Botulinum Toxin A in Blepharospasm and Hemifacial Spasm and Meige’s Syndrome: An 8 Year of Experience in Northeast India

Author(s):

Shri Ram Sharma*, Hussain Masaraf and Md. Jamil

Aim of study: This study was done to examine the usefulness of botulinum toxin A injections in treating various neurological disorders such as Hemifacial spasm, Blepharospasm and Meige’s Syndrome, in patients of the resource limited communities from Northeastern parts of India, who attended neurology movement disorder clinic of NEIGRIHMS. Material and methods: This was a prospective, interventional trial of patients seen in a movement disorder clinic of NEIGRIHMS a tertiary care institute in Northeast India over a period of 8 years from August 2008 to September 2016, with diskinesias potentially treatable with botulinum toxin. All the patients were assessed before and after injections using Jankovic spasm grading and improvement in functional impairment scale. Relevant findings were noted. Results: There were 29 patients with Hemifacial spasm, 5 with Blepharospasm and 1 with Meige’s Syndrome. The mean Jankovic disability rating score in cases of hemifacial spasm and blepharospasm was 2.86 ( ± Standard deviation 0.54, range 2 to 4), 2.51( ± Standard deviation 0.58, range 2 to 4) respectively and Meige’s Syndrome 4. The mean improvement in function score was 3.4 ± 0.7 SD in hemifacial spasm and 3.9 ± 0.3 in blepharospasm. The clinical benefits induced by botulinum toxin lasted for a mean of 4.5( ± Standard deviation 2.8, range 2.5 to 6.5), 4.3( ± Standard deviation 1.6, range 3 to 7.5) of hemifacial spasm and blepharospasm respectively. While 1 with Meige’s Syndrome received substantial benefit. Blepharoptosis was the commonest complication accounting for 55.7%. HFS seems more prevalent in northeastern Indian compared with western populations. Conclusions: Our findings have shown that Injections of botulinum toxin are useful in treating various neurological disorders studied in Northeast part of India. This is advancement in the treatment of these diskinesias which responds poorly to oral medications.