title: Clinical outcomes of individualized botulinum neurotoxin type A injection techniques in patients with essential blepharospasm.
abstract: OBJECTIVE
  To assess the clinical outcomes following botulinum neurotoxin type A (BoNT-A) treatment with an individualized injection technique based on the types of spasms and to compare the results of the individualized injection technique with those of the conventional injection technique in the same patients.
  
  
  METHODS
  From November 2011 to July 2013, 77 BoNT-A injections were performed in 38 patients. Eighteen patients were treated with conventional BoNT-A injections before 2011, and 20 patients were referred to our hospital for unsatisfactory results after a conventional injection technique. We classified the patients by spasm-dominant sites: the lateral orbital area, representing the orbital orbicularis-dominant group (ODG); the glabella, representing the corrugator-dominant group (CDG); and the ptosis, representing the palpebral part of the orbicularis-dominant group (PDG). We increased the injection dose into the spasm-dominant sites of the blepharospasm groups. We assessed subjective symptom scores (functional disability score, FDS) after treatment.
  
  
  RESULTS
  This study included 38 patients (26 women, 12 men; mean age, 60.6 ± 10.9 years). There were 21 patients in the ODG, 10 patients in the CDG, and 7 patients in the PDG. Mean ages were 59.7 ± 12.6, 59.8 ± 8.5, and 66.8 ± 9.0 years, and mean BoNT-A injection dose was 38.8 ± 11.2, 38.8 ± 11.2, and 38.8 ± 10.8 U in each group, respectively (p = 0.44, 0.82 Kruskal-Wallis test). Mean FDS after injection was 1.7 ± 0.7 in the ODG, 1.4 ± 0.8 in the CDG, and 1.2 ± 0.3 in the PDG. There were significant differences in reading and job scale among the three groups. In a comparison between the conventional and individualized injection techniques, there was a significant improvement in mean FDS and in the reading scale in the PDG with the individualized injection technique. The success rate was 92.1% in the conventional injection group and 94.1% in the individualized injection group.
  
  
  CONCLUSIONS
  The individualized injection technique of BoNT-A according to the spasm-dominant site is an effective and safe treatment method for essential blepharospasm patients.
authors.affiliation: Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Youngje
authors.initials: Y
authors.lastname: Sung
authors.affiliation: Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Nam
authors.affiliation: Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Helen
authors.initials: H
authors.lastname: Lew
mesh_terms: D000368:Aged; D001764:Blepharospasm / Q000188:drug therapy* / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005133:Eye Movements / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D009801:Oculomotor Muscles / Q000503:physiopathology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Benign essential blepharospasm; Botulinum nerotoxin A; Individualized injection technique
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