Publication: The role of the injection Botulinum Toxin A in cases of Essential Blepharospasm Syndrome, Hemifacial Spasm and Meige’s Syndrome
Date
2010
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of
blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control
centre is the primary cause of this disease.
Objectives
To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm
Symdrome, Hemifacial Spasm and Meige’s Syndrome, and to assess orbicularis oculi
muscle post treatment, in the patients who attended neuro-ophthalmology clinic and
the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies.
Methods
A prospective, interventional study was carried out on all the patients of Essential
Blepharospasm Symdrome, Hemifacial Spasm and Meige’s syndrome who underwent
treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies
during a study period of one and half years. Pre- treatment grading of the spasm
was done with Jankovic spasm grading and post treatment response was seen with
assessment of orbicularis oculi muscle and improvement in functional impairment
scale. Relevant findings were noted.
Results
A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in
cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 3.61
(+ Standard deviation 0.50, range 3-4), 3.21 (+Standard deviation 0.63, range 2-4)
and 3.67 (+- Standard deviation 0.57, range 3-4) respectively. The mean value for
reappearance of significant spasms (in months) in cases of essential blepharospasm,
hemifacial spasm and Meige’s syndrome was 4.3 (+ Standard deviation 1.6, range
2.0-6.5), 5.8 (+Standard deviation 1.4, range 3-8) and 4.5 (+ Std.deviation 2.8, range
2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for
66.6% of the complications.
Conclusions
The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige’s
syndrome are treated by different modalities. An acceptable and effective treatment
modality has been a long felt need in these cases. Our study has shown that injection
of botulinum toxin A has been a safe and effective method of treating these cases in
Nepal.
Key Words
essential blepharospasm syndrome, hemifacial spasm, jankovic spasm grading, meige’s
syndrome
Description
1Gandaki Medical College, Charak Hospital, Kaski, Pokhara, Nepal
2,4BP Koirala Lions Centre for Ophthalmic Studies, 3Department of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal