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Botulinum Toxin A Treatment for Primary Hemifacial Spasm
A 10-Year Multicenter Study
Giovanni Defazio, MD;
Giovanni Abbruzzese, MD;
Paolo Girlanda, MD;
Laura Vacca, MD;
Antonio Currà, MD;
Roberto De Salvia, MD;
Roberta Marchese, MD;
Roberto Raineri, MD;
Francesco Roselli, MD;
Paolo Livrea, MD;
Alfredo Berardelli, MD
Arch Neurol. 2002;59:418-420.
Background Botulinum toxin A (BTX) is the currently preferred symptomatic treatment
for primary hemifacial spasm (HFS), but its long-term efficacy and safety
are not known.
Objective To assess the long-term effectiveness and safety of BTX in the treatment
of primary HFS.
Design Retrospective review of medical records of the 1st and 10th years of
treatment.
Setting Outpatient clinics of 4 Italian university centers in the Italian Movement
Disorders Study Group.
Participants A series of 65 patients with primary HFS who had received BTX injections
regularly for at least 10 years.
Main Outcome Measures Mean duration of improvement and quality of the effect induced by the
preceding treatment (measured using a patient self-evaluation scale) and occurrence
and duration of adverse effects in the 1st and 10th years of treatment.
Results Using a mean BTX dose per treatment session similar to that used by
others, we obtained a 95% response rate and an overall mean duration of improvement
of 12.6 weeks during year 1. The effectiveness of BTX in relieving the symptoms
of primary HFS, as measured by the response rate and average duration of improvement,
remained unchanged in the 1st and 10th years. Patients needed statistically
similar BTX doses in the 1st and 10th years. The rate of local adverse effects
(including upper lid ptosis, facial weakness, and diplopia) diminished significantly
in the 10th year of treatment.
Conclusion Treatment with BTX effectively induces sustained relief from symptoms
of HFS in the long term, with only minimal and transient adverse reactions.
From the Department of Neurological and Psychiatric Sciences, University
of Bari, Bari (Drs Defazio, De Salvia, Roselli, and Livrea); the Department
of Neurological Sciences and Vision, University of Genova, Genova (Drs Abbruzzese
and Marchese); the Department of Neurosciences, Psychiatric and Anaesthesiological
Sciences, University of Messina, Messina (Drs Girlanda and Raineri); and the
Department of Neurological Sciences (Roma) and the Institute NEUROMED (Pozzilli
IS), University of Rome "La Sapienza," Rome (Drs Vacca, Currà, and
Berardelli), Italy.
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