Botulinum toxin safe and effective treatment for Indian patients with hemifacial spasm: JAPI

The study, one of the most extensive studies on the botulinum toxin effects in patients with hemifacial spasms in the Indian population, showed that Botulinum toxin therapy significantly improved the quality of life (QoL) in HFS patients. Adverse effects were mild, well-tolerated, reversible and local.

A hemifacial spasm is an involuntary, irregular, distressing tonic-clonic contraction of the facial muscles innervated by the cranial nerve (seventh) that affects the quality of life. The preferred symptomatic treatment option for the condition is botulinum toxin. However, in the Indian scenario, not many studies have been performed on this topic.

Against the above background, Amar Kumar Misra and the research team from India observed the therapeutic response, clinical spectrum, demographic profile, and adverse effects of botulinum toxin. They examined the QoL in the pre and post-injection phases in patients with HFS.

For this purpose, the researchers performed a prospective open-label observational study. The selection of consecutive cases of HFS was made from the movement disorder clinic and the general neurology outpatient department (OPD) of a medical college hospital in Eastern India. Before the administration of botulinum toxin injection, informed consent was taken from patients. The assessment tools for pre and post-injection were quantification of facial asymmetry, spasm rate for a specific period, Jankovic disability rating scale, widening palpebral fissure by visual analog scale, videography, and HFS-7 scale. 

The authors reported the following findings:

• The author's studied a total of 250 HFS cases (F: M = 138:112). The presentation's mean age was 47 years.
• Botulinum toxin injection's mean dose was 24.2 units per patient. The mean duration of improvement was four months.
• The spasm frequency was reduced by 90%, and there was an improvement in facial asymmetry by 86 percent.
• The quality of life improved by 86%.
• Local adverse effects are observed in 10.4% of cases, and all were reversible.

"So far, this is one of the largest studies on botulinum toxin type A uses in HFS cases reported from India," the researchers wrote. "Bt toxin provides excellent therapeutic efficacy for controlling HFS in our series."

No cases of primary failure following botulinum toxin type A injection were found. In many cases, the researchers observed definite improvement in QoL after botulinum toxin type A injection. Temporary side effects occurred but were seen to be reversible and of a mild degree. A group of subjects saw dropout as primarily related to economic restraints.

Reference:

Misra AK, Mukherjee J, Kumar S, et al. A Study on Clinical Profile of Hemifacial Spasm in India and the Therapeutic Response to Botulinum Toxin Type A Injection as well as Pre and Postinjection Quality of Life. J Assoc Physicians India 2022;70(12):44–47.