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Facial asymmetry in patients with hemifacial spasm before and after botulinum toxin A treatment

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Abstract

Botulinum toxin A (BoNT-A) injection is one of the most widely used methods for hemifacial spasm (HFS) with high efficacy in controlling spasm. However, it is still unknown if esthetic symmetry could be desired as the spasm was controlled by BoNT-A therapy. The purpose of this study is to clarify the facial asymmetric characteristics of HFS patients and if the asymmetry could be amended by BoNT-A injection in the abnormal side. In this prospective analysis, HFS patients were enrolled, who received hemifacial BoNT-A injection and completed follow-up at weeks 2–4. Self-reported improvement and negative influence of facial asymmetry in social life were documented. Facial asymmetry was assessed by the Sunnybrook facial grading system (SFGS) and a new scale created by our clinic—the Symmetry Scale for Hemifacial Spasm (SSHS). Thirty-eight patients were eligible for analysis. Among them, 34 patients (89 %) had marked improvement in spasm after BoNT-A injection. After BoNT-A injection, SFGS showed an improvement of synkinesis (p = 0.01). And SSHS showed an amelioration of resting symmetry in lower face after treatment (p < 0.05). However, SFGS showed a deterioration of voluntary movement in lower face after treatment (p < 0.01). In addition, a deterioration of voluntary movement in upper face and lower face was found in SSHS after treatment (p < 0.01). SSHS composite score showed a deterioration after BoNT-A injection (p = 0.01). In conclusions, BoNT-A was effective in controlling spasm and synkinesis of HFS and improved resting symmetry in lower face, but facial symmetry of voluntary movement deteriorated after hemifacial BoNT-A injection.

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References

  1. Wang A, Jankovic J (1998) Hemifacial spasm: clinical findings and treatment. Muscle Nerve 21(12):1740–1747

    Article  CAS  PubMed  Google Scholar 

  2. Chaudhry N, Srivastava A, Joshi L (2015) Hemifacial spasm: the past, present and future. J Neurol Sci 356(1–2):27–31. doi:10.1016/j.jns.2015.06.032

    Article  PubMed  Google Scholar 

  3. Sorgun MH, Yilmaz R, Akin YA, Mercan FN, Akbostanci MC (2015) Botulinum toxin injections for the treatment of hemifacial spasm over 16 years. J Clin Neurosci 22(8):1319–1325. doi:10.1016/j.jocn.2015.02.032

    Article  CAS  PubMed  Google Scholar 

  4. Rudzinska M, Wojcik M, Szczudlik A (2010) Hemifacial spasm non-motor and motor-related symptoms and their response to botulinum toxin therapy. J Neural Transm 117(6):765–772. doi:10.1007/s00702-010-0416-5

    Article  PubMed  Google Scholar 

  5. Park YC, Lim JK, Lee DK, Yi SD (1993) Botulinum a toxin treatment of hemifacial spasm and blepharospasm. J Korean Med Sci 8(5):334–340

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kwan MC, Ko KF, Chan TP, Chan YW (1998) Treatment of dystonia with botulinum A toxin: a retrospective study of 170 patients. Hong Kong Med J = Xianggang yi xue za zhi/Hong Kong Academy of Medicine 4(3):279–282

    Google Scholar 

  7. Tan EK, Fook-Chong S, Lum SY, Lim E (2004) Botulinum toxin improves quality of life in hemifacial spasm: validation of a questionnaire (HFS-30). J Neurol Sci 219(1–2):151–155. doi:10.1016/j.jns.2004.01.010

    Article  CAS  PubMed  Google Scholar 

  8. Zafeiriou DI, Mauromatis IV, Hatjisevastou HK, Bostantjopoulou MC, Kontopoulos EE (1997) Benign congenital hemifacial spasm. Pediatr Neurol 17(2):174–176

    Article  CAS  PubMed  Google Scholar 

  9. Ross BR, Fradet G, Nedzelski JM (1994) Development of a sensitive clinical facial grading system. Eur Arch Oto-rhino-laryngology  114(3):380–386

    Google Scholar 

  10. Chundury RV, D’Angelo AS, Couch SM, Holds JB (2015) Subjective and objective measures in the treatment of hemifacial spasm with OnabotulinumtoxinA. Ophthalmic Plast Reconstr Surg. doi:10.1097/IOP.0000000000000443

    Google Scholar 

  11. Kayhan FT, Zurakowski D, Rauch SD (2000) Toronto facial grading system: interobserver reliability. Otolaryngology-Head Neck Surg 122(2):212–215

    Article  CAS  Google Scholar 

  12. Ross BG, Fradet G, Nedzelski JM (1996) Development of a sensitive clinical facial grading system. Otolaryngology-Head Neck Surg 114(3):380–386

    Article  CAS  Google Scholar 

  13. Kanerva M, Poussa T, Pitkaranta A (2006) Sunnybrook and House-Brackmann facial grading systems: intrarater repeatability and interrater agreement. Otolaryngology-Head Neck Surg 135(6):865–871. doi:10.1016/j.otohns.2006.05.748

    Article  Google Scholar 

  14. Colosimo C, Bologna M, Lamberti S, Avanzino L, Marinelli L, Fabbrini G, Abbruzzese G, Defazio G, Berardelli A (2006) A comparative study of primary and secondary hemifacial spasm. Arch Neurol 63(3):441–444. doi:10.1001/archneur.63.3.441

    Article  PubMed  Google Scholar 

  15. Tang X, Wan X (2000) Comparison of Botox with a Chinese type A botulinum toxin. Chin Med J 113(9):794–798

    CAS  PubMed  Google Scholar 

  16. Rieder CR, Schestatsky P, Socal MP, Monte TL, Fricke D, Costa J, Picon PD (2007) A double-blind, randomized, crossover study of prosigne versus botox in patients with blepharospasm and hemifacial spasm. Clin Neuropharmacol 30(1):39–42. doi:10.1097/01.WNF.0000236771.77021.3C

    Article  PubMed  Google Scholar 

  17. Quagliato EM, Carelli EF, Viana MA (2010) Prospective, randomized, double-blind study, comparing botulinum toxins type a botox and prosigne for blepharospasm and hemifacial spasm treatment. Clin Neuropharmacol 33(1):27–31. doi:10.1097/WNF.0b013e3181c46f61

    CAS  PubMed  Google Scholar 

  18. Wu CJ, Shen JH, Chen Y, Lian YJ (2011) Comparison of two different formulations of botulinum toxin A for the treatment of blepharospasm and hemifacial spasm. Turkish Neurosurg 21(4):625–629. doi:10.5137/1019-5149.JTN.4524-11.1

    CAS  Google Scholar 

  19. Fujimura T, Hotta M (2012) The preliminary study of the relationship between facial movements and wrinkle formation. Skin Res Technol 18(2):219–224. doi:10.1111/j.1600-0846.2011.00557.x

    Article  PubMed  Google Scholar 

  20. Tiryaki T, Ciloglu NS (2007) Eyebrow asymmetry: definition and symmetrical correction using botulinum toxin A. Aesthetic Surg J Am Soc Aesthetic Plastic Surg 27(5):513–517. doi:10.1016/j.asj.2007.06.005

    Article  CAS  Google Scholar 

  21. Koch RJ, Troell RJ, Goode RL (1997) Contemporary management of the aging brow and forehead. Laryngoscope 107(6):710–715

    Article  CAS  PubMed  Google Scholar 

  22. Isse NG (1994) Endoscopic facial rejuvenation: endoforehead, the functional lift. Case reports. Aesthetic Plastic Surg 18(1):21–29

    Article  CAS  Google Scholar 

  23. Campos-Benitez M, Kaufmann AM (2008) Neurovascular compression findings in hemifacial spasm. J Neurosurg 109(3):416–420. doi:10.3171/JNS/2008/109/9/0416

    Article  PubMed  Google Scholar 

  24. Oh CH, Shim YS, Park H, Kim EY (2015) A case of hemifacial spasm caused by an artery passing through the facial nerve. J Korean Neurosurg Soc 57(3):221–224. doi:10.3340/jkns.2015.57.3.221

    Article  PubMed  PubMed Central  Google Scholar 

  25. Saybel A, Artemenko A, Nikitin S, Kurenkov A (2015) A prospective, neurophysiologic comparative study to assess the efficacy and duration of effect of incobotulinumtoxinA and abobotulinumtoxinA in the treatment of crow’s feet. J Drugs Dermatol 14(11):1291–1296

    CAS  PubMed  Google Scholar 

  26. Sneath J, Humphrey S, Carruthers A, Carruthers J (2015) Injecting botulinum toxin at different depths is not effective for the correction of eyebrow asymmetry. Dermatol Surg 41(Suppl 1):S82–S87. doi:10.1097/DSS.0000000000000159

    Article  CAS  PubMed  Google Scholar 

  27. Couch SM, Chundury RV, Holds JB (2014) Subjective and objective outcome measures in the treatment of facial nerve synkinesis with onabotulinumtoxinA (Botox). Ophthalmic Plast Reconstr Surg 30(3):246–250. doi:10.1097/IOP.0000000000000086

    Article  Google Scholar 

  28. Armstrong MW, Mountain RE, Murray JA (1996) Treatment of facial synkinesis and facial asymmetry with botulinum toxin type A following facial nerve palsy. Clin Otolaryngol Allied Sci 21(1):15–20

    Article  CAS  PubMed  Google Scholar 

  29. Toffola ED, Furini F, Redaelli C, Prestifilippo E, Bejor M (2010) Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy. Disabil Rehabil 32(17):1414–1418. doi:10.3109/09638280903514697

    Article  PubMed  Google Scholar 

  30. Bentsianov B, Zalvan C, Blitzer A (2004) Noncosmetic uses of botulinum toxin. Clin Dermatol 22(1):82–88. doi:10.1016/j.clindermatol.2003.12.030

    Article  PubMed  Google Scholar 

  31. Atassi MZ (2004) Basic immunological aspects of botulinum toxin therapy. Mov Disord 19(Suppl 8):S68–S84. doi:10.1002/mds.20020

    Article  PubMed  Google Scholar 

  32. Muhlbauer W, Holm C (1998) Eyebrow asymmetry: ways of correction. Aesthetic Plast Surg 22(5):366–371

    Article  CAS  PubMed  Google Scholar 

  33. Pennock JD, Johnson PC, Manders EK, VanSwearingen JM (1999) Relationship between muscle activity of the frontalis and the associated brow displacement. Plastic Reconstr Surg 104(6):1789–1797 (discussion 1798–1789)

    Article  CAS  Google Scholar 

  34. Cannon PS, MacKenzie KR, Cook AE, Leatherbarrow B (2010) Difference in response to botulinum toxin type A treatment between patients with benign essential blepharospasm and hemifacial spasm. Clin Exp Ophthalmol 38(7):688–691. doi:10.1111/j.1442-9071.2010.02303.x

    Article  PubMed  Google Scholar 

  35. Borodic GE, Cheney M, McKenna M (1992) Contralateral injections of botulinum A toxin for the treatment of hemifacial spasm to achieve increased facial symmetry. Plastic Reconstr Surg 90(6):972–977 (discussion 978–979)

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The work was supported by Science Foundation of Ministry of Health of China, Talent Development Foundation of Putuo District (2014-A-21) and sponsored by “Shuguang Program” supported by Shanghai Education Development Foundation and Shanghai Municipal Education Commission (14SG21).

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Authors and Affiliations

  1. Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, Xin-Cun Road 389, Shanghai, 200065, China

    Libin Xiao, Yougui Pan, Xiaolong Zhang, Yong Hu, Zhiyu Nie, Lizhen Pan, Bing Li, Yijing He & Lingjing Jin

  2. Department of Scientific Research, Shanghai Tongji Hospital, Tongji University School of Medicine, Xin-Cun Road 389, Shanghai, 200065, China

    Li Cai

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  1. Libin Xiao
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  2. Yougui Pan
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Correspondence to Lingjing Jin.

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Xiao, L., Pan, Y., Zhang, X. et al. Facial asymmetry in patients with hemifacial spasm before and after botulinum toxin A treatment. Neurol Sci 37, 1807–1813 (2016). https://doi.org/10.1007/s10072-016-2670-2

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  • DOI: https://doi.org/10.1007/s10072-016-2670-2

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