[Safety and efficacy of botulinum toxin in hemifacial spasm]

Given the failure of pharmacologic and surgical treatment in the management of hemifacial spasm, the use of botulinum toxin as first line therapy is interesting.

To evaluate the safety and efficacy of type A botulinum toxin in the treatment of hemifacial spasm.

We conducted a retrospective, descriptive and comparative study of 25 patients with hemifacial spasm followed in the ophthalmology department of Habib Thameur hospital in Tunis over the period from June 2003 to June 2009. All patients received injections of botulinum toxin type A (Botox).

We carried out 168 Botulinum A toxin injections (Botox) with an average of 6.85 ± 4.32 injections per patient. Doses varied between 12.5 U and 28 U Botox. A good response to treatment was observed in 92% of patients with a satisfactory return to daily activities and work. Based on a subjective scale from 1 to 3, the average total functional benefit was 2.55 ± 0.56. Average total duration of therapeutic response was 9.35 ± 3.64 weeks. Local side effects observed were comparable to those described in the literature: ptosis (32.4%), diplopia (8.2%), drooping of the labial commissure (11.2%), lagophthalmos (21.3%), tearing (7%), dry eye (4%). No systemic complication was noted.

Botulinum toxin type A provides effective short-term and medium-term results in the treatment of hemifacial spasm. It is well tolerated locally and systemically. This safety and efficacy make it a valuable therapeutic alternative in the management of hemifacial spasm.