Document Detail

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases.
MedLine Citation:
PMID:  16531977     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To evaluate a protocol for the treatment of facial dystonias. METHOD: A retrospective noncomparative interventional case series of all patients who attended a specialised tertiary referral clinic between January 2000 and January 2003. At the start of treatment, patients were seen and treated at weekly intervals until their symptoms were controlled or they developed complications. The sum of the weekly doses was taken as the individual patient dose and then given at 3-4 monthly intervals as required for the individual patient. Refractory cases of spasm underwent orbicularis muscle reduction. Pretarsal spasm was treated with pretarsal botulinum toxin. If the spasm was relieved but the patient could not open their eyelids, a trial of ptosis props was undertaken and the toxin injections continued, before considering a brow suspension. If patients could not see because of a spastic Bell's phenomenon, they were given centrally acting systemic medication. RESULTS: Of 182 new patients, 63 (35%) required two or more sets of injections to titrate their optimum dose of toxin. Symptoms improved in 169 patients (93%). Of a total 332 new patients and follow-up patients, 47 (14%) underwent surgery during their management, 36 protractor myectomy, and 13 brow suspension. Protractor myectomy improved symptoms in 23 (64%). Brow suspension improved symptoms in 12 patients (92%). CONCLUSIONS: The dose of botulinum toxin can be titrated to the individual patient, and the refractory cases managed satisfactorily if a logical protocol is followed.
E Ortisi; H W A Henderson; C Bunce; W Xing; J R O Collin
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Publication Detail:
Type:  Journal Article     Date:  2006-03-10
Journal Detail:
Title:  Eye (London, England)     Volume:  20     ISSN:  0950-222X     ISO Abbreviation:  Eye (Lond)     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-09     Completed Date:  2007-05-10     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8703986     Medline TA:  Eye (Lond)     Country:  England    
Other Details:
Languages:  eng     Pagination:  916-22     Citation Subset:  IM    
Moorfields Eye Hospital, London, UK.
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MeSH Terms
Aged, 80 and over
Anti-Dyskinesia Agents / administration & dosage*
Blepharospasm / drug therapy*
Botulinum Toxins / administration & dosage*
Chronic Disease
Hemifacial Spasm / drug therapy*
Middle Aged
Retrospective Studies
Treatment Outcome
Reg. No./Substance:
0/Anti-Dyskinesia Agents; 0/Botulinum Toxins

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