Abstract

Background: Botulinum Toxin A (BTX A) is a proven medication used in neurological disorders like Meige’s syndrome (MS), essential blepharospasm (ES) and hemifacial spasm (HS). Jankovic spasm grading is a time trusted grading system to detect the severity of these movement disorders pre-treatment. Orbicularis oculi muscle weakness and functional improvement ratings post treatment are trusted guidelines to judge the efficacy of BTX A.

Aim/Objective: The study aimed to find out the correct dosing of BTX A in treating cases of MS, ES and HS using Jankovic Spasm grading pre-treatment and orbicularis oculi muscle weakness and functional impairment improvement post treatment.

Methods: This was a hospital based, interventional, prospective study. All diagnosed consecutive patients of HS, ES and MS attending the neuro-Ophthalmologic/oculoplastic clinic, general outpatient department of Ophthalmology and or referred diagnosed cases were enrolled for the study, an informed consent was taken from all the patients before the treatment for medico-legal issues. The pre-treatment dosing was done using Jankovic spasm grading, post treatment assessment was done using orbicularis oculi muscle assessment and functional improvement. The study subjects were followed up to 9 months or till spasms reappeared.

Results: A total of 50 study subjects were enrolled in the study, 80% of them were women. The highest number of study subjects were in ES (50%) group followed by HS (40%) and MS (10%). Mean Jankovic spasm grading in all study subjects was 3.59 (± 0.38 Std. deviation). The study groups ES and MS required a higher dose of BTX A (P value: < 0.0001) when compared with HS study group. Mean orbicularis oculi muscle weakening and functional impairment improvement scale in all study subjects was 2.7 (± 0.3 Std. deviation) and 3.8 (± 0.6) respectively. Mean duration of action till the spasms reappeared in the study subjects was 5.1 months (± 1.7 Std. deviation). HS and ES study groups had better treatment when compared to MS.

Conclusions: Jankovic spasm grading pre-treatment and orbicularis oculi muscle weakness grading and functional improvement score post treatment plays a very effective role to titrate the correct dose of BTX A in patients of HS, ES and MS.

Keywords: Botulinum Toxin A; Essential Blepharospasm; Hemifacial Spasm; Jankovic Spasm Grading; Meige’s Syndrome

References

1. Houser M and Waltz T. “Meige syndrome and pallidal deep brain stimulation”. Movement of Disorder9 (2005): 1203-1205.
2. Abbruzzese G., et al. “Hemifacial spasm”. Handbook of Clinical Neurology 100 (2011): 675-680.
3. Jankovic J. “Etiology and differential diagnosis of blepharospasm and oromandibular dystonia”. Advances in Neurology 49 (1988): 103-116.
4. Tan NC., et al. “Hemifacial spasm and involuntary facial movements”. QJ Medicine 95 (2002): 493-500.
5. Joseph Jankovic and Mitchell FBrin. “Botulinum toxin: Historical perspective and potential new indications”. Muscle Nerve 20 (1997): 129-145.
6. Hallett Mark. “One Man's Poison. Clinical Applications of Botulinum Toxin”. The New England Journal of Medicine 341 (1999): 118-120.
7. Thussu A., et al. “Botulinum toxin treatment of hemifacial spasm and blepharospasm: objective response evaluation”. Neurology India47 (1999): 206-209.
8. Bastola P., et al. “The role of the injection Botulinum Toxin A in cases of Essential Blepharospasm Syndrome, Hemifacial Spasm and Meige’s Syndrome”. Kathmandu University Medical Journal 3 (2001): 305-310.
9. Rahman R., et al. “A new grading system for assessing orbicularis muscle function”. Eye17 (2003): 610-612.
10. Gulevich Steven. eMedicine. Hemifacial Spasm (2005).
11. Donald CF. “Essential blepharospasm”. In:Yanoff M, Duker Jay S.CD- ROM Ophthalmology: Mosby International (1998).
12. Tan A. “Botulinum Toxin for Neurological Disorders in a Movement Disorders Clinic in Singapore”. Singapore Medical Journal39 (1998): 403-405.
13. Cakmur R., et al. “Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm”. Journal of Neurology249 (2002): 64-68.
14. Bastola P. “Orbicularis oculi muscle function and functional improvement rating as grading tools to evaluate the efficacy of Botulinum Toxin A in patients with movement disorders of head and neck”. Bangladesh Ophthalmology Journal 2 (2016): 11-18.
15. Price J andO’Day J. “Efficacy and side effects of botulinum toxin treatment for blepharospasm and hemifacial spasm”. Australian and New Zealand Journal of Ophthalmology 22 (1994): 255-260.
16. Maurri S., et al. “Beneficial effect of botulinum A toxin in blepharospasm: 16 months’ experience with 16 cases”. The Italian Journal of Neurological Sciences 9 (1988): 337-344.
17. Snir M., et al. “Quantitative changes in botulinum toxin A treatment over time in patients with essential blepharospasm and idiopathic hemifacial spasm”.American Journal of Ophthalmology136 (2003): 99-105.

Citation

Citation: Bastola P and Koirala S. “The Role of Jankovic Spasm Grading, Orbicularis Oculi Muscle Function and Functional Improvement Scale Pre-and Post-Treatment in Dosing Botulinum Toxin A in Treatment of Essential Blepharospasm, Meige’s Syndrome and Hemifacial Spasm". Acta Scientific Paediatrics 3.8 (2020): 06-12.

Copyright

Copyright: © 2020 Bastola P and Koirala S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.