title: Assessment of blepharospasm surgery using an improved disability scale: study of 138 patients.
abstract: OBJECTIVE
  To assess a new scale for grading functional disability in a series of patients operated on for blepharospasm resistant to treatment by botulinum toxin (BT) injections.
  
  
  METHODS
  The bicentric study included 138 patients: 80 (58%) with essential blepharospasm; 46 (33%) with apraxia of eyelid opening; and 12 (9%) with intermediate forms. They had undergone orbicularis myectomy (92 cases, 67%), frontalis suspension (31 cases, 22%), or both (15 cases, 11%). Functional disability was assessed by using an original scale covering 6 daily life activities, each graded using 5 levels from 0 (no disability) to 4 (activity impossible). The score obtained was related to the total of activities actually performed to produce a functional disability score (FDS) from 0 to 100. Each patient's FDS was prospectively determined, before surgery and 3 months after surgery (M3). In patients who, after surgery, required a further course of BT injections, the FDS was assessed immediately before the third injection.
  
  
  RESULTS
  The mean FDS fell significantly, from 78 +/- 15 (standard deviation) before surgery to 45 +/- 21 at M3 (p < 0.01%), whatever the clinical form of essential blepharospasm or surgical procedure. The mean postoperative FDS was significantly lower in the 62 patients (45%) weaned off BT than in the unweaned group, respectively (31 +/- 17 versus 56 +/- 18; p < 0.01). In the latter group, the mean FDS after BT reinjection (34 +/- 19) fell to a level comparable with that of the weaned patients.
  
  
  CONCLUSIONS
  This accurate, easy-to-use scale makes it possible to quantify in patients with blepharospasm functional improvement as the result of surgery and, where applicable, of BT reinjection.
authors.affiliation: Department of Ophthalmology, Bellevue Hospital, Saint-Etienne, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Grivet
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Robert
authors.forename: Gilles
authors.initials: G
authors.lastname: Thuret
authors.forename: Olivier Pellissier
authors.initials: OP
authors.lastname: De Féligonde
authors.forename: Philippe
authors.initials: P
authors.lastname: Gain
authors.forename: Jean
authors.initials: J
authors.lastname: Maugery
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Adenis
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001764:Blepharospasm / Q000175:diagnosis* / Q000628:therapy; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D004185:Disability Evaluation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D009801:Oculomotor Muscles / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A