to-male ratio of 3.5:1. The mean BFMDRS score before the injections was 8.89, and after 14 days, it was 2.88. The most reported side effect was ptosis, with a 7.3% incidence. OBTA significantly reduced dystonia severity (p < 0.0001). The clinical response for the blepharospasm component was superior to the oromandibular dystonia component. CONCLUSION Our results support that OBTA seems to be an effective and safe therapeutic option for treating Meige's syndrome. The effect of OBTA was more pronounced in the treatment of blepharospasm than in oromandibular dystonia.
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Affiliation(s)
- Alexia Duarte
- Universidade Federal do Paraná, Setor de Ciências da Saúde, Curitiba PR, Brazil.
| | - Léo Coutinho
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna, Curitiba PR, Brazil.
| | | | - Hélio Afonso Ghizoni Teive
- Universidade Federal do Paraná, Setor de Ciências da Saúde, Curitiba PR, Brazil.
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Clínica Médica, Setor de Neurologia, Curitiba PR, Brazil.
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Li X, Su L, Zhao Y. Sjogren's syndrome meets Meige's syndrome. J Neuroimmunol 2024; 387:578264. [PMID: 38134494 DOI: 10.1016/j.jneuroim.2023.578264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
This report details a rare case where a patient simultaneously suffered from Sjogren's syndrome (SS) and Meige's syndrome (MS). SS, an autoimmune disorder, and MS, a rare neurological condition characterized by involuntary eyelid closure, presented in a 73-year-old male. The patient had been experiencing dry eye symptoms for the past 5 years, with the onset of eyelid spasms and tetanic eye closure occurring 3 years ago. Traditional treatments, including subthalamic nucleus deep brain stimulation, provided only temporary relief. Diagnostic evaluations, including blood tests and imaging, confirmed SS and MS coexistence. Treatment involved a combination of steroids, immunosuppressants, and immunoglobulin, leading to significant symptom relief. This case suggests a potential association between SS and the development of MS, highlighting the importance of immunomodulatory therapy in managing neurological symptoms. Further research is needed to explore the relationship between these two conditions and to develop more effective treatment strategies.
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Affiliation(s)
- Xuemei Li
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Li Su
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Yi Zhao
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China.
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Jing C, Chen L, Huang X. Meta-analysis of botulinum toxin in the treatment of benign prostatic hyperplasia. Minerva Surg 2024; 79:117-119. [PMID: 35023701 DOI: 10.23736/s2724-5691.21.09273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Chao Jing
- Department of Anus and Intestine Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Li Chen
- Department of Anus and Intestine Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Xuefeng Huang
- Department of Anus and Intestine Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China -
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Ban A, Roman R, Bran S, Băciuț M, Dinu C, Crasnean E, Almășan O, Hedeșiu M. Botulinum Toxin Injection into the Digastric Muscle: Current Clinical Use and a Report of Five Cases. Biomedicines 2023; 11:2767. [PMID: 37893140 PMCID: PMC10604337 DOI: 10.3390/biomedicines11102767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
The present research aimed to review the clinical applications of botulinum toxin-A (BTX-A) injection into the anterior belly of the digastric muscle (ABDM) and to highlight the potential role of the BTX-A injection into ABDM in preventing postsurgical relapse. Five Class II malocclusion patients who underwent orthognathic surgery received BTX-A injections into both ABDM for the prevention of postoperative relapse. The relapse was evaluated using lateral cephalometric radiographs by comparing the postoperative cephalometric analyses at two different time points, postoperatively at 2 weeks (T1), and long-term, at 9 months after the surgical intervention (T2). The results demonstrated no significant differences between T2 and T1 for the Selle-Nasion-point A (SNA) angle, Selle-Nasion-point B (SNB) angle, point A-Nasion-point B (ANB) angle, mandibular length, and sagittal mandibular position. The patients exhibited stable occlusion without any signs of relapse after the surgery. A single BTX-A injection into the ABDM can effectively prevent postoperative relapse in Class II malocclusion patients, following orthognathic surgery. From a clinical perspective, in case of optimal dosage and procedure, BTX-A injection could be considered as the primary option for the prevention of postsurgical relapse for Class II malocclusion patients.
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Affiliation(s)
- Alina Ban
- Department of Maxillofacial Surgery and Radiology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Raluca Roman
- Department of Maxillofacial Surgery and Radiology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Simion Bran
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Mihaela Băciuț
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Emil Crasnean
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Oana Almășan
- Department of Prosthetic Dentistry and Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Mihaela Hedeșiu
- Department of Maxillofacial Surgery and Radiology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
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Park JS, Park K. Operative Findings of over 5000 Microvascular Decompression Surgeries for Hemifacial Spasm: Our Perspective and Current Updates. Life (Basel) 2023; 13:1904. [PMID: 37763307 PMCID: PMC10533158 DOI: 10.3390/life13091904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Hemifacial spasm (HFS) is a hyperactive cranial neuropathy, and it has been well established that the cause of primary HFS is compression on the root exit zone (REZ) of the facial-vestibulocochlear nerve complex (CN VII-VIII) by a vessel or vessels. MVD is the only curative treatment option for HFS with a high success rate and low incidence of recurrence and complications. We categorize six classical compressive patterns on the REZ as well as five challenging types. Knowledge of these patterns may help in achieving a better surgical outcome.
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Affiliation(s)
- Jae Sung Park
- Department of Neurosurgery, Konyang University Hospital, 158, Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea;
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Higher betweenness and degree centrality in the frontal and cerebellum cortex of Meige's syndrome patients than hemifacial spasm patients. Neuroreport 2023; 34:102-107. [PMID: 36608166 DOI: 10.1097/wnr.0000000000001865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Meige's syndrome and hemifacial spasm (HFS) are two different forms of dystonic movement disorder, but their difference in terms of resting state functional connectivity (rsFC) remains unclear. The present study applied resting state fMRI on the patients and quantified their functional connectivity with graph theoretical measures, including the degree centrality and the betweenness centrality. Fifteen Meige's syndrome patients and 19 HFS patients matched in age and gender were recruited and their MRI data were collected. To analyze the rsFC, we adopted the Anatomical Automatic Labeling (AAL) template, a brain atlas system including 90 regions of interest (ROIs) covering all the brain regions of cerebral cortex. For each participant, the time-course of each ROI was extracted, and the corresponding degree centrality and betweenness centrality of each ROI were computed. These measures were then compared between the Meige's syndrome patients and the HFS patients. Meige's syndrome patients showed higher betweenness centrality and degree centrality of bilateral superior medial frontal cortex, the left cerebellum cortex, etc. than the HFS patients. Our results suggest that the rsFC pattern in Meige's syndrome patients might become more centralized toward the prefrontal and vestibular cerebellar systems, indicating less flexibility in their functional connections. These results preliminarily revealed the characteristic abnormality in the functional connection of Meige's patients and may help to explore better treatment.
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Huang B, Du XD, Yao M, Lin HD, Yu WH, Zhou QH. CT-guided radiofrequency ablation of the extracranial cranial nerve for the treatment of Meige’s syndrome. Front Neurosci 2022; 16:1013555. [DOI: 10.3389/fnins.2022.1013555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMeige’ s syndrome, a rare form of dystonia, lacks effective treatment. The purpose of this study was to determine the effects of CT-guided percutaneous extracranial radiofrequency ablation of the facial and/or trigeminal nerves in the treatment of Meige’s syndrome.MethodsA total of 10 patients were enrolled in this study, with the numbers of blepharospasm dystonia syndrome (BDS), oromandibular dystonia syndrome (ODS), and blepharospasm combined with oromandibular dystonia syndrome (B-ODS) being 7, 1, and 2, respectively. BDS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve; ODS patients underwent radiofrequency ablation of the bilateral foramen oval trigeminal mandibular branch, and B-ODS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve and foramen oval trigeminal mandibular branch. The therapeutic effects and complications were observed.ResultsAll 10 patients in this series experienced improved Meige’s syndrome-related symptoms after extracranial radiofrequency ablation of the cranial and/or mandibular branches of the extracranial trigeminal nerve. Adverse events included class II–III facial paralysis and/or mandibular skin numbness. Two patients had recurrences at the 18th and 22nd months postoperatively, respectively; the other patients were being followed up.ConclusionThese results shown that CT-guided radiofrequency ablation of bilateral stylomastoid foramen facial nerve and/or oval foramen trigeminal mandibular branch can effectively treat the corresponding types of Meige’s syndrome. According to preliminary observations, the therapeutic effect may last more than 18 months.
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Ghadery CM, Kalia LV, Connolly BS. Movement disorders of the mouth: a review of the common phenomenologies. J Neurol 2022; 269:5812-5830. [PMID: 35904592 DOI: 10.1007/s00415-022-11299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
Movement disorders of the mouth encompass a spectrum of hyperactive movements involving the muscles of the orofacial complex. They are rare conditions and are described in the literature primarily in case reports originating from neurologists, psychiatrists, and the dental community. The focus of this review is to provide a phenomenological description of different oral motor disorders including oromandibular dystonia, orofacial dyskinesia and orolingual tremor, and to offer management strategies for optimal treatment based on the current literature. A literature search of full text studies using PubMed/Medline and Cochrane library combined with a manual search of the reference lists was conducted until June 2021. Results from this search included meta-analyses, systematic reviews, reviews, clinical studies, case series, and case reports published by neurologists, psychiatrists, dentists and oral and maxillofacial surgeons. Data garnered from these sources were used to provide an overview of most commonly encountered movement disorders of the mouth, aiding physicians in recognizing these rare conditions and in initiating appropriate therapy.
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Affiliation(s)
- C M Ghadery
- Division of Neurology, Department of Medicine, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - L V Kalia
- Division of Neurology, Department of Medicine, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - B S Connolly
- Division of Neurology, Department of Medicine, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
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Girard B, Begnaud S. [Dry eye and qualitative tear alteration in essential blepharospasm]. J Fr Ophtalmol 2022; 45:288-297. [PMID: 35148903 DOI: 10.1016/j.jfo.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We aimed to analyze the tears of patients with Benin Essential Blepharospasm (BEB) to explore possible corneo-conjunctival mechanisms for photophobia, tear deficiency and ocular pain. METHODS Using an observational cohort of 42 patients diagnosed with BEB, we performed Schirmer's testing, measurement of tear film pH, tear film protein electrophoresis and conjunctival impression cytology. RESULTS Schirmer's testing showed dry eye (8.4±9.7mm) with 71.3% eyes having a Schirmer's score<10mm. Surprisingly, the pH was basic (8.4±0.4) and was improved in patients receiving the standard treatment of quarterly botulinum toxin injections (8.32±0.36 for treated patients vs. 8.74±0.53 for untreated patients; P=0.045). Together, tear protein electrophoresis and conjunctival impression cytology showed conjunctival inflammation associated with BEB. CONCLUSION For the first time, this study emphasizes corneo-conjunctival mechanisms to explain the photophobia, dry eye and pain in Benign Essential Blepharospasm. While encouraging, complementary studies remain necessary to evaluate the effect of correcting tear film pH and inflammation on the quality of life of blepharospasm patients.
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Affiliation(s)
- B Girard
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France.
| | - S Begnaud
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France; École de l'Inserm, fondation Bettencourt-Schueller, Paris, France
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Wabbels B, Fimmers R, Roggenkämper P. Ultra-Long-Term Therapy of Benign Essential Blepharospasm with Botulinumtoxin A-30 Years of Experience in a Tertiary Care Center. Toxins (Basel) 2022; 14:120. [PMID: 35202148 PMCID: PMC8875585 DOI: 10.3390/toxins14020120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 02/06/2023] Open
Abstract
Aim of this study was to investigate the long-term results of botulinum toxin A (BoNT-A) injections for the treatment of benign essential blepharospasm (BEB) and to report our experience with (ultra-)long-term treatment with onabotulinumtoxin-A. We conducted a retrospective cross-sectional analysis at a university hospital. Patients with BEB and BoNT-A treatment were assigned to the Total Blepharospasm Group, patients with ≥21 onabotulinumtoxin-A injections to the Ona Long-Term Group. The Total Blepharospasm Group (n = 1940) included 33,933 BoNT-A injections. The age of patients at symptom onset was (mean ± SD) 58.0 ± 13.1 years, and 70.4% were female. The Ona long-term group (n = 234) included 10,632 onabotulinumtoxin-A injections. In this group, patients received 45.4 ± 22.9 injections with a mean dose of 22.2 IU ± 0.5. The duration of treatment was 12.6 ± 5.4 years, ranging from 2.9 to 30.0 years. The effect-duration-dose quotient did not change during long-term treatment. The observed side effects were comparable in type and frequency to other studies, even with the (ultra-)long treatment with onabotulinumtoxin-A. Our results, based on one of the largest patient populations and a treatment duration of up to 30 years, impressively demonstrate that onabotulinumtoxin-A is a safe and effective therapy for essential blepharospasm, even in the ultra-long term.
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Affiliation(s)
- Bettina Wabbels
- Department of Ophthalmology, University Hospital of Bonn, Ernst-Abbe-Street 2, D-53127 Bonn, Germany;
| | - Rolf Fimmers
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, D-53127 Bonn, Germany;
| | - Peter Roggenkämper
- Department of Ophthalmology, University Hospital of Bonn, Ernst-Abbe-Street 2, D-53127 Bonn, Germany;
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Czyz CN, Burns JA, Bergstrom RE. Antibody Development in Patients Treated Long-Term With OnabotulinumtoxinA for Benign Essential Blepharospasm and Hemifacial Spasm. J Neuroophthalmol 2021; 41:e684-e687. [PMID: 33470741 DOI: 10.1097/wno.0000000000001171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Report the development of onabotulinumtoxinA neutralizing antibodies in patients treated consecutively for 20 years or longer for benign essential blepharospasm (BEB), hemifacial spasm (HFS), and Meige Syndrome. METHODS Prospective, randomized, cross-sectional study of 12 randomly selected patients from a single clinical practice that have been treated consecutively for 20 or more years with onabotulinumtoxinA for BEB, HFS, or Meige Syndrome. Serum samples were collected from each subject and analyzed for neutralizing antibody formation using the Mouse Protection Assay. RESULTS None of the tested patients (0%) displayed neutralizing antibodies to onabotulinumtoxinA. The mean duration of treatment was 27.5 years (range 22.1-34.1, SD 3.1, 95% confidence interval 25.45-29.50). Nine of the patients had a diagnosis of BEB, 2 HFS, and one Meige. Eleven of the 12 patients were women. There was no statistically significant difference in treatment dosage or interval over the course of treatment. CONCLUSIONS The data support previous studies showing low incidence of antibody formation for botulinum A toxins with this subset of long-term treated patients. The results also provide further evidence for studies that have suggested increased onabotulinumtoxinA treatment volumes and/or decreased intervals between treatments are not due to neutralizing antibody formation and secondary non-response, but rather study designs that do not consider the titration phase of initial treatments. This study is specific to long-term treated patients, and the results cannot be generalized to patients naive to treatment.
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Affiliation(s)
- Craig N Czyz
- Division of Ophthalmology (CNC, RB), Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/Ohio Health Doctor's Hospital, Columbus, Ohio; and Department of Ophthalmology (CNC, JAB), Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, Ohio
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Maneksha V, Chakrabarty S, Tanwar M, Pillai MR. Outcomes of a regional variant of botulinum toxin type A in the treatment of essential blepharospasm and hemifacial spasms: A retrospective study. Indian J Ophthalmol 2021; 69:2777-2781. [PMID: 34571634 PMCID: PMC8597510 DOI: 10.4103/ijo.ijo_3656_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose: The aim of this study was to report the outcomes of a regional variant of botulinum toxin type A (BtA) in essential blepharospasm and hemifacial spasm. Methods: The medical records of all patients with facial dystonias, who received at least one dose of BtA between May 2016 and April 2017 were retrospectively evaluated. The pre- and post-injection severity of symptoms, graded using the Jankovic rating system for essential blepharospasm and the Samsung Medical Center grading system for hemifacial spasm, the complications after each sitting, and the mean symptom-free interval were recorded. A correlation analysis was done to identify factors associated with longer symptom-free intervals. A P value < 0.05 was considered statistically significant. Results: The mean age at presentation was 56.62 ± 10.56 years. The mean duration of follow-up was 1.86 ± 2.06 years. The modal disease severity reduced from 5 to 0 in essential blepharospasm and from 2 to 0 in hemifacial spasm a week after injection of botulinum toxin. The mean symptom-free intervals with doses of 20, 22.5, 25, 30, and 50 units were 102.1 ± 44.7, 132.4 ± 35.3, 147.2 ± 61.6, 124.4 ± 55.1, and 142.4 ± 59.7 days, respectively. The commonest complication was lagophthalmos (26.3%; n = 20). Injections for primary dystonias were associated with longer disease-free intervals than those for secondary dystonias (P = 0.02). In nine sittings, the dose was increased for increased severity or presumed resistance, which resulted in a significant increase in the symptom-free interval (P = 0.004) without an increased incidence of complications (P = 0.48). Conclusion: BtA is safe and effective in the treatment of facial dystonias. The drug is more efficacious for primary facial dystonias.
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Affiliation(s)
- V Maneksha
- Department of Orbit and Oculoplastics, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Sabyasachi Chakrabarty
- Department of General Ophthalmology, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Meghana Tanwar
- Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Madhavi Ramanatha Pillai
- Department of General Ophthalmology, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Badarny S, Ibrahim R, Susel Z, Zaina A, Nasar R, Badarny Y. Long-term stable efficacy of botulinum toxin A in facial movement disorders with no need for increasing dose. Medicine (Baltimore) 2021; 100:e26481. [PMID: 34160460 PMCID: PMC8238266 DOI: 10.1097/md.0000000000026481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
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.
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Affiliation(s)
- Samih Badarny
- Department of Neurology, Galilee Medical Center Naharyia
- Bar Ilan Faculty of Medicine, Safed
| | - Raphiq Ibrahim
- Edmond J. Safra Brain Research Center & Department of Learning Disabilities, University of Haifa, Haifa
| | | | - Adnan Zaina
- Endocrinology Clinic, Zvulun Medical Clinic, Kiryat Bialik
| | | | - Yazid Badarny
- Department of Neurosurgery, Rambam Medical Center, Haifa, Israel
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Tian H, Zhang B, Yu Y, Zhen X, Zhang L, Yuan Y, Wang L. Electrophysiological signatures predict clinical outcomes after deep brain stimulation of the globus pallidus internus in Meige syndrome. Brain Stimul 2021; 14:685-692. [PMID: 33848676 DOI: 10.1016/j.brs.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has been shown to be a safe and effective alternative therapy for ameliorating medically refractory primary Meige syndrome. However, the associations between DBS target position and surrounding electrophysiological properties as well as patients' clinical outcomes remains largely unknown. In a large number of patients, we investigated electrophysiological features around stimulation targets and explored their roles in predicting clinical outcomes following bilateral GPi-DBS. METHODS The locations of DBS active contacts along the long axis of the GPi in a standard space were calculated and compared among three groups with different clinical outcomes. The firing rates of individual neurons within the GPi were calculated for each patient and compared across the three groups. RESULTS Compared with the bad group (poor clinical outcome), active contacts in the good group (good clinical outcome) and the best group (best clinical outcome) were located in the more posterior GPi. The average firing rates in the good and best groups were significantly higher than in the bad group, and this difference was pronounced within the ventral GPi. For the bad group, the average firing rates were significantly lower in the ventral than in the dorsal GPi. CONCLUSIONS This study suggests that DBS of the posterior GPi may produce better clinical outcomes during primary Meige syndrome treatment and that higher GPi neuronal activity, particularly within the ventral part, can be used as a biomarker to guide DBS electrode implantation during surgery.
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Affiliation(s)
- Hong Tian
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhang
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China; Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China; The Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yanbing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China.
| | - Xueke Zhen
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Li Zhang
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Yue Yuan
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Liang Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Zhong Z, Xiong J, Lu L, Chen J, Tang G, Zhu S, Zhou X, Guo H. Efficacy of fire needle on patients of facial spasm: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e22731. [PMID: 33120772 PMCID: PMC7581102 DOI: 10.1097/md.0000000000022731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Facial spasm causes a lot of troubles to patients daily life and seriously affects their mental and physical health. Relevant studies have shown that fire needle therapy has certain benefits for facial spasm, is an integral part of acupuncture therapy. However, there is no unanimous conclusion. The main purpose of our study is to measure whether fire needle therapy is effective for facial spasm. METHODS The following electronic databases will be searched for the collection of fire-needle related randomized controlled trials (RCTS) for facial spasm, including 4 English databases (Web of Science, the Cochrane Library, EMBASE, Pubmed) and 3 Chinese databases (Chinese National Knowledge Infrastructure [CNKI], Wanfang data, Chinese VIP Information). The cure rate and total effective rate are the main outcomes, while the intensity, frequency, recurrence rate and adverse events are the secondary outcomes. We will use Endnote software X9 for study selection, Review Manager software 5.4 and STATA 13.0 software for analysis and synthesis. RESULTS We will evaluate the efficacy of fire needles in the treatment of facial spasm in combination with current studies. CONCLUSION The conclusion of this study will provide evidence for the efficacy of fire needle in the treatment of facial spasm. TRIAL REGISTRATION NUMBER INPLASY202080036.
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Affiliation(s)
- Zhiying Zhong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Jun Xiong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Lunbin Lu
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jun Chen
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Genhua Tang
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Siyuan Zhu
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xingchen Zhou
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Han Guo
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Rayess YA, Awaida CJ, Jabbour SF, Ballan AS, Sleilati FH, Abou Zeid SM, Nasr MW. Botulinum toxin for benign essential blepharospasm: A systematic review and an algorithmic approach. Rev Neurol (Paris) 2020; 177:107-114. [PMID: 32654779 DOI: 10.1016/j.neurol.2020.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Currently, there is no standardised approach for benign essential blepharospasm treatment with botulinum toxin, and controversies still exist regarding this subject. OBJECTIVE The objective of this systematic review is to summarise and compare all the published data regarding benign essential blepharospasm treatment with botulinum toxin. METHODS On October 3, 2018, an online search of the Medline database was conducted. All articles with a detailed description of their botulinum toxin injection technique for benign essential blepharospasm were included in this review. RESULTS Five studies were selected for inclusion with a total of 854 patients. Four of the included studies used onabotulinumtoxin A and one study used abobotulinumtoxin A. All studies injected the pretarsal orbicularis occuli muscle. The preseptal orbicularis occuli was injected in four studies, and the preorbital muscle in three studies. The most commonly used method of evaluation was the Jankovic Rating Scale. Adverse events were transient, and dose related. Ptosis was more frequently encountered with the preseptal orbicularis injections. CONCLUSION Botulinum toxin injection for benign essential blepharospasm is a non-invasive and safe procedure. The pretarsal muscle should be considered as the key component when treating benign essential blepharospasm with botulinum toxin. We developed an algorithmic approach to the treatment of benign essential blepharospasm with botulinum toxin. However, further randomised controlled trials are warranted.
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Affiliation(s)
- Y A Rayess
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Paris Saint-Joseph Hospital, Paris, France.
| | - C J Awaida
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - S F Jabbour
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - A S Ballan
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - F H Sleilati
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - S M Abou Zeid
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - M W Nasr
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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Lai KK, Kuk AK, Chan E, Ko ST. The good toxin: 10 years of experience with botulinum toxin A in the treatment of benign essential blepharospasm. Eur J Ophthalmol 2020; 31:1345-1350. [PMID: 32544987 DOI: 10.1177/1120672120925630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the efficacy and safety of botulinum toxin A (Botox) in patients with benign essential blepharospasm. METHODS Retrospective review of operation, injection, and medical records. RESULTS Information of 29 patients (nine males) was reviewed, and the average age of benign essential blepharospasm onset was 59.1 years. The average number of injections per patient was 14.2 ± 8.2 (5-44) and the average follow-up was 75.8 ± 47.3 months (15-180). The average unit dose was 14.2 ± 8.2 (10-30) ipsilaterally in the patient's first year and was 21.4 ± 5.0 (12.5-30) ipsilaterally in their last year (p = 0.00458). The average onset time was 3.8 ± 1.9 (1-7) days in a patient's first year and was 3.6 ± 1.7 (2-7) days in their last year (p = 0.549). The average effective duration was 2.86 ± 1.1 months in a patient's first year and was 2.53 ± 0.9 in their final year (p = 0.187). The Subjective Spasm Alleviation Scale was 1.72 ± 0.4 at the first year and was 1.79 ± 0.5 in the last year (p = 0.187). Ten (34.5%) patients with eyelid disease had surgical correction. The Subjective Spasm Alleviation Scale was 1.50 ± 0.5 before and was 2.0 ± 0 six months after the operation (p = 0.0268). Post-injection complications were experienced in eight (27.6%) patients. The most common complication was ptosis (n = 7), followed by diplopia (n = 1), dry eye (n = 1), and tearing (n = 1). No life-threatening complication was reported. CONCLUSION Botox was a safe and effective treatment in benign essential blepharospasm which required an increased dosage over time. Ptosis was the most common complication and no life-threatening condition was reported. Surgical correction of those with eyelid diseases showed subjective improvement of subsequent Botox treatment.
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Affiliation(s)
- Kenneth Kh Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
| | - Andrew Kt Kuk
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
| | - Edwin Chan
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
| | - Simon Tc Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
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Huh G, Bae YJ, Woo HJ, Park JH, Koo JW, Song JJ. Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia. Clin Exp Otorhinolaryngol 2020; 13:123-132. [PMID: 31522490 PMCID: PMC7248613 DOI: 10.21053/ceo.2019.00780] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/15/2019] [Accepted: 08/04/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Vertebrobasilar dolichoectasia (VBD), an elongation and distension of vertebrobasilar artery, may present with cranial nerve symptoms due to nerve root compression. The objectives of this study are to summarize vestibulocochlear manifestations in subjects with VBD through a case series and to discuss the needs of thorough oto-neurotologic evaluation in VBD subjects before selecting treatment modalities. METHODS Four VBD subjects with vestibulocochlear manifestations were reviewed retrospectively. VBD was confirmed by either brain or internal auditory canal magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Patient information, medical history, MRI/MRA findings, and audiometry or vestibular function tests were reviewed according to patient's specific symptom. RESULTS Of the four subjects, three presented with ipsilesional sensorineural hearing loss (SNHL), three with paroxysmal recurrent vertigo, and two with typewriter tinnitus. The MRI/MRA of the four subjects revealed unilateral VBD with neurovascular compression of cisternal segment or the brainstem causing displacement, angulation, or deformity of the cranial nerve VII or VIII that corresponded to the symptoms. CONCLUSION Vestibulocochlear symptoms such as SNHL, recurrent paroxysmal vertigo, or typewriter tinnitus can be precipitated from a neurovascular compression of the vestibulocochlear nerve by VBD. Because proper medical or surgical treatments may stop the disease progression or improve audio-vestibular symptoms in subjects with VBD, a high index of suspicion and meticulous radiologic evaluation are needed when vestibulocochlear symptoms are not otherwise explainable, and if VBD is confirmed to cause audiovestibular manifestation, a thorough oto-neurotologic evaluation should be performed before initial treatment.
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Affiliation(s)
- Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Jun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Hyun Park
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Tian H, Yu Y, Zhen X, Zhang L, Yuan Y, Zhang B, Wang L. Long-Term Efficacy of Deep Brain Stimulation of Bilateral Globus Pallidus Internus in Primary Meige Syndrome. Stereotact Funct Neurosurg 2020; 97:356-361. [DOI: 10.1159/000504861] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
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Singh M, Das S, Sangwan V. Comments on: Ocular surface status in patients with hemifacial spasm under long-lasting treatment with botulinum A toxin: A comparative fellow eye study. Indian J Ophthalmol 2020; 68:264-265. [PMID: 31856551 PMCID: PMC6951154 DOI: 10.4103/ijo.ijo_1645_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yang H, Zhou J, Zhong D, Yin Z, Xu G, Chen J, Li J, Liang F. Acupuncture therapy for patients with hemifacial spasm: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18329. [PMID: 31860984 PMCID: PMC6940167 DOI: 10.1097/md.0000000000018329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) brings a lot of trouble to patients' daily life, having a severe influence on the psychological and physical wellbeing of patients. Relevant researches suggested that acupuncture therapy has potential benefits for HFS. However, there is no consistent conclusion. The purpose of our study is to assess whether acupuncture therapy is effective and safe for HFS. METHODS To collect relevant randomized controlled trials (RCTs), the following electronic databases will be searched: Web of Science, the Cochrane Library, EMBASE, MEDLINE, ISI Web of Knowledge, PsycINFO, Allied and Alternative Medieine, Chinese National Knowledge Infrastructure, Wanfang data, and Chinese Scientific Journals Database. We will take the cure rate and the total effective rate as the primary outcomes, and change in intensity after treatment, change in frequency after treatment, the recurrence rate, and adverse events as secondary outcomes. Endnote software 9.1 will be used for study selection, Review Manager software 5.3, and STATA 13.0 software will be used for analysis and synthesis. RESULTS Current relevant studies will be synthesized to assess whether acupuncture therapy is effective and safe for HFS. CONCLUSION Our research will provide evidence of acupuncture therapy for HFS. REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42019142473.
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Affiliation(s)
- Han Yang
- College of Acupuncture and Moxibustion and Tuina
| | - Jun Zhou
- College of Acupuncture and Moxibustion and Tuina
| | - Dongling Zhong
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zihan Yin
- College of Acupuncture and Moxibustion and Tuina
| | - Guixing Xu
- College of Acupuncture and Moxibustion and Tuina
| | - Jiao Chen
- College of Acupuncture and Moxibustion and Tuina
| | - Juan Li
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Vivancos-Matellano F, Rodríguez-Sanz A, Herrero-Infante Y, Mascías-Cadavid J. Efficacy and Safety of Long-Term Therapy with Type A Botulinum Toxin in Patients with Blepharospasm. Neuroophthalmology 2019; 43:277-283. [PMID: 31741669 DOI: 10.1080/01658107.2018.1542009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/16/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022] Open
Abstract
Blepharospasm (BPS) is one of the most frequent types of facial dystonia and, at the same time, one of the most disabling, being able to trigger functional blindness if not treated. Our aim with this work was to evaluate the efficacy and safety of long-term onabotulinum A toxin (BAT) treatment in a cohort of patients with BPS. The retrospective study was conducted on consecutive patients with BPS treated with subcutaneous BAT. The selection of muscles and dose was made based on each patient's needs. The clinical and demographic characteristics, number of sessions, dose, duration and effectiveness of treatment, and adverse events were analysed. 130 patients were included in the study. The median (95% confidence interval) length of follow-up was 14 (13-15.6) years with an average of 20.5 sessions (range from 10 to 57). Regarding the efficacy of the treatment, 114 (87.7%) experienced satisfactory results with functional and aesthetics recovery. Patient evaluation of global response suggested a clear improvement without adverse events in 72 (55.4%) patients. Adverse events developed at least once during the treatment in 39% of patients, with transient ptosis and haematoma the most common reported both by physician and patient. The results of our study suggest that botulin toxin A is a safe and effective long-term treatment for blepharospasm with mild, transient and well-tolerated side effects when they appear.
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Treatment of blepharospasm and Meige's syndrome with abo- and onabotulinumtoxinA: long-term safety and efficacy in daily clinical practice. J Neurol 2019; 267:267-275. [PMID: 31630241 DOI: 10.1007/s00415-019-09581-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Thirty years after their approval, botulinum toxin injections still are the first-line therapy for blepharospasm. The aim of our study was to analyze long-term data concerning safety and efficacy in a large cohort over decades. METHODS Treatment data of all patients with blepharospasm and Meige´s syndrome in our outpatient clinic having undergone at least three subsequent treatment sessions with current onabotulinumtoxinA or abobotulinumtoxin A were analyzed with respect to the course of dose, effect duration, side effects, patients´ satisfaction and occurrence/reasons for treatment discontinuation. RESULTS The observation period was up to 18 years for onabotulinumtoxinA and 29 years for abobotulinumtoxinA with a total of 1778 and 9319 treatment sessions in 69 patients with onabotulinumtoxinA, 281 with abobotulinumtoxin A and 2 of these having used both products. The dose increased in the first years followed by a stable dose in the following years. The mean dose was 39.1/198.7 mouse units (onabotulinumtoxinA/abobotulinumtoxinA). In over 25% of all sessions, inhibition of the eyelid opening was effectively treated with pretarsal injections. The most common adverse events included ptosis (4%/5%), epiphora/sicca (4%/5%), double vision (1%/1%) and facial asymmetry (1%/1%). Reasons for therapy discontinuation were change to a nearby doctor, age, other diseases, spontaneous improvement, side effects or possible treatment failure. Only one patient was tested positive for neutralizing antibodies against botulinum toxin A. CONCLUSION The treatment of blepharospasm and Meige's syndrome with onabotulinumtoxinA and abobotulinumtoxinA is safe and effective, also over a long observation period of up to 29 years.
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Orbicularis Oculi Morphological Alterations in Affected and Nonaffected Sides in Hemifacial Spasm. J Neuroophthalmol 2019; 40:193-197. [PMID: 31453923 DOI: 10.1097/wno.0000000000000823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the nonaffected side appears to be clinically normal in hemifacial spasm (HFS), it is not known whether this side can be considered normal regarding histopathological findings. The purpose of this study was to objectively evaluate and compare orbicularis oculi samples of patients with HFS (not previously treated with botulinum toxin) and control patients undergoing cosmetic upper eyelid blepharoplasty. METHODS Orbicularis oculi samples from 22 eyelids were evaluated. There were 7 samples from the affected and 7 samples from the nonaffected sides of patients with HFS who had not been previously treated with botulinum toxin, and 8 samples from normal control patients. Muscle samples were prepared using hematoxylin and eosin staining, and a digital image analysis software was used for objective analyses. RESULTS When compared with normal controls, endomysial and perimysial connective tissue areas were significantly increased (P = 0.015) on the affected side in HFS, suggesting that this disorder is associated with chronic alterations that lead to muscle degeneration. Cell density was significantly reduced on the affected (P = 0.028) and also on the nonaffected sides in HFS (P = 0.003) compared with normal controls. This was observed, although, clinically, there were no signs or symptoms of increased muscular contraction on the nonaffected sides in any of the patients with HFS studied. CONCLUSIONS Significant morphological differences in the orbicularis oculi muscle in patients with HFS were observed on both the affected and nonaffected sides. Our findings suggest a potential role for muscle homeostasis disturbances on both sides for patients with HFS. Affected sides in patients with HFS did, however, demonstrate muscle degeneration that was not present on the nonaffected sides.
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Increase lipid tear thickness after botulinum neurotoxin A injection in patients with blepharospasm and hemifacial spasm. Sci Rep 2018; 8:8367. [PMID: 29849166 PMCID: PMC5976660 DOI: 10.1038/s41598-018-26750-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/17/2018] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate changes in the tear film lipid layer thickness (LLT) and aqueous tear production after botulinum neurotoxin A (BoNT) injection in patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS). Eleven and six patients with BEB and HFS, respectively, who received BoNT injection were consecutively enrolled in this prospective study. The blepharospasm disability index (BSDI), blink pattern, dry eye symptoms, Schirmer test 1 findings, LLT, eyelid performance, and corneal integrity were evaluated before and after treatment. Both BEB and HSF patients experienced remarkable relief from spasms and ocular discomfort after BoNT injection. LLT, the partial blink rate, the snap-back time, the lid distraction distance, and lateral canthal laxity were significantly increased at 1 month after treatment. There were no significant changes in Schirmer test 1 findings and meibomian gland dropout. Our findings suggest that LLT, a decisive factor for tear film stability, significantly increases at 1 month after BoNT injection for BEB and HFS. A decrease in BSDI and an increase in the snap-back time may contribute to the increase in LLT; this mechanism is probably responsible for the relief from dryness after BoNT injection in patients with facial movement disorders.
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Odderson IR. Can botulinum toxin cause chronic muscle weakness? Muscle Nerve 2018; 57:350-352. [DOI: 10.1002/mus.25988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Ib R. Odderson
- Department of Rehabilitation Medicine; University of Washington, 1959 Northeast Pacific Street, Box 356490; Seattle Washington 98195 USA
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Abstract
Botulinum neurotoxins (BoNTs) are now among the most widely used therapeutic agents in clinical medicine with indications applied to the fields of movement disorders, pain disorders, and autonomic dysfunction. In this literature review, the efficacy and utility of BoNTs in the field of movement disorders are assessed using the criteria of the Guideline Development Subcommittee of the American Academy of Neurology. The literature supports a level A efficacy (established) for BoNT therapy in cervical dystonia and a level B efficacy (probably effective) for blepharospasm, hemifacial spasm, laryngeal dystonia (spasmodic dysphonia), task-specific dystonias, essential tremor, and Parkinson rest tremor. It is the view of movement disorder experts, however, that despite the level B efficacy, BoNTs should be considered treatment of first choice for blepharospasm, hemifacial spasm, laryngeal, and task-specific dystonias. The emerging data on motor and vocal tics of Tourette syndrome and oromandibular dystonias are encouraging but the current level of efficacy is U (undetermined) due to lack of published high-quality studies.
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Affiliation(s)
- Yasaman Safarpour
- Division of Nephrology, Department of Medicine, University of California, Irvine, USA
| | - Bahman Jabbari
- Division of Movement Disorders, Department of Neurology, Yale University School of Medicine, New Haven-CT, 31 Silver Pine Drive, Newport Coast, CA, 92657, USA.
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Lee S, Park S, Lew H. Long-term Efficacy of Botulinum Neurotoxin-A Treatment for Essential Blepharospasm. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:1-7. [PMID: 29376224 PMCID: PMC5801084 DOI: 10.3341/kjo.2017.0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose In the present study, we investigated the treatment efficacy and clinical outcomes of botulinum neurotoxin-A (BoNT-A) administered for longer than 5 years to patients with essential blepharospasm. Methods We retrospectively reviewed 19 patients (male : female = 8 : 11) diagnosed with essential blepharospasm between March 2006 and July 2016 who underwent BoNT-A injections for over 5 years and were followed. Efficacy of 297 injections of Botox (n = 162), Meditoxin (n = 75), Hugel-tox (n = 40), or Dysport (n = 20) was based on the symptom improvement score at the final injection (−1, worse; 0, same; 1, better). Injection dose (botox unit), duration of efficacy (months), and adverse events were also investigated. Results Based on product type, significant differences in patient age (59.3 ± 9.8 years), disease period (5.0 ± 5.4 years), number of botulinum neurotoxin injections before visiting our clinic (1.6 ± 2.6), and follow-up period (7.2 ± 1.6 years) were not observed. Treatment efficacy score and injection dose of repetitive injections were 0.1 ± 0.5 and 39.1 ± 4.0 units, respectively, and did not show significant differences with repeated injections. Duration of response was 5.9 ± 5.4 months, but this significantly decreased as the injections were repeated (p < 0.01). Among the 297 injections, adverse events occurred 12 times (4.0%) with no severe sequelae. Conclusions In this study, we showed that repetitive, long-term BoNT-A injections are considered a stable and effective treatment for essential blepharospasm in terms of consistent injection dose and maintenance of treatment efficacy. However, the duration of long-term efficacy could be decreased in patients injected repetitively.
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Affiliation(s)
- Seunghyun Lee
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sangrye Park
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Radke PM, Mokhtarzadeh A, Lee MS, Harrison AR. Medical Cannabis, a Beneficial High in Treatment of Blepharospasm? An Early Observation. Neuroophthalmology 2017; 41:253-258. [PMID: 29339959 DOI: 10.1080/01658107.2017.1318150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/07/2017] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
The objective of this study was to observe the effect of medical cannabis in benign essential blepharospasm (BEB) as an adjunct to botulinum toxin. A retrospective chart review was performed on patients certified for medical cannabis use for BEB from September 2015 to May 2016. Patient demographics and responses, cannabis history, and severity indices were collected. Ten patients were certified for medical cannabis use. Five met the inclusion criteria, which was any patient with a diagnosis of BEB receiving standard botulinum toxin treatment who had started medical cannabis treatment by a registered distributor within the state, and was contactable by phone. Four patients discontinued use. Three out of four patients (75%) reported symptomatic improvement. Medical cannabis is an accepted therapy for muscle spastic disorders. Its potential as an adjunctive therapy for BEB remains unknown, and further investigations would be of benefit.
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Affiliation(s)
- Phillip M Radke
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ali Mokhtarzadeh
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
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Batisti JPM, Kleinfelder ADF, Galli NB, Moro A, Munhoz RP, Teive HAG. Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:87-91. [DOI: 10.1590/0004-282x20160191] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT Hemifacial spasm (HFS) is a common movement disorder characterized by involuntary tonic or clonic contractions of the muscles innervated by the facial nerve. Objective To evaluate the long-term effect of botulinum toxin type A (BTX-A) in the treatment of HFS. Methods A retrospective analysis of patients treated at the Movement Disorders Outpatient Clinic in the Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, from 2009 to 2013 was carried out. 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.
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Pandey S, Sharma S. Meige's syndrome: History, epidemiology, clinical features, pathogenesis and treatment. J Neurol Sci 2017; 372:162-170. [DOI: 10.1016/j.jns.2016.11.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
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Başar E, Arıcı C. Use of Botulinum Neurotoxin in Ophthalmology. Turk J Ophthalmol 2016; 46:282-290. [PMID: 28050326 PMCID: PMC5177786 DOI: 10.4274/tjo.57701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/02/2016] [Indexed: 01/02/2023] Open
Abstract
Botulinum neurotoxin (BoNT) is the first biological toxin used in the treatment of ophthalmic diseases and to decrease skin wrinkles as an aesthetic agent. When used appropriately, it weakens the force of muscular contraction and/or inhibits glandular secretion. The most common areas for botulinum toxin treatment are the upper face, including the glabella, forehead, brows, and lateral canthal lines, or crow's feet. By relaxing the muscles causing wrinkles, non-permanent results may be achieved with its use. BoNT has gained widespread use in a variety of ophthalmic diseases. The effect of BoNT is temporary, but the therapeutic benefit is usually maintained even after repeated injections. Treatment is usually well tolerated. Complications and side effects associated with the treatment are rare and temporary. Complications occur due to weakness (chemodenervation) of adjacent muscle groups, immunological mechanisms and injection technique. Current therapeutic indications, doses, complications and contraindications of BoNT use in the following disorders related to ophthalmology were investigated: aesthetic use, strabismus, blepharospasm, hemifacial spasm, eyelid retraction, entropion, lacrimal hypersecretion syndrome, and facial paralysis.
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Affiliation(s)
- Emel Başar
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Ceyhun Arıcı
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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Abstract
Meige's syndrome consists of idiopathic blepharospasm and oromandibular dystonia. The exact etiology is not known and various hypotheses have been proposed for its causation. The hypothesis suggesting dopaminergic and cholinergic hyperactivity is most widely accepted. There is no curative drug for Meige's syndrome although a variety of treatments have been proposed. We report a case which responded to tetrabenazine.
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Affiliation(s)
- Priyanka Gautam
- Department of Psychiatry, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Manjeet Singh Bhatia
- Department of Psychiatry, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Jaswinder Kaur
- Department of Psychiatry, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Anubhav Rathi
- Department of Psychiatry, University College of Medical Sciences and GTB Hospital, New Delhi, India
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Impact of botulinum toxin-A on corneal curvature assessed with Scheimpflug and Placido systems. J Cataract Refract Surg 2016; 42:750-8. [DOI: 10.1016/j.jcrs.2016.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/24/2015] [Accepted: 01/19/2016] [Indexed: 11/20/2022]
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Hemifacial spasm due to vertebrobasilar dolichoectasia: a case report. Radiol Case Rep 2015; 10:65-7. [PMID: 26649123 PMCID: PMC4661493 DOI: 10.1016/j.radcr.2015.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/29/2015] [Indexed: 11/21/2022] Open
Abstract
Hemifacial spasm (HFS) happens because of vascular compression of the facial nerve at the root exit zone. Vertebrobasilar dolichoectasia (VBD) is a very rare cause of HFS. VBD is diagnosed by computed tomography angiography and magnetic resonance imaging. Here, we report a case of 65-year-old female patient with HFS due to VBD. We discuss the complications and the treatment options for the case.
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Trentman TL, Maloney JA, Wie CS, Rebecca AM, Rosenfeld DM. Use of botulinum toxin injections to treat peripheral stimulator induced facial muscle twitching: a case report. SPRINGERPLUS 2015; 4:671. [PMID: 26558174 PMCID: PMC4633430 DOI: 10.1186/s40064-015-1473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/26/2015] [Indexed: 11/14/2022]
Abstract
Background Facial pain can be a management challenge. Peripheral nerve/field stimulation may be an effective option for refractory cases, but direct muscle stimulation with facial twitching may result. Botulinum toxin injections have been used for blepharospasm and may be effective when facial stimulation results in unacceptable facial muscle twitching due to peripheral stimulation. Case presentation A 53-year old female suffered with chronic, refractory facial pain and migraines. Her facial pain began after a root canal of a left upper molar. She was trialed and then permanently implanted with a 1 × 8 sub-compact percutaneous stimulator lead, resulting in improved pain control and reduced medication use. However, she experienced blepharospasm whenever the amplitude was above 2.75 A. Therefore, she was treated with botulinum toxin injections into her bilateral cheek, face, temple and occiput. This treatment provided excellent relief of the facial spasms, allowing her to use her stimulator at high amplitudes, and thereby maximizing her pain relief. She received two subsequent treatments of botulinum toxin injections at 5-month intervals with similar results. Conclusion Peripheral nerve/field stimulation is being used for headaches and facial pain. An undesirable side effect of this emerging therapy is direct muscle stimulation. Botulinum toxin injections may be an effective treatment modality when stimulation techniques provide pain relief but also causes muscle twitching.
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Affiliation(s)
- Terrence L Trentman
- Department of Anesthesiology and Pain Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 USA
| | | | - Christopher S Wie
- Department of Anesthesiology and Pain Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 USA
| | - Alanna M Rebecca
- Department of Plastics and Reconstructive Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 USA
| | - David M Rosenfeld
- Department of Anesthesiology and Pain Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 USA
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Osaki T, Osaki MH, Osaki TH, Hirai FE, Nallasamy N, Campos M. Influence of involuntary eyelid spasms on corneal topographic and eyelid morphometric changes in patients with hemifacial spasm. Br J Ophthalmol 2015; 100:963-970. [PMID: 26541432 DOI: 10.1136/bjophthalmol-2015-307272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/18/2015] [Accepted: 10/10/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS In patients with hemifacial spasm (HFS), treatment relieves eyelid spasms on the affected side, thus changes in corneal topography and eyelid morphometry may be observed after treatment. We aimed to evaluate these parameters during a 4-month period in patients with HFS treated with botulinum toxin A (BTX-A). METHODS This prospective study evaluated eyelid morphometric and corneal topographic changes in patients with HFS before onabotulinum toxin A application, and after 15 days and 2, 3 and 4 months. RESULTS 24 patients were treated with BTX-A. On the normal side, the mean palpebral fissure height (PF), interpalpebral surface area (ISA), steep K and astigmatism values were 8.7±1.98 mm, 122.09±39.37 mm2, 44.99±1.45 D and 0.9±0.64 D, respectively, before treatment. A statistically significant difference was not observed in these parameters after treatment (p>0.05). On the affected side, the mean PF, ISA, steep K and astigmatism were 5.5±1.77 mm, 67.68±28.49 mm2, 46.91±3.57 D and 2.63±2.46 D, respectively, before treatment. We observed a statistically significant (p<0.05) increase in the mean PF and ISA on the affected side 15 days (8.36±1.91 mm and 115.92±34.44 mm2, respectively), 2 months (8.18±1.80 mm and 112.22±33.57 mm2, respectively) and 3 months (7.27±1.65 mm and 95.48±27.80 mm2, respectively) after treatment. A statistically significant decrease in steep K and astigmatism was observed at 2 months (45.14±1.20 D and 1.01±0.58 D, respectively) and 3 months (45.64±1.77 D and 1.36±1.31 D, respectively) after treatment. CONCLUSIONS The results suggest that treatment with BTX-A in patients with HFS leads to eyelid and corneal changes on the affected eye that are significant during the known period of action of the toxin. Thus, caution should be taken when performing ophthalmological examination in patients with HFS, since it may vary according to BTX-A period of action.
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Affiliation(s)
- Teissy Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo/UNIFESP, São Paulo, SP, Brazil
| | - Midori H Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo/UNIFESP, São Paulo, SP, Brazil
| | - Tammy H Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo/UNIFESP, São Paulo, SP, Brazil
| | - Flavio E Hirai
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo/UNIFESP, São Paulo, SP, Brazil
| | - Nambi Nallasamy
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, USA
| | - Mauro Campos
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo/UNIFESP, São Paulo, SP, Brazil
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Sung Y, Nam SM, Lew H. Clinical outcomes of individualized botulinum neurotoxin type A injection techniques in patients with essential blepharospasm. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:115-20. [PMID: 25829828 PMCID: PMC4369513 DOI: 10.3341/kjo.2015.29.2.115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/01/2014] [Indexed: 12/02/2022] Open
Abstract
Purpose To assess the clinical outcomes following botulinum neurotoxin type A (BoNT-A) treatment with an individualized injection technique based on the types of spasms and to compare the results of the individualized injection technique with those of the conventional injection technique in the same patients. Methods From November 2011 to July 2013, 77 BoNT-A injections were performed in 38 patients. Eighteen patients were treated with conventional BoNT-A injections before 2011, and 20 patients were referred to our hospital for unsatisfactory results after a conventional injection technique. We classified the patients by spasm-dominant sites: the lateral orbital area, representing the orbital orbicularis-dominant group (ODG); the glabella, representing the corrugator-dominant group (CDG); and the ptosis, representing the palpebral part of the orbicularis-dominant group (PDG). We increased the injection dose into the spasm-dominant sites of the blepharospasm groups. We assessed subjective symptom scores (functional disability score, FDS) after treatment. Results This study included 38 patients (26 women, 12 men; mean age, 60.6 ± 10.9 years). There were 21 patients in the ODG, 10 patients in the CDG, and 7 patients in the PDG. Mean ages were 59.7 ± 12.6, 59.8 ± 8.5, and 66.8 ± 9.0 years, and mean BoNT-A injection dose was 38.8 ± 11.2, 38.8 ± 11.2, and 38.8 ± 10.8 U in each group, respectively (p = 0.44, 0.82 Kruskal-Wallis test). Mean FDS after injection was 1.7 ± 0.7 in the ODG, 1.4 ± 0.8 in the CDG, and 1.2 ± 0.3 in the PDG. There were significant differences in reading and job scale among the three groups. In a comparison between the conventional and individualized injection techniques, there was a significant improvement in mean FDS and in the reading scale in the PDG with the individualized injection technique. The success rate was 92.1% in the conventional injection group and 94.1% in the individualized injection group. Conclusions The individualized injection technique of BoNT-A according to the spasm-dominant site is an effective and safe treatment method for essential blepharospasm patients.
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Affiliation(s)
- Youngje Sung
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Min Nam
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Current uses of botulinum toxin A as an adjunct to hand therapy interventions of hand conditions. J Hand Ther 2014; 27:85-94; quiz 95. [PMID: 24524884 DOI: 10.1016/j.jht.2013.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Literature review. DISCUSSION Botulinum toxin A, a neurotoxin causing temporary muscle paralysis at the neuromuscular junction, has been used to treat multiple acquired conditions of the hand and upper extremity. Initially approved for use in treating blepharospasm and strabismus in the 1980s, indications have expanded to include spasticity associated with cerebrovascular accidents, vasospastic disorders, focal dystonias, and pain conditions. This article reviews the current literature discussing the efficacy of botulinum toxin A in management of disorders of the hand and upper extremity relevant to hand therapists. LEVEL OF EVIDENCE NA.
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Martinez-Ramirez D, Giugni JC, Hastings E, Wagle Shukla A, Malaty IA, Okun MS, Rodriguez RL. Comparable Botulinum Toxin Outcomes between Primary and Secondary Blepharospasm: A Retrospective Analysis. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:286. [PMID: 25562037 PMCID: PMC4266684 DOI: 10.7916/d8h41q4x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/18/2014] [Indexed: 12/01/2022]
Abstract
Background Blepharospasm is a focal cranial dystonia, which could be idiopathic in origin or secondary to an underlying disorder that commonly impairs quality of life. Botulinum toxin (BoNT) injections have become the treatment of choice; however, a less favorable response to BoNT is expected in secondary blepharospasm. No studies have been conducted comparing outcomes between blepharospasm cohorts. We therefore aim to compare BoNT outcomes in primary and secondary blepharospasm subjects. Methods A retrospective review of 64 blepharospasm subjects receiving BoNT therapy was conducted. Demographics, BoNT treatment schedules, duration of BoNT therapy, and side effects were recorded. Outcome measures were duration of benefit, peak-dose benefit recorded with the Clinical Global Impressions Scale (CGIS), and related side effects. Results No difference was found between the two cohorts regarding duration of benefit from treatment (primary 9.47 weeks vs. secondary 9.63 weeks, p = 0.88). Perceived peak-dose benefit was more commonly reported as “very much improved” in secondary patients, but this was not significant (p = 0.13). Higher BoNT dosages were required in both groups over time, with a mean increase of 20.5% in primary and 26.5% in secondary blepharospasm. Ptosis (8%) and diplopia (6%) were the most common reported side effects. Mean follow-up in years was similar between groups, 3.6 years for primary vs. 2.4 years for secondary blepharospasm (p = 0.17). Discussion BoNT injections were effective with comparable benefits seen in both primary and secondary blepharospasm populations. Clinicians should be aware of the similar benefit from BoNT reported in secondary blepharospasm patients. The average duration of benefit in this cohort was comparable with previous reports.
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Affiliation(s)
- Daniel Martinez-Ramirez
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Juan C Giugni
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Erin Hastings
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Irene A Malaty
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA ; Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Ramon L Rodriguez
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
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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. Acta Neurol Belg 2014; 114:285-91. [PMID: 24604684 DOI: 10.1007/s13760-014-0285-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 02/10/2014] [Indexed: 12/28/2022]
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.
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Karapantzou C, Dressler D, Rohrbach S, Laskawi R. Frontalis suspension surgery to treat patients with essential blepharospasm and apraxia of eyelid opening-technique and results. Head Face Med 2014; 10:44. [PMID: 25338619 PMCID: PMC4213496 DOI: 10.1186/1746-160x-10-44] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We describe the results of 15 patients suffering from essential blepharospasm with apraxia of eyelid opening who underwent frontalis suspension surgery. MATERIAL AND METHODS Patients with apraxia of eyelid opening and unresponsive to botulinum toxin injections were studied. Bilateral frontalis suspension surgery was performed (sling operation) using polytetrafluoroethylene (Gore-Tex®) sutures. The patients reported the degree of improvement using a subjective rating scale to evaluate the benefit of the operation at two times after surgery (0-10 days and 180-360 days). RESULTS The patients reported a high degree of subjective improvement. In the early postoperative period (0-10 days) the mean degree of subjective improvement was 74.6% (standard deviation (SD) 26.4%). At 180-360 days after surgery the mean improvement was 70.0% (SD 26.7%). Small hematomas of the upper lid occurred postoperatively in all patients. Other complications were suture extrusions (9.1%), suture granulomas (6.1%), lacrimation (5.0%) and local infections (7.5%). Postoperatively, all patients needed additional botulinum toxin injections for optimal outcome. CONCLUSION Frontalis suspension surgery is a minimally invasive and effective treatment option for apraxia of eyelid opening in patients with essential blepharospasm unresponsive to botulinum toxin injections alone.
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Affiliation(s)
| | | | | | - Rainer Laskawi
- ENT-Department, University of Göttingen Medical Center, Göttingen, Germany.
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Ramirez-Castaneda J, Jankovic J. Long-term efficacy, safety, and side effect profile of botulinum toxin in dystonia: a 20-year follow-up. Toxicon 2014; 90:344-8. [PMID: 25130293 DOI: 10.1016/j.toxicon.2014.07.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/18/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
Abstract
Most long-term studies of the efficacy and safety profile of botulinum toxin (BoNT) in the treatment of dystonia are limited by lack of objective assessments, relatively small sample size, or short follow-up periods. We present one of the longest follow-up studies of BoNT treatment. This is a retrospective, longitudinal study that analyzes data on 89 patients treated with BoNT for dystonia at our Movement Disorders Clinic for up to 26 years (mean follow-up period of 18.5 years). The mean ages at the time of the first and last injections were 49 and 68 years old, respectively. The most common diagnoses were cervical dystonia (N = 51), blepharospasm (N = 34), and oromandibular dystonia (N = 26). The total number of onabotulinumtoxinA units received during the first injection was 140.3 as compared to 224.5 at the last injection (p < 0.0001). The global response effect was 3.18 after the first injection session and 3.57 after the last injection (p < 0.0001). The duration of response after the initial injection session and at the last injection was 16.33 weeks versus 19.42 weeks (p 0.0037), respectively. Adverse events, typically related to injection site, were reported in 19% of the visits. This series of dystonia patients with the longest reported treatment with BoNT provide evidence that in selected patients repeated chemodenervation is associated with sustained symptomatic benefit, decreased latency effect, and prolonged duration of therapeutic response. Despite the higher requirement of mean units per visit over time, only 19% of all treatment cycles are associated with adverse, but tolerable, side effects.
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Affiliation(s)
- Juan Ramirez-Castaneda
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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Taylan Sekeroglu H, Kocabeyoglu S, Mocan MC, Muz E, Karakaya J, Irkec M, Sanac AS. Ocular surface changes following botulinum toxin injection for strabismus. Cutan Ocul Toxicol 2014; 34:185-8. [PMID: 25069002 DOI: 10.3109/15569527.2014.941996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Botulinum toxin injection is widely used for many purposes, including neuromuscular diseases, movement disorders and strabismus. OBJECTIVE To evaluate and report the impact of botulinum toxin injection on ocular surface parameters in patients with strabismus. PARTICIPANTS Twenty-six consecutive patients who underwent botulinum toxin A injection for ocular misalignment were recruited for this prospective study. MATERIALS AND METHODS Testing of ocular surface parameters including tear break-up time (BUT), lissamine green (LG) staining and Schirmer test (under topical anesthesia) was performed, and Ocular Surface Disease Index (OSDI) questionnaire scores were recorded before and at certain time points after injection (one week, two weeks, one month, three months and six months after botulinum toxin A injection). Two-way analysis of variance (ANOVA) with repeated measures, Friedman's test and Wilcoxon test were used for statistical analysis. RESULTS Twenty six patients (15 eso- and 11 exo-deviations) with a mean age of 32.46 ± 14.41 (17-65) years were recruited for the study. All injections were performed in one eye. The mean amount of deviation at near and distance reduced after injection. The change of BUT, LG staining and OSDI scores was found to be significant during follow-up in treated eyes (p = 0.001, p = 0.007 and p = 0.009, respectively) whereas the change was insignificant for the Schirmer test results (p = 0.266). CONCLUSIONS The ocular surface parameters appear to be altered by botulinum toxin injection in strabismic patients. Even though these effects seemed to be temporary, the findings of the present study support the notion of botulinum toxin effects on ocular surface parameters.
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Kollewe K, Mohammadi B, Köhler S, Pickenbrock H, Dengler R, Dressler D. Blepharospasm: long-term treatment with either Botox®, Xeomin® or Dysport®. J Neural Transm (Vienna) 2014; 122:427-31. [PMID: 25059456 DOI: 10.1007/s00702-014-1278-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/15/2014] [Indexed: 11/28/2022]
Abstract
Botulinum toxin (BT) therapy is the treatment of choice for blepharospasm (BPS). Currently available BT type A drugs include Botox(®), Dysport(®) and Xeomin(®). Until now, there are few long-term studies on BT therapy for BPS. This is the first long-term study comparing all three major BT drugs. We collected treatment, efficacy and adverse effect data on BPS patients treated with either Botox(®), Dysport(®) or Xeomin(®) for at least eight consecutive treatments. Two hundred and eighty-eight patients (208 females, 80 males, age 62 ± 12 years) were included in this study. The treatment time was 11.2 ± 4.1 years covering 10,701 injection series. Doses were 47 ± 10 MU for Botox(®), 120 ± 35 MU for Dysport(®) and 62 ± 11 MU for Xeomin(®) (Botox(®) dose vs Xeomin(®) dose: p < 0.001, unpaired t test). 85 % of all patients had stable doses. The onset of the therapeutic effect was after 6.1 ± 3.3 days and its duration lasted 10.2 ± 3.5 weeks. The Global Clinical Improvement (GCI, 0 = no, 1 = slight, 2 = moderate, 3 = marked improvement in severity and function) as estimated by the patient was 2.5 ± 0.6. It was stable in 90% of the patients. Adverse effect frequency was 3.0% (ptosis 2.3%, dry eye 0.5%, diplopia 0.2%). None of these findings was significantly different between Botox(®), Dysport(®) and Xeomin(®). Our study, one of the largest studies on BT therapy of BPS and the study with the longest follow-up, confirms that BT therapy produces robust clinical improvement which is stable throughout the treatment time. Therapeutic effects start after 6.1 days and last for about 10 weeks before they start to vanish. With this, they are approximately 2 weeks shorter than the recommended inter-injection interval. Adverse effects were rare, mild and always transient. BT therapy is a safe and effective treatment for BSP. Shorter inter-injection intervals may improve therapeutic results.
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Affiliation(s)
- Katja Kollewe
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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Anwar MS, Zafar H. Efficacy of botulinum toxin in benign essential Blepharospasm: Desirable & undesirable effects. Pak J Med Sci 2014; 29:1389-93. [PMID: 24550960 PMCID: PMC3905398 DOI: 10.12669/pjms.296.3853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/26/2013] [Accepted: 09/04/2013] [Indexed: 12/27/2022] Open
Abstract
Objective: To study the efficacy, desirable and undesirable effects of locally injectable preparation of botulinum toxin in patients suffering from Benign Essential Blepharospasm (BEB). Methods: It was a prospective study carried out from October 2006 till November 2012 at a private set up, “Dr Shakaib’s Eye Clinic”, in Islamabad. Follow up of Seventeen patients of BEB has been done over six years period after injecting botulinum toxin. The patients had been explained about the study and informed consent was taken. After taking all the standard precautions for botulinum toxin injection, 5 to 7 (mean 6) sites for injecting 1.5 to 2.0 IU of the toxin were selected depending upon the severity and duration of the problem. These patients were requested to attend the clinic regularly, initially after three days and then weekly for two weeks, followed by every month for three months and then at three monthly intervals for up to six years. Results: The useful effects of the injection appeared in all the patients within 48 hours. There were minor side effects like irritation in the eyes and heaviness in the brow region. One (5.88 %) patient developed mild ptosis, which subsided over two weeks. Four (23.52 %) patients felt almost cured after three to four repetitions of injections. The useful effect of the injection lasted for about three months in all the patients. Conclusion: Botulinum toxin is a useful remedy for Benign Essential Blepharospasm (BEB), although the effects are short term and repeated applications are required which is quite costly for the patient.
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Affiliation(s)
- M Shakaib Anwar
- M Shakaib Anwar, Associate Professor of Ophthalmology, Rawal Institute of Health Sciences, Islamabad. Pakistan
| | - Humaira Zafar
- Humaira Zafar, Assistant Professor of Microbiology, Al Nafees Medical College, Islamabad, Pakistan
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Ababneh OH, Cetinkaya A, Kulwin DR. Long-term efficacy and safety of botulinum toxin A injections to treat blepharospasm and hemifacial spasm. Clin Exp Ophthalmol 2013; 42:254-61. [PMID: 23844601 DOI: 10.1111/ceo.12165] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate efficacy and safety of botulinum toxin A injections after more than 10 consecutive years of treatment for benign essential blepharospasm and hemifacial spasm. DESIGN Retrospective chart review at university-affiliated hospital. PARTICIPANTS Study consisted of 64 patients treated with botulinum toxin A injections between October 2005 and May 2006. METHODS Inclusion criteria included patients treated with at least one annual botulinum toxin-A injection for more than 10 consecutive years. Data collected included diagnoses and patient characteristics, injection dates, doses administered at each visit, response scores, duration of effect, and adverse events. MAIN OUTCOME MEASURES Included changes in doses, response scores, duration of effects, and adverse events between the first and last botulinum toxin A injections. RESULTS Thirty-two of 64 patients (mean age at first injection, 57.2 ± 12.4 years; 25 women) met the inclusion criteria. The mean duration of follow up was 14.1 ± 3.1 years (range 10-20 years; mean total visits 44.4 ± 19). A higher mean injection dose per visit was administered during the last year compared with the first year (26.8 ± 10.3 vs. 22.5 ± 7.5 units, respectively) (P = 0.003). The mean durations of effect during the first and last years were 12.4 ± 7.1 and 14.6 ± 7.0 weeks, respectively (P = 0.076). There were no significant differences between genders or between benign essential blepharospasm and hemifacial spasm subgroups. The most common adverse events were ptosis, lagophthalmos and dry eye. CONCLUSIONS Botulinum toxin A is an effective, safe, long-term treatment for patients with benign essential blepharospasm and hemifacial spasm. Sustained treatment efficacy required higher doses; however, fewer adverse reactions developed.
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Affiliation(s)
- Osama H Ababneh
- Department of Ophthalmology, The University of Jordan, and Jordan University Hospital, Amman, Jordan
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