Original article
Quantitative changes in botulinum toxin a treatment over time in patients with essential blepharospasm and idiopathic hemifacial spasm

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Abstract

Purpose

To evaluate the quantitative changes in botulinum toxin A (BTA) treatment required over time to achieve relief for 3 to 4 months in patients with essential blepharospasm (EBS) and idiopathic hemifacial spasm (IHFS).

Design

Interventional case series.

Methods

In this retrospective longitudinal study in an institutional ophthalmologic outpatient clinic, data were retrieved from patient files and a comparison between patients with EBS and IHFS was performed. The patient population consisted of 27 patients, 17 with EBS and 10 with IHFS, who were treated for the first time with BTA injections and were followed up for 4 to 6 consecutive years. All patients initially received 12 or more courses of treatment with a lower dose (≤20 U) and were then switched to a higher dose (>20 U). The main outcome measures were the shift in the dose-response relationship between the lower and higher doses and were analyzed with respect to four variables: average number of treatments, dosage, duration of therapy, and interval of symptomatic relief.

Results

In the EBS group the mean dose for each patient changed from 16.0 ± 1.4 U (lower dose) to 24.2 ± 1.4 U (higher dose). The shift occurred after a mean of 8.8 ± 2.9 treatments per patient given for a mean of 33.5 ± 13.3 months. The mean interval of relief was longer with the lower dose than with the higher dose (4.0 ± 1.4 months vs 3.2 ± 1.0 months, respectively). In the IHFS group, the mean dose / patient changed from 16.8 ± 1.2 U to 25.0 ± 1.8 U, and the switch occurred after a mean of 6.5 ± 2.3 treatments given over a mean period of 23.8 ± 6.6 months. The mean duration of treatment with the lower dose was shorter than with the higher dose. The interval of relief was similar for both dose ranges (3.8 ± 10 months and 4.1 ± 1.3 months, respectively). The IHFS group switched to the higher dose earlier, by both number and duration of treatments, than the EBS group. Only minor and transient side effects of treatment were observed in both groups.

Conclusions

Botulinum toxin A is an effective and safe treatment for EBS and IHFS. The dose in our study was increased over time by 50% to achieve 3 to 4 months of symptomatic relief with minimal complications.

Section snippets

Design

An interventional case series is described.

Methods

A retrospective, longitudinal, comparative study was performed. The study was conducted in the ophthalmology outpatient clinic in a major tertiary care university-affiliated medical center. The study sample consisted of 33 patients with EBS or IHFS who were treated for the first time with BTA (Botox, Allergan, Irvine, California, USA) injections between January 1995 and December 2000, and were followed up for at least 4 years. The two groups were compared for clinical outcome.

All were under the

Results

Six of the 33 patients in the study group were excluded from the analysis: two failed to respond to BTA treatment, and four underwent facial nerve avulsion surgery. The remaining 27 patients included 14 men of mean age 75.7 ± 9.2 years and 13 women of mean age 74.0 ± 4.7 years. Seventeen patients (63%; 7 male, 10 female) had EBS and 10 (37%; 7 male, 3 female) had IHFS. We did not find a significant difference in males versus females according to diagnosis (χ2 = 2.1, P = .15). The 27 patients

Discussion

Botulinum toxin A therapy for strabismus was introduced by Scott8 in the early 1980s, and in 1989 the Food and Drug Administration approved BTA for ophthalmologic and neurologic use in treating strabismus, blepharospasm, and hemifacial spasm.9, 10 Since then, BTA has replaced eyelid surgery and cranial surgery as the first-line therapy for EBS and IHFS, respectively.2, 6, 11

All botulinum serotypes act on the peripheral nervous system by inhibiting the release of acetylcholine at the

Acknowledgements

The authors thank Mrs. Dorit Karsh, BSc, Department of Statistics, for the statistical calculations.

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