title: Supramaximal doses of botulinum toxin for refractory blepharospasm.
abstract: OBJECTIVE
  To investigate the response to supramaximal doses of botulinum toxin in patients with refractory blepharospasm.
  
  
  METHODS
  Prospective, nonrandomized, open-label interventional case series.
  
  
  METHODS
  Eight consecutive patients with blepharospasm requiring injections every 2 months despite receiving 100 U of botulinum toxin per session.
  
  
  METHODS
  Increasing the dose of botulinum toxin per session above the conventional maximum.
  
  
  METHODS
  Duration of treatment effect and patients' subjective response to treatment.
  
  
  RESULTS
  Supramaximal dosages were well tolerated. Seven of 8 patients had a prolonged interval between injections relative to that associated with their previous dosing regimen. Four of the patients elected to continue with the new dosage.
  
  
  CONCLUSIONS
  In select patients with essential blepharospasm who are refractory to standard treatment regimens, increasing the dosage of botulinum toxin above 100 U per session may decrease the interval between injections, improve the patient's quality of life, or both.
authors.affiliation: Neuro-ophthalmology Unit, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Levy
authors.forename: Dalia
authors.initials: D
authors.lastname: Berman
authors.forename: Mona
authors.initials: M
authors.lastname: Parikh
authors.forename: Neil R
authors.initials: NR
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001764:Blepharospasm / Q000188:drug therapy*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A