Hemifacial Spasm Treated with Botulinum Toxin Injection : A Ten-Year Experience at Siriraj Hospital

Abstract

Background : Hemifacial spasm is a common movement disorder in Thailand. Botulinum toxin has been introduced as an advanced treatment for this condition recently.
Objective: To evaluate the efficacy and complication of botulinum toxin in the treatment of hemifacial spasm.
Methods: We reviewed all files of patients with hemifacial spasm in the Movement Disorders Clinic at Siriraj Hospital, Mahidol University, who were treated with botulinum toxin injection from January 1989 until September 1999. Sex, age, duration of treatment, times of injection, treatment outcome, and complications were analyzed.
Results: There were 913 patients of which 38 patients were excluded because they were lost to follow up. 875 patients were analyzed, (269 males, 606 females sex ratio 1:2.25). The mean age of all patients was 50.86 ± 12.53 years with a range of 18 to 81 years. The follow-up period ranged from 1-130 months (mean = 32.5 ± 35.05 months). The outcome were classified as excellent (improvement >50%) in 58.9%, good (improvement >25%) in 37.3%, fair (improvement <25%) in 3.1%, and no improvement in 0.8%. Thus the efficacy of this treatment (improvement >25%) was 96.2 percent. There were complications of mild facial paresis in 80 patients (9.1%), ptosis in 39 patients (4.5%), excessive lacrimation in 7 patients (0.8%), and others (including pain and itching at the injection sites and double vision) in 7 patients (0.8%). All of the complications ere transient.
Conclusion: Botulinum toxin A injection is a safe and effective way with no long term systemic complications (of treating patients with hemifacial spasm).