Efficacy and side effects of botulinum toxin treatment for blepharospasm and hemifacial spasm

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Abstract
Purpose : To analyse the effectiveness and rate of side effects of botulinum toxin treatment for blepharospasm and hemifacial spasm. Methods : In a prospective trial, 81 patients with blepharospasm and 70 with hemifacial spasm were treated with botulinum toxin A in the neuro‐ophthalmology clinic at St Vincent's Hospital, Melbourne. Some 989 treatments were given and the mean follow‐up time was 28.7 months. Results : The duration of action was longer for patients with hemifacial spasm than for those with blepharospasm (median 12.0 weeks compared with 7.0 weeks, P 0.05). Once an effective dosage was reached, increasing the dose further did not prolong the duration of effect. There were no systemic side effects, but there were a number of local transient side effects. The most significant side effect was ptosis, which occurred in 12% of treatments given to those patients with blepharospasm and hemifacial spasm. Conclusion : Botulinum toxin is an effective treatment for blepharospasm and hemifacial spasm, but there are a number of side effects, the most significant being ptosis.