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Long-term outcome of flexible onabotulinum toxin A treatment in facial dystonia

Abstract

Purpose

The purpose of this study was to assess the long-term outcome of onabotulinum used to treat facial dystonia and compare a flexible and fixed treatment regimen.

Methods

This was a retrospective comparative study looking at benign essential blepharospasm (BEB), hemifacial spasm (HFS) and aberrant facial nerve regeneration synkinesis (AFR) treatment with onabotulinum toxin A (Botox®) over a minimum of 10 years. Fifty-one patients were recruited into the study, with each dystonia subgroup having 17 patients. Blepharospasm disability score (BDS), subjective improvement score (SIS), duration of maximal effect (DME) and complications were recorded at each visit.

Results

The mean age was 63 years and gender predominately female. Thirty-seven patients underwent flexible treatment intervals compared to 14 fixed treatment intervals, averaging 3.4 and 4 per annum, respectively. Mean BDS significantly improved from 6 to 3 at last review across all 3 groups, with the highest effect on BEB. BDS improvement was greater in flexible intervals. SIS remained similar for all three conditions during follow-up, but in those undergoing flexible intervals, SIS increased by a small margin compared to fixed interval. Mean DME was 10.5 weeks across all dystonias, but increased progressively only in the flexible interval group. Complications included ptosis (30%), dry eye (14%) and lagophthalmos (8%).

Conclusion

Flexible onabotulinum provided better long-term relief on BDS for facial dystonia than a fixed regimen. Flexible interval treatment may also provide better patient satisfaction and longer DME compared to fixed treatment. Both have similar complication rates. With flexible treatment however, fewer injections were required over 10 years, leading to cost saving.

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References

  1. 1.

    Jankovic J, Orman J. Botulinum A toxin for cranial-cervical dystonia: a double-blind, placebo-controlled study. Neurology. 1987;37:616–23.

  2. 2.

    Clark RP, Berris CE. Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis. Plast Reconstr Surg. 1989;84:353–5.

  3. 3.

    Van den Bergh P, Francart J, Mourin S, Kollmann P, Laterre EC. Five-year experience in the treatment of focal movement disorders with low-dose Dysport botulinum toxin. Muscle Nerve. 1995;18:720–9.

  4. 4.

    Greene P, Fahn S, Diamond B. Development of resistance to botulinum toxin type A in patients with torticollis. Mov Disord. 1994;9:213–7.

  5. 5.

    Sethi KD, Rodriguez R, Olayinka B. Satisfaction with botulinum toxin treatment: a cross-sectional survey of patients with cervical dystonia. J Med Econ. 2012;15:419–23.

  6. 6.

    Hawamdeh ZM, Ibrahim AI, Al-Qudah AA. Long-term effect of botulinum toxin (A) in the management of calf spasticity in children with diplegic cerebral palsy. Eura Med. 2007;43:311–8.

  7. 7.

    Kanovsky P, Bares M, Severa S, Richardson A. Long-term efficacy and tolerability of 4-monthly versus yearly botulinum toxin type A treatment for lower-limb spasticity in children with cerebral palsy. Dev Med Child Neurol. 2009;51:436–45.

  8. 8.

    Cronemberger MF, Mendonca TS, Bicas HE. [Botulinum toxin treatment for horizontal strabismus in children with cerebral palsy]. Arq Bras Oftalmol. 2006;69:523–9.

  9. 9.

    Roggenkamper P, Jost WH, Bihari K, Comes G, Grafe S. Efficacy and safety of a new Botulinum Toxin Type A free of complexing proteins in the treatment of blepharospasm. J Neural Transm (Vienna). 2006;113:303–12.

  10. 10.

    Hankins CL, Strimling R, Rogers GS. Botulinum A toxin for glabellar wrinkles. Dose and response. Dermatol Surg. 1998;24:1181–3.

  11. 11.

    Carruthers J, Rivkin A, Donofrio L, Bertucci V, Somogyi C, Lei X, et al. A multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of repeated onabotulinumtoxinA treatments in subjects with Crow’s feet lines and glabellar lines. Dermatol Surg. 2015;41:702–11.

  12. 12.

    Stotland MA, Kowalski JW, Ray BB. Patient-reported benefit and satisfaction with botulinum toxin type A treatment of moderate to severe glabellar rhytides: results from a prospective open-label study. Plast Reconstr Surg. 2007;120:1386–93. discussion 1394

  13. 13.

    Carruthers JD, Carruthers JA. Treatment of glabellar frown lines with C. botulinum-A exotoxin. J Dermatol Surg Oncol. 1992;18:17–21.

  14. 14.

    Nussgens Z, Roggenkamper P. Comparison of two botulinum-toxin preparations in the treatment of essential blepharospasm. Graefes Arch Clin Exp Ophthalmol. 1997;235:197–9.

  15. 15.

    Bihari K. Safety, effectiveness, and duration of effect of BOTOX after switching from Dysport for blepharospasm, cervical dystonia, and hemifacial spasm dystonia, and hemifacial spasm. Curr Med Res Opin. 2005;21:433–8.

  16. 16.

    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. 2014;42:254–61.

  17. 17.

    Toffola ED, Furini F, Redaelli C, Prestifilippo E, Bejor M. Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy. Disabil Rehabil. 2010;32:1414–8.

  18. 18.

    Kollewe K, Mohammadi B, Kohler S, Pickenbrock H, Dengler R, Dressler D. Blepharospasm: long-term treatment with either Botox(R), Xeomin(R) or Dysport(R). J Neural Transm (Vienna). 2015;122:427–31.

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  1. Corneo Plastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK

    • John C Bladen
    • , Ilan Feldman
    • , Maribel Favor
    • , Marizol Dizon
    • , Andre Litwin
    •  & Raman Malhotra

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to John C Bladen.

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DOI

https://doi.org/10.1038/s41433-018-0203-3