title: The role of the injection botulinum toxin A in cases of blepharospasm syndrome, hemifacial spasm and Meige's syndrome.
abstract: BACKGROUND
  Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease.
  
  
  OBJECTIVE
  To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies.
  
  
  METHODS
  A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted.
  
  
  RESULTS
  A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 3.61 (+/- Standard deviation 0.50, range 3-4), 3.21 (+/- Standard deviation 0.63, range 2-4) and 3.67 (+/- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 4.3 (+/- Standard deviation 1.6, range 2.0-6.5), 5.8 (+/- Standard deviation 1.4, range 3-8) and 4.5 (+/- Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications.
  
  
  CONCLUSIONS
  The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige's syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal.
authors.affiliation: Gandaki Medical College, Charak Hospital, Pokhara, Nepal. pbs_dinku@yahoo.com
authors.forename: P
authors.initials: P
authors.lastname: Bastola
authors.forename: M
authors.initials: M
authors.lastname: Chaudhary
authors.forename: J P
authors.initials: JP
authors.lastname: Agrawal
authors.forename: D N
authors.initials: DN
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D001764:Blepharospasm / Q000188:drug therapy*; D001767:Blinking / Q000187:drug effects; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D019569:Hemifacial Spasm / Q000188:drug therapy*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008538:Meige Syndrome / Q000188:drug therapy*; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
chemical_list: D019274:Botulinum Toxins, Type A