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Botulinum A toxin treatment for eyelid spasm, spasmodic torticollis and apraxia of eyelid opening

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Abstract

Botulinum-A toxin (botAtox) was used in the treatment of blepharospasm (BS), idiopathic hemifacial spasm (HFS), idiopathic spasmodic torticollis (ST) and apraxia of eyelid opening (AEO). The injection of 7.5–30 U botAtox per eye spread over 3 or 4 sites in the palpebral part of orbicularis palpebrae (OP) reduced palpebral spasm in 12/13 cases of BS and in 7/8 cases of HFS. The effect lasted for 14.5 weeks on average (range 4–30 weeks). Palpebral ptosis (lasting 1–3 weeks) was the most frequent side effect (16/107 eyes treated) but was not related to dose of botAtox or number of inoculation sites. Injection of 60–160 U botAtox into the sternocleidomastoid, trapezius and splenius capitis muscles reduced ST objectively in 1/4 patients for about 4 weeks. In the other patients the reduction or abolition of the hypertrophy of the previous hyperactive muscles was accompanied by persistence or rearrangement of the dystonia pattern, suggesting a change in the pattern of activity of the neck muscles after botAtox. 5 U botAtox per eye spread over 4 sites in the OP significantly reduced the frequency of the episodes of involuntary eyelid closure in 2 patients with AEO but not BS. The therapeutic effect lasted for 7 months after the first treatment and for 8 months after the second in a 46 year old woman with a 6 month history while the second patient (72 year old parkinsonian) has now completed her 3rd month of treatment.

Sommario

La tossina botulinica di tipo A (botAtox) è stata utilizzata nel trattamento di blefarospasmo (BS), emispasmo facciale idiopatico (HFS), torcicollo spasmodico idiopatico (ST) e aprassia dell'apertura delle palpebre (A-EO). L'iniezione di 7.5–30 U di botAtox per occhio, suddivise in 3 o 4 punti negli orbicolari delle palpebre (OP) riduceva gli spasmi palpebrali in 12/13 casi di BS e in 7/8 casi di HFS. L'effetto persisteva per 14.5 settimane in media (range 4–30 settimane). Ptosi palpebrale (durata 1–3 settimane) è stato l'effetto collaterale di più frequente riscontro (16/107 occhi trattati) ma non era influenzata dalla dose di botAtox o dal numero dei punti di inoculo. L'iniezione di 60–160 U di botAtox nei muscoli sternocleidomastoideo, trapezio e splenio della testa riduceva obiettivamente il ST in 1/4 pazienti per circa 4 mesi. Negli altri pazienti, la riduzione o l'abolizione dell'ipertrofia dei muscoli prima iperattivi si accompagnava a persistenza o modificazione della sintomatologia distonica, suggerendo una modificazione del pattern di attività della muscolatura cervicale dopo botAtox. Cinque U di botAtox per occhio suddivise in 4 punti negli OP riducevano significativamente la frequenza degli episodi di chiusura involontaria delle palpebre in due pazienti affette de AEO non associata a BS. L'effetto terapeutico si manteneva per 7 mesi dopo il primo trattamento e 8 mesi dopo il secondo in una donna di 46 anni con 6 mesi di storia mentre la seconda paziente (Parkinsoniana di 72 anni) ha finora completato il 3° mese di trattamento.

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Authors and Affiliations

  1. Istituto di Clinica delle Malattie Nervose e Mentali, Università di Bari, 70124, Bari

    Defazio G., Lepore V., Lamberti P., Livrea P. & Ferrari E.

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  1. Defazio G.
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  2. Lepore V.
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  3. Lamberti P.
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  4. Livrea P.
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  5. Ferrari E.
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Defazio, G., Lepore, V., Lamberti, P. et al. Botulinum A toxin treatment for eyelid spasm, spasmodic torticollis and apraxia of eyelid opening. Ital J Neuro Sci 11, 275–280 (1990). https://doi.org/10.1007/BF02333858

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  • DOI: https://doi.org/10.1007/BF02333858

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