Background: Botulinum toxin (BTX) injections are accepted as safe and efficacious in the treatment of hemifacial spasm (HFS), but it is still debated whether BTX treatment of lower facial muscles should be performed or not. Objective: The study aims to evaluate the necessity of BTX administration into lower facial muscles in patients with HFS. Methods: A randomized, single-blind, crossover, clinical trial was conducted. Twenty-three HFS patients were randomly allocated to two different application methods. The patients were administered BTX type A into both the orbicularis oculi and perioral muscles in the first method and BTX type A into the orbicularis oculi but placebo into the perioral muscles in the second method. Subjects were crossed over to the alternate method when they needed BTX injection with a minimum of 3 months’ duration. All the patients underwent both methods with no change in the total dose of BTX. Results: All the patients benefited from BTX treatment regardless of the methods. However, in the patients with severe lower facial muscle involvement, the application of BTX into both orbicularis oculi and lower facial muscles led to better results. Conclusion: Our data suggest that BTX application to lower facial muscles might not be necessary in patients with mild lower facial involvement.

Keywords:
Hemifacial spasm, Botulinum toxin, Facial muscles
1.
Wang A, Jankovic J: Hemifacial spasm: clinical findings and treatment. Muscle Nerve 1998;21:1740–1747.
2.
Flanders M, Chin D, Boghen D: Botulinum toxin: preferred treatment for hemifacial spasm. Eur Neurol 1993;33:316–319.
3.
Jost WH, Kohl A: Botulinum toxin: evidence-based medicine criteria in blepharospasm and hemifacial spasm. J Neurol 2001;248(suppl 1):21–24.
4.
Simpson DM, Blitzer A, Brashear A, Comella C, Dubinsky R, Hallett M, Jankovic J, Karp B, Ludlow CL, Miyasaki JM, Naumann M, So Y: Assessment: botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2008;70:1699–1706.
5.
Yoshimura DM, Aminoff MJ, Tami TA, Scott AB: Treatment of hemifacial spasm with botulinum toxin. Muscle Nerve 1992;15:1045–1049.
6.
Eleopra R, Tugnoli V, Caniatti L, De Grandis D: Botulinum toxin treatment in the facial muscles of humans: evidence of an action in untreated near muscles by peripheral local diffusion. Neurology 1996;46:1158–1160.
7.
Ishikawa M, Takashima K, Kamochi H, Kusaka G, Shinoda S, Watanabe E: Treatment with botulinum toxin improves the hyperexcitability of the facial motoneuron in patients with hemifacial spasm. Neurol Res 2010;32:656–660.
8.
Defazio G, Abbruzzese G, Girlanda P, Vacca L, Curra A, De Salvia R, Marchese R, Raineri R, Roselli F, Livrea P, Berardelli A: Botulinum toxin a treatment for primary hemifacial spasm. Arch Neurol 2002;59:418–420.
9.
Jitpimolmard S, Tiamkao S, Laopaiboon M: Long-term results of botulinum toxin type A (Dysport) in the treatment of hemifacial spasm: a report of 175 cases. J Neurol Neurosurg Psychiatry 1998;64:751–757.
10.
Bentivoglioa AR, Fasanoa A, Ialongoa T, Soletia F, Lo Fermob S, Albanese A: Outcome predictors, efficacy and safety of Botox and Dysport in the long-term treatment of hemifacial spasm. Eur J Neurol 2009;16:392–398.
11.
Cakmur R, Ozturk V, Uzunel F, Donmez B, Idiman F: Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm. J Neurol 2002;249:64–68.
12.
Elston SJ: Botulinum toxin treatment of hemifacial spasm. J Neurol Neurosurg Psychiatry 1986;49:827–829.
13.
Kollewe K, Mohammadi B, Dengler R, Dressler D: Hemifacial spasm and reinnervation synkinesias: long-term treatment with either Botox or Dysport. J Neural Transm 2010;117:759–763.
14.
Chen RS, Lu CS, Tsai CH: Botulinum toxin A injection in the treatment of hemifacial spasm. Acta Neurol Scand 1996;94:207–211.
15.
Quagliato EMAB, Carelli EF, Viana MA: Prospective, randomized, double-blind study, comparing botulinum toxins type A Botox and Prosigne for blepharospasm and hemifacial spasm treatment. Clin Neuropharmacol 2010;33:27–31.
16.
Ogawara K, Kuwabara S, Kamitsukasa I, Mizobuchi K, Misawa S, Hattori T: Trigeminal afferent input alters the excitability of facial motoneurons in hemifacial spasm. Neurology 2004;62:1749–1752.
17.
Lorenzano C, Bagnato S, Glio F, Fabbrini G, Berardelli A: No clinical or neurophysiologial evidence of botulinum toxin diffusion to non-injected muscles in patients with hemifacial spasm. Neurotox Res 2006;9:141–144.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.