Skip to main content
SpringerLink
Log in

The combined treatment with orbital and pretarsal botulinum toxin injections in the management of poorly responsive blepharospasm

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Blepharospasm (BS) is a focal dystonia involving involuntary contractions of muscles around the eyes. Botulinum toxin (BoNT) is the most effective treatment for BS and the technique of injection changes depending on the clinical picture. Usually typical BS benefits from the injection in the orbital part of the orbicularis oculi (OOc) muscle (orbital injection), while BoNT injection in the pretarsal part of OOc muscle is helpful especially for the atypical BS (opening eyelid apraxia). The aim of this study was to compare the efficacy of two injection techniques, the orbital versus the combined (injection in both orbital and pretarsal part of OOc) in BS patients with unsatisfactory response to BoNT. Nineteen patients with typical BS not having a satisfactory response from BoNT treatment with the orbital injection (primary and secondary resistant patients) were studied. After 3 months from the last orbital injection patients received the combined injection; they were assessed with the JRS and BSDI scales after 4 weeks from the last orbital and the first combined injection. Statistical analysis showed a significant reduction (p < 0.05) of the mean score of JRS and BSDI scales comparing the combined with orbital injection. This study shows that the treatment of typical BS can have better results when BoNT is injected with the combined technique in primary and secondary resistant patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Defazio G, Livrea P (2004) Primary blepharospasm: diagnosis and management. Drugs. 64:237–244

    Article  PubMed  Google Scholar 

  2. Hallett M, Evinger C, Jankovic J, Stacy M (2008) Update on blepharospasm: report from the BEBRF International Workshop. BEBRF International Workshop. Neurology 71:1275–1282

  3. Bentivoglio AR, Ialongo T, Bove F, De Nigris F, Fasano A (2012) Retrospective evaluation of the dose equivalence of Botox (®) and Dysport (®) in the management of blepharospasm and hemifacial spasm: a novel paradigm for a never ending story. Neurol Sci. 33:261–267

    Article  PubMed  Google Scholar 

  4. Gill HS, Kraft SP (2010) Long-term efficacy of botulinum a toxin for blepharospasm and hemifacial spasm. Can J Neurol Sci 37:631–636

    PubMed  Google Scholar 

  5. Aramideh M, Ongerboer de Visser BW, Brans JW, Koelman JH, Speelman JD (1995) Pretarsal application of botulinum toxin for treatment of blepharospasm. J Neurol Neurosurg Psychiatry 59:309–311

    Article  CAS  PubMed  Google Scholar 

  6. Jankovic J, Kenney C, Grafe S, Goertelmeyer R, Comes G (2009) Relationship between various clinical outcome assessments in patients with blepharospasm. Mov Disord 15(24):407–413

    Article  Google Scholar 

  7. Kenney C, Jankovic J (2008) Botulinum toxin in the treatment of blepharospasm and hemifacial spasm. J Neural Transm. 115:585–591

    Article  CAS  PubMed  Google Scholar 

  8. Gordon PH, Gooch CL, Greene PE (2002) Extensor digitorum brevis test and resistance to botulinum toxin type A. Muscle Nerve 26:828–831

    Article  PubMed  Google Scholar 

  9. Albanese A, Bentivoglio AR, Colosimo C, Galardi G, Maderna L, Tonali P (1996) Pretarsal injections of botulinum toxin improve blepharospasm in previously unresponsive patients. J Neurol Neurosurg Psychiatry 60:693–694

    Article  CAS  PubMed  Google Scholar 

  10. Cakmur R, Ozturk V, Uzunel F, Donmez B, Idiman F (2002) Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm. J Neurol 249(1):64–68

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors do not have financial disclosures or conflict of interest concerning the research related to the manuscript. There are no funding sources for this study.

Author information

Authors and Affiliations

  1. Department of Neurological Sciences, University Federico II of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy

    Marcello Esposito, R. Dubbioso, R. Iodice & Lucio Santoro

  2. Division of Neurology, Movement Disorders Center, TWH, UHN, University of Toronto, Toronto, ON, Canada

    A. Fasano

  3. Neurorehabilitation Department, Clinic Center, Naples, Italy

    C. Crisci

Authors
  1. Marcello Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Fasano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Crisci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Dubbioso
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Iodice
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lucio Santoro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcello Esposito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Esposito, M., Fasano, A., Crisci, C. et al. The combined treatment with orbital and pretarsal botulinum toxin injections in the management of poorly responsive blepharospasm. Neurol Sci 35, 397–400 (2014). https://doi.org/10.1007/s10072-013-1526-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-013-1526-2

Keywords

Search

Navigation