Support Group Meeting, Fall 2003



Mr. Jason Herod Therapeutic Product Manager, Allergan Inc.


Mr. Herod began the afternoon detailing the history of BOTOX®: from its inception to the present day. Interspersed with these facts was various details about Allergan Inc. For more detail on BOTOX® and Allergan please visit our "Link To Other Resources" page.


Throughout the afternoon, Mr. Herod gamely answered the various questions tossed his way regarding BOTOX®. Any and all medical questions he passed on to Drs. Kazdan and Kraft.


Mr. Herod brought handouts. The following paragraphs are merely excerpts from two of the handouts and should provide you with an idea of what was discussed that fall afternoon. The detailed studies may be found in the European Journal of Ophthalmology I Vol. 13 no. 4, 2003 / pp. 331 -336,and in the American Journal of Ophthalmology 2003;136:99-105. 2003 by Elsevier Inc. All rights reserved.


Treatment of blepharospasm with botulinum neurotoxin type A: long-term results


P. CALACE, G. CORTESE, R. PISCOPO, G. DELLA VOL PE, V GAGLIARDI, A. MAGLI, T DE BERARDINIS
Department of Ophthalmologic Sciences, Faculty of Medicine and Surgery, University "Federico II", Napoli - Italy


  • PURPOSE. To describe the long-term efficacy and side effects of treatment of blepharospasm with botulinum neurotoxin type A (Botox).


  • METHODS. A total of 178 patients with blepharospasm were treated by injections of botulinum toxin in the Eye Clinic of the University of Naples from 1980 to 2001. The severity of spasm for each patient was graded on a four-point scale. Duration of improvement was assessed and reported in months.


  • RESULTS. Of 178 cases, 10 were lost to follow-up; of the remaining patients, 93% reported improvement after treatments. The mean duration of improvement was 3.6 months. Twelve patients (76%) who underwent more than 14 treatments maintained stable relief. Three patients (1.7%) had a total remission of spasms. Side-effects were local; none of the 168 patients experienced any systemic or toxic reaction.


  • CONCLUSIONS. Botulinum toxin therapy for blepharospasm can provide long-lasting relief and reduction of spasms in the majority of patients. This therapy has the advantages of being safe, simple, and repeatable. (Eur J Ophthalmol 2003; 13: 33 1-6)


Quantitative Changes in Botulinum Toxin A Treatment Over Time in Patients With Essential Blepharospasm and Idiopathic Hemifacial Spasm


MOSHE SNIR, MD, DOV WEINBERGER, MD, DAN BOURLA, MD, ORHIT KRISTAL-SHALIT, MD, GAD DOTAN, MD, AND RUTH AXER-SIEGEL, MD
Accepted for publication Jan 3, 2003.From the Department of Ophthalmology (M.S., D.W., D.B., G.D. R.A.-S.), Rabin Medical Center, Beilinson Campus, and the Pediatric Ophthalmology Unit (M.S., O.K.-S.), Schneider Children's Medical Center of Israel, Petah Tiqva, and Sad:1er Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.


  • PURPOSE: To evaluate the quantitative changes in botulinum toxin A (BTA) treatment required over time to achieve relief for 3 to 4 months in patients with essential blepharospasm (EBS) and idiopathic hemifacial spasm (IHFS).


  • DESIGN: Interventional case series.


  • METHODS: In this retrospective longitudinal study in an institutional ophthalmologic outpatient clinic, data were retrieved from patient files and a comparison between patients with EBS and IHFS was performed. The patient population consisted of 27 patients, 17 with EBS and 10 with IHFS, who were treated for the first time with BTA injections and were followed up for 4 to 6 consecutive years. All patients initially received 12 or more courses of treatment with a lower dose (<20 U) and were then switched to a higher dose (>20 U). The main outcome measures were the shift in the dose-response relationship between the lower and higher doses and were analyzed with respect to four variables: average number of treatments, dosage, duration of therapy, and interval of symptomatic relief.


  • RESULTS: In the EBS group the mean dose for each patient changed from 16.0 1.4 U (lower dose) to 24.2 1.4 U (higher dose). The shift occurred after a mean of 8.8 2.9 treatments per patient given for a mean of 33.5 13.3 months. The mean interval of relief was longer with the lower dose than with the higher dose (4.0 1.4 months vs 3.2 - 1.0 months, respectively). In the IHFS group, the mean dose / patient changed from 16.8 1.2 U to 25.0 1.8 U, and the switch occurred after a mean of 6.5 2.3 treatments given over a mean period of 23.8 6.6 months. The mean duration of treatment with the lower dose was shorter than with the higher dose. The interval of relief was similar for both dose ranges (3.8 10 months and 4.1 1.3 months, respectively). The IHFS group switched to the higher dose earlier, by both number and duration of treatments, than the EBS group. Only minor and transient side effects of treatment were observed in both groups.


  • CONCLUSIONS: Botulinum toxin A is an effective and safe treatment for EBS and IHFS. The dose in our study was increased over time by 50% to achieve 3 to 4 months of symptomatic relief with minimal complications.

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