Clinical Outcomes of Individualized Botulinum Neurotoxin Type A Injection Techniques in Patients with Essential Blepharospasm
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Purpose: To assess the clinical outcomes following botulinum neurotoxin type A (BoNT-A) treatment with an individualizedinjection technique based on the types of spasms and to compare the results of the individualizedinjection technique with those of the conventional injection technique in the same patients. Methods: From November 2011 to July 2013, 77 BoNT-A injections were performed in 38 patients. Eighteenpatients were treated with conventional BoNT-A injections before 2011, and 20 patients were referred toour hospital for unsatisfactory results after a conventional injection technique. We classified the patients byspasm-dominant sites: the lateral orbital area, representing the orbital orbicularis-dominant group (ODG); theglabella, representing the corrugator-dominant group (CDG); and the ptosis, representing the palpebral partof the orbicularis-dominant group (PDG). We increased the injection dose into the spasm-dominant sites ofthe blepharospasm groups. We assessed subjective symptom scores (functional disability score, FDS) aftertreatment. Results: This study included 38 patients (26 women, 12 men; mean age, 60.6 ± 10.9 years). There were 21 patientsin the ODG, 10 patients in the CDG, and 7 patients in the PDG. Mean ages were 59.7 ± 12.6, 59.8 ± 8.5,and 66.8 ± 9.0 years, and mean BoNT-A injection dose was 38.8 ± 11.2, 38.8 ± 11.2, and 38.8 ± 10.8 U in eachgroup, respectively (p = 0.44, 0.82 Kruskal-Wallis test). Mean FDS after injection was 1.7 ± 0.7 in the ODG, 1.4± 0.8 in the CDG, and 1.2 ± 0.3 in the PDG. There were significant differences in reading and job scale amongthe three groups. In a comparison between the conventional and individualized injection techniques, there wasa significant improvement in mean FDS and in the reading scale in the PDG with the individualized injectiontechnique. The success rate was 92.1% in the conventional injection group and 94.1% in the individualizedinjection group. Conclusions: The individualized injection technique of BoNT-A according to the spasm-dominant site is aneffective and safe treatment method for essential blepharospasm patients.
Abstract
Purpose: To assess the clinical outcomes following botulinum neurotoxin type A (BoNT-A) treatment with an individualizedinjection technique based on the types of spasms and to compare the results of the individualizedinjection technique with those of the conventional injection technique in the same patients. Methods: From November 2011 to July 2013, 77 BoNT-A injections were performed in 38 patients. Eighteenpatients were treated with conventional BoNT-A injections before 2011, and 20 patients were referred toour hospital for unsatisfactory results after a conventional injection technique. We classified the patients byspasm-dominant sites: the lateral orbital area, representing the orbital orbicularis-dominant group (ODG); theglabella, representing the corrugator-dominant group (CDG); and the ptosis, representing the palpebral partof the orbicularis-dominant group (PDG). We increased the injection dose into the spasm-dominant sites ofthe blepharospasm groups. We assessed subjective symptom scores (functional disability score, FDS) aftertreatment. Results: This study included 38 patients (26 women, 12 men; mean age, 60.6 ± 10.9 years). There were 21 patientsin the ODG, 10 patients in the CDG, and 7 patients in the PDG. Mean ages were 59.7 ± 12.6, 59.8 ± 8.5,and 66.8 ± 9.0 years, and mean BoNT-A injection dose was 38.8 ± 11.2, 38.8 ± 11.2, and 38.8 ± 10.8 U in eachgroup, respectively (p = 0.44, 0.82 Kruskal-Wallis test). Mean FDS after injection was 1.7 ± 0.7 in the ODG, 1.4± 0.8 in the CDG, and 1.2 ± 0.3 in the PDG. There were significant differences in reading and job scale amongthe three groups. In a comparison between the conventional and individualized injection techniques, there wasa significant improvement in mean FDS and in the reading scale in the PDG with the individualized injectiontechnique. The success rate was 92.1% in the conventional injection group and 94.1% in the individualizedinjection group. Conclusions: The individualized injection technique of BoNT-A according to the spasm-dominant site is aneffective and safe treatment method for essential blepharospasm patients.
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