title: Comparable Botulinum Toxin Outcomes between Primary and Secondary Blepharospasm: A Retrospective Analysis.
abstract: BACKGROUND
  Blepharospasm is a focal cranial dystonia, which could be idiopathic in origin or secondary to an underlying disorder that commonly impairs quality of life. Botulinum toxin (BoNT) injections have become the treatment of choice; however, a less favorable response to BoNT is expected in secondary blepharospasm. No studies have been conducted comparing outcomes between blepharospasm cohorts. We therefore aim to compare BoNT outcomes in primary and secondary blepharospasm subjects.
  
  
  METHODS
  A retrospective review of 64 blepharospasm subjects receiving BoNT therapy was conducted. Demographics, BoNT treatment schedules, duration of BoNT therapy, and side effects were recorded. Outcome measures were duration of benefit, peak-dose benefit recorded with the Clinical Global Impressions Scale (CGIS), and related side effects.
  
  
  RESULTS
  No difference was found between the two cohorts regarding duration of benefit from treatment (primary 9.47 weeks vs. secondary 9.63 weeks, p = 0.88). Perceived peak-dose benefit was more commonly reported as "very much improved" in secondary patients, but this was not significant (p = 0.13). Higher BoNT dosages were required in both groups over time, with a mean increase of 20.5% in primary and 26.5% in secondary blepharospasm. Ptosis (8%) and diplopia (6%) were the most common reported side effects. Mean follow-up in years was similar between groups, 3.6 years for primary vs. 2.4 years for secondary blepharospasm (p = 0.17).
  
  
  CONCLUSIONS
  BoNT injections were effective with comparable benefits seen in both primary and secondary blepharospasm populations. Clinicians should be aware of the similar benefit from BoNT reported in secondary blepharospasm patients. The average duration of benefit in this cohort was comparable with previous reports.
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Martinez-Ramirez
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Giugni
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Hastings
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Wagle Shukla
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Malaty
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA ; Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA.
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Rodriguez
keywords: Clinical Global Impressions Scale; Cranial dystonia; Parkinson's; botulinum toxin; tardive syndromes