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December 1988, Vol 114, No. 12 >
ARTICLE | December 1988

Management of Facial Spasm With Clostridium botulinum Toxin, Type A (Oculinum) FREE

Albert W. Biglan, MD; Mark May, MD; Richard A. Bowers, MD
[+] Author Affiliations

Accepted for publication Sept 2, 1988.

Reprint requests to 3815 Fifth Ave, Pittsburgh, PA 15213-3388 (Dr Biglan).


Arch Otolaryngol Head Neck Surg. 1988;114(12):1407-1412. doi:10.1001/archotol.1988.01860240057024
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• One hundred five patients received 391 graded injections of Clostridium botulinum type A toxin (Oculinum) to treat uncontrollable facial muscle spasm. Patients had essential blepharospasm (n = 61), hemifacial spasm (n = 24), or aberrant regeneration of the seventh cranial nerve (n = 20). Muscle spasms were reduced within two days of the first injection of toxin and, in most cases, the drug effect lasted three to four months. Control of facial muscle spasm was achieved in all patients. Complications related to treatment included transient blepharoptosis (n = 7), diplopia (n = 2), and altered facial expression (n = 11). Systemic side effects were not observed. Select chemodenervation of facial muscles with graded injections of botulinum toxin is a useful adjunct to control blepharospasm, hemifacial spasm, and facial spasm due to aberrant regeneration of the facial nerve.

(Arch Otolaryngol Head Neck Surg 1988;114:1407-1412)

REFERENCES

1 +
Rowan GE, Sedlacek K:  Biofeedback in the treatment of blepharospasm: A case study . Am J Psychiatry 1981;;138:1487-1489.
2 +
Alexander GE, Moses H:  Carbamazepine for hemifacial spasm . Neurology 1982;;32:286-287.
3 +
Jankovic J, Havins WE, Wilkins RB:  Blinking and blepharospasm mechanism: Diagnosis and management . JAMA 1982;;248:3160-3164.
4 +
Battista AF:  Blepharospasm: A surgical procedure for therapy . Ophthalmic Surg 1981;; 12:823-829.
5 +
Gillum WN, Anderson RL:  Blepharospasm surgery: An anatomic approach . Arch Ophthalmol 1981;;99:1056-1062.
6 +
McCord CD Jr, Coles WH, Shore JW, et al:  Treatment for essential blepharospasm: I. Comparison of facial nerve avulsion and eyebrow-eyelid muscle stripping procedure . Arch Ophthalmol 1984;;102:266-273.
7 +
Dortzbach RK:  Complications in surgery for blepharospasm . Am J Ophthalmol 1973;;75:142-147.
8 +
Frueh BR, Felt DP, Wojno TH, et al:  Treatment of blepharospasm with botulinum toxin: A preliminary report . Arch Ophthalmol 1984;; 102:1464-1468.
9 +
Tsoy EA, Buckley EG, Dutton JJ:  Treatment of blepharospasm with botulinum toxin . Am J Ophthalmol 1985;;99:176-179.
10 +
Scott AB, Kennedy RA, Stubbs HA:  Botulinum A toxin injection as a treatment for blepharospasm . Arch Ophthalmol 1985;;103:347-350.
11 +
Shorr N, Seiff SR, Kopelman J:  The use of botulinum toxin in blepharospasm . Am J Ophthalmol 1985;;99:542-546.
12 +
Lingua RW:  Sequelae of botulinum toxin injection . Am J Ophthalmol 1985;;100:305-307.
13 +
Savino PJ, Sergott RC, Bosley TM, et al:  Hemifacial spasm treated with botulinum A toxin injection . Arch Ophthalmol 1985;;103:1305-1306.
14 +
Magoon EH:  Botulinum injection for treatment of blepharospasm, corneal exposure and entropion . J Ocul Ther Surg 1985;;4:133-135.
15 +
Mauriello JA Jr, Coniaris H, Haupt EJ:  Use of botulinum toxin in the treatment of 100 patients with facial dyskinesis . Ophthalmology 1987;;94:976-979.
16 +
Engstrom PF, Arnoult JB, Mazow ML, et al:  Effectiveness of botulinum toxin therapy for essential blepharospasm . Ophthalmology 1987;; 94:971-975.
17 +
Frueh BR, Musch DC:  Treatment of facial spasm with botulinum toxin: An interim report . Ophthalmology 1986;;93:917-923.
18 +
Elston JS:  Long-term results of treatment of idiopathic blepharospasm with botulinum toxin injections . Br J Ophthalmol 1987;;71:664-668.
19 +
Perman KI, Baylis HI, Rosenbaum AL, et al:  The use of botulinum toxin in the medical management of benign essential blepharospasm . Ophthalmology 1986;;93:1-3.
20 +
Shore JW, Leone CR Jr, O'Connor PS, et al:  Botulinum toxin for the treatment of essential blepharospasm . Ophthalmic Surg 1986;;17:747-753.
21 +
Biglan AW, May M:  Treatment of facial spasm with Oculinum (C botulinum toxin) . J Pediatr Ophthalmol Strabismus 1986;;23:216-221.
22 +
Jannetta PJ:  Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia: Definitive microsurgical treatment and results in 117 patients . Neurochirurgia 1977;;20:145-154.
23 +
Maroon JC:  Hemifacial spasm: A vascular cause . Arch Neurol 1978;;35:481-483.
24 +
Jannetta PJ, Abbasy M, Maroon JC, et al:  Etiology and definitive microsurgical treatment of hemifacial spasm: Operative techniques and results in 47 patients . J Neurosurg 1977;;47:321-328.
25 +
Wright GP:  The neurotoxins of Clostridium botulinum and Clostridium tetani . Pharmacol Rev 1955;;7:413.
26 +
Sellin LC:  Botulism: An update . Milit Med 1984;;149:12.
27 +
Scott AB, Rosenbaum AL, Collins CC:  Pharmacologic weakening of extraocular muscles . Invest Ophthalmol Vis Sci 1973;;12:924-927.
28 +
Scott AB:  Botulinum toxin injection of eye muscles to correct strabismus . Trans Am Ophthalmol Soc 1981;;79:734-770.
29 +
Magoon EH:  Botulinum toxin chemodenervation for strabismus in infants and children . J Pediatr Ophthalmol Strabismus 1984;; 21:110-113.
30 +
Metz HS:  Botulinum injections for strabismus . J Pediatr Ophthalmol Strabismus 1984;; 21:199-204.
31 +
Schloss MD, Bebear JP:  Hemifacial spasm: Importance of a complete investigation . J Otolaryngol 1976;;5:319-330.
32 +
Jankovic J, Patel SC:  Blepharospasm associated with brainstem lesions . Neurology 1983;; 33:1237-1240.
33 +
Callahan A:  Intractable blepharospasm . Am J Ophthalmol 1965;;60:788.
34 +
Bird AC, McDonald WI:  Essential blepharospasm . Trans Ophthalmol Soc UK 1975;;95:250-253.
35 +
Irvine AR, Daroff RB, Sanders MD, et al:  Familial reflex blepharospasm . Am J Ophthalmol 1968;;65:889-890.
36 +
Frueh BR, Callahan A, Dortzbach RK, et al:  A profile of patients with intractable blepharospasm . Trans Am Acad Ophthalmol Otolaryngol 1976;;81:591-594.
37 +
Tolosa E:  Clinical features of Meige's disease (idiopathic orofacial dystonia) . Arch Neurol 1981;;38:147-151.
38 +
May M:  Management of hemifacial spasm and synkinesis following acute Bell's palsy . Am J Otolaryngol 1983;;4:350-351.
39 +
Biglan AW, Gonnering R, Lockhart LB, et al:  Absence of antibody production in patients treated with Oculinum (botulinum A toxin) . Am J Ophthalmol 1986;;101:232-235.

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1 +
Rowan GE, Sedlacek K:  Biofeedback in the treatment of blepharospasm: A case study . Am J Psychiatry 1981;;138:1487-1489.
2 +
Alexander GE, Moses H:  Carbamazepine for hemifacial spasm . Neurology 1982;;32:286-287.
3 +
Jankovic J, Havins WE, Wilkins RB:  Blinking and blepharospasm mechanism: Diagnosis and management . JAMA 1982;;248:3160-3164.
4 +
Battista AF:  Blepharospasm: A surgical procedure for therapy . Ophthalmic Surg 1981;; 12:823-829.
5 +
Gillum WN, Anderson RL:  Blepharospasm surgery: An anatomic approach . Arch Ophthalmol 1981;;99:1056-1062.
6 +
McCord CD Jr, Coles WH, Shore JW, et al:  Treatment for essential blepharospasm: I. Comparison of facial nerve avulsion and eyebrow-eyelid muscle stripping procedure . Arch Ophthalmol 1984;;102:266-273.
7 +
Dortzbach RK:  Complications in surgery for blepharospasm . Am J Ophthalmol 1973;;75:142-147.
8 +
Frueh BR, Felt DP, Wojno TH, et al:  Treatment of blepharospasm with botulinum toxin: A preliminary report . Arch Ophthalmol 1984;; 102:1464-1468.
9 +
Tsoy EA, Buckley EG, Dutton JJ:  Treatment of blepharospasm with botulinum toxin . Am J Ophthalmol 1985;;99:176-179.
10 +
Scott AB, Kennedy RA, Stubbs HA:  Botulinum A toxin injection as a treatment for blepharospasm . Arch Ophthalmol 1985;;103:347-350.
11 +
Shorr N, Seiff SR, Kopelman J:  The use of botulinum toxin in blepharospasm . Am J Ophthalmol 1985;;99:542-546.
12 +
Lingua RW:  Sequelae of botulinum toxin injection . Am J Ophthalmol 1985;;100:305-307.
13 +
Savino PJ, Sergott RC, Bosley TM, et al:  Hemifacial spasm treated with botulinum A toxin injection . Arch Ophthalmol 1985;;103:1305-1306.
14 +
Magoon EH:  Botulinum injection for treatment of blepharospasm, corneal exposure and entropion . J Ocul Ther Surg 1985;;4:133-135.
15 +
Mauriello JA Jr, Coniaris H, Haupt EJ:  Use of botulinum toxin in the treatment of 100 patients with facial dyskinesis . Ophthalmology 1987;;94:976-979.
16 +
Engstrom PF, Arnoult JB, Mazow ML, et al:  Effectiveness of botulinum toxin therapy for essential blepharospasm . Ophthalmology 1987;; 94:971-975.
17 +
Frueh BR, Musch DC:  Treatment of facial spasm with botulinum toxin: An interim report . Ophthalmology 1986;;93:917-923.
18 +
Elston JS:  Long-term results of treatment of idiopathic blepharospasm with botulinum toxin injections . Br J Ophthalmol 1987;;71:664-668.
19 +
Perman KI, Baylis HI, Rosenbaum AL, et al:  The use of botulinum toxin in the medical management of benign essential blepharospasm . Ophthalmology 1986;;93:1-3.
20 +
Shore JW, Leone CR Jr, O'Connor PS, et al:  Botulinum toxin for the treatment of essential blepharospasm . Ophthalmic Surg 1986;;17:747-753.
21 +
Biglan AW, May M:  Treatment of facial spasm with Oculinum (C botulinum toxin) . J Pediatr Ophthalmol Strabismus 1986;;23:216-221.
22 +
Jannetta PJ:  Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia: Definitive microsurgical treatment and results in 117 patients . Neurochirurgia 1977;;20:145-154.
23 +
Maroon JC:  Hemifacial spasm: A vascular cause . Arch Neurol 1978;;35:481-483.
24 +
Jannetta PJ, Abbasy M, Maroon JC, et al:  Etiology and definitive microsurgical treatment of hemifacial spasm: Operative techniques and results in 47 patients . J Neurosurg 1977;;47:321-328.
25 +
Wright GP:  The neurotoxins of Clostridium botulinum and Clostridium tetani . Pharmacol Rev 1955;;7:413.
26 +
Sellin LC:  Botulism: An update . Milit Med 1984;;149:12.
27 +
Scott AB, Rosenbaum AL, Collins CC:  Pharmacologic weakening of extraocular muscles . Invest Ophthalmol Vis Sci 1973;;12:924-927.
28 +
Scott AB:  Botulinum toxin injection of eye muscles to correct strabismus . Trans Am Ophthalmol Soc 1981;;79:734-770.
29 +
Magoon EH:  Botulinum toxin chemodenervation for strabismus in infants and children . J Pediatr Ophthalmol Strabismus 1984;; 21:110-113.
30 +
Metz HS:  Botulinum injections for strabismus . J Pediatr Ophthalmol Strabismus 1984;; 21:199-204.
31 +
Schloss MD, Bebear JP:  Hemifacial spasm: Importance of a complete investigation . J Otolaryngol 1976;;5:319-330.
32 +
Jankovic J, Patel SC:  Blepharospasm associated with brainstem lesions . Neurology 1983;; 33:1237-1240.
33 +
Callahan A:  Intractable blepharospasm . Am J Ophthalmol 1965;;60:788.
34 +
Bird AC, McDonald WI:  Essential blepharospasm . Trans Ophthalmol Soc UK 1975;;95:250-253.
35 +
Irvine AR, Daroff RB, Sanders MD, et al:  Familial reflex blepharospasm . Am J Ophthalmol 1968;;65:889-890.
36 +
Frueh BR, Callahan A, Dortzbach RK, et al:  A profile of patients with intractable blepharospasm . Trans Am Acad Ophthalmol Otolaryngol 1976;;81:591-594.
37 +
Tolosa E:  Clinical features of Meige's disease (idiopathic orofacial dystonia) . Arch Neurol 1981;;38:147-151.
38 +
May M:  Management of hemifacial spasm and synkinesis following acute Bell's palsy . Am J Otolaryngol 1983;;4:350-351.
39 +
Biglan AW, Gonnering R, Lockhart LB, et al:  Absence of antibody production in patients treated with Oculinum (botulinum A toxin) . Am J Ophthalmol 1986;;101:232-235.

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