Treatment Patterns and Outcomes in Botulinum Therapy for Patients With Facial Synkinesis

Area of Science:

• Neurology
• Dermatology
• Otolaryngology

Background:

• Facial synkinesis, often a sequela of conditions like Bell palsy or vestibular schwannoma resection, significantly impacts quality of life.
• While botulinum toxin is increasingly used, treatment patterns and their impact on outcomes remain under-researched.

Purpose of the Study:

• To evaluate botulinum toxin treatment patterns for facial synkinesis.
• To assess the association between treatment parameters (dosing, frequency) and patient-reported functional outcomes.

Main Methods:

• Prospective cohort study of 99 patients with facial synkinesis treated with onabotulinumtoxinA.
• Data collected on muscle targeting, dosage, injection frequency, and patient-reported outcomes via the Synkinesis Assessment Questionnaire.
• Analysis compared pre- and post-treatment scores and correlated outcomes with patient demographics and treatment variables.

Main Results:

• Botulinum toxin treatment led to significant improvements in patient-reported outcomes (mean difference -14.2, P < .001).
• Mean doses were 2-3 U per facial muscle and 9-10 U for the platysma, with doses increasing until steady state after a median of 3 treatments.
• Younger patients, females, higher total doses, and greater synkinesis severity were associated with better post-injection scores. Oculo-oral synkinesis showed a potentially greater response than oro-ocular synkinesis.

Conclusions:

• Botulinum toxin is an effective treatment for facial synkinesis, yielding significant patient-reported improvements.
• Treatment typically involves 6 core facial muscles, with initial dose escalation leading to a steady state.
• Factors such as younger age, female sex, higher dosage, and specific synkinesis types (oculo-oral) influence treatment response.