Botulinum toxin injections for the facial region

Abstract

Objective: Therapeutic use of botulinum neurotoxins (BoNT) are widely used in neurology. Local injection of BoNT is a highly effective treatment and there is now considerably well documented experience and knowledge of its indications, effects and safety in clinical practice. In this study, we report our experience in BoNT use for facial region. Methods: Patients who have been followed at the Botulinum Toxin Outpatient Clinic of the Neurology Department of the Istanbul Medical School from 1996 to December 2009 are evaluated. Two preparations of BoNT type A (Botox, Dysport) are used. The efficacy of BoNT injections are judged as very good if the symptoms are relieved 75-100%, as good if 50-74%, as average if 25-49% and as insufficient if less than 25%. Results: Two hundred ten patients (87 male) were included. The mean age was 57,6 (range 18–88 years). The mean follow-up period was 3,9 years (range 1–12). Hundred and fourteen patients had hemifacial spasm. Of the remaining 96, thirty had facial synkinesis, 25 blepharospasm, 9 oromandibular dystonia (OMD), 8 Meige Syndrome and 6 had drooling. Eighteen were considered as miscellaneous (hemimasticatory spasm, musician’s cramp, tics, hyperhidrosis etc.). A total of 1134 injections were made. The efficacy rates were high (very good and good) in blepharospasm, Meige syndrome and HFS whereas 73,8% in facial synkinesis, 58.8% in oromandibular dystonia and 41,7% in drooling. Temporary weakness was the most common side effect. Conclusion: BoNT injections are very effective for the treatment of blepharospasm, Meige Syndrome and HFS whereas the effect is moderate in facial synkinesis and OMD.