Purpose: To evaluate the treatment efficacy of botulinum toxin A (BTX-A) for blepharospasm (BS) and hemifacial spasm (HS).
Methods: We conducted a questionnaire survey on patients who received BTX-A for 1 year from November 2014 at Inouye eye hospital. Numerical rating scale (NRS) was used to assess their subjective symptoms before and after the previous BTX-A and immediately before the present BTX-A. Information on the duration of the subjective treatment effect, association among severity, treatment efficacy, and duration of treatment effect, rate of treatment discontinuation, and incidence of side effects were collected.
Results: This survey included 1224 patients with BS and 519 with HS. NRS before treatment with BTX-A was 6.4 in BS and 5.2 in HS patients. NRS score was higher in BS patients (p<0.0001). After treatment with BTX-A, NRS decreased to 3.6 and 2.2, respectively. The efficacy of BTX-A lasted for 2.6 months in BS and 3.6 months in HS patients on average. The duration of treatment effect was longer in HS patients (p<0.0001). The rate of treatment discontinuation within 2 years of starting the survey was 28.3% in BS and 24.1% in HS patients. There was no significant difference in NRS score and duration of treatment effect between the discontinuation and continuation groups. The rate of subsequent side effects was 36.6%.
Conclusions: BTX-A is effective in alleviating the symptoms of BS and HS. BS patients had higher NRS scores and shorter duration of BTX-A treatment effect than HS patients. In addition, BS can be accompanied by sensory and psychotic disorders as well as involuntary movement. Therefore, BS is a complicated and serious disease, and except for involuntary movement, the improvement seen on treatment with BTX-A may be poor in BS. Clinical features of BS including its stronger subjective symptoms and lower treatment effect should be carefully considered for the treatment of BS.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 905-911, 2018.