Use of Alleviating Maneuvers for Periocular Facial Dystonias.
OBJECTIVE
Patients with benign essential blepharospasm or hemifacial spasm are known to use botulinum toxin injections and alleviating maneuvers to help control their symptoms. The clinical correlates between the use of botulinum toxin injections and the use of alleviating maneuvers are not well established.


OBJECTIVE
To determine whether the use of alleviating maneuvers for benign essential blepharospasm or hemifacial spasm correlates with disease severity or botulinum toxin treatment.


METHODS
A prospective cross-sectional observational study (designed in September 2013) of 74 patients with benign essential blepharospasm and 56 patients with hemifacial spasm who were consecutively recruited from adnexal clinics at Moorfields Eye Hospital (January-June 2014) to complete a questionnaire and undergo a clinical review. Data analysis was performed in December 2015.


METHODS
Prevalence and type of alleviating maneuvers used for blepharospasm and hemifacial spasm, dystonia severity, and dose and frequency of botulinum toxin injections.


RESULTS
Of the 74 patients with blepharospasm, 39 (52.7%) used alleviating maneuvers (mean [SD] age, 70.4 [9.1] years); of the 56 patients with hemifacial spasm, 25 (44.6%) used alleviating maneuvers (mean [SD] age, 66.5 [12.7] years). The most commonly used maneuver was the touching of facial areas (35 of 64 patients [54.7%]); other maneuvers included covering the eyes (6 of 64 patients [9.4%]), singing (5 of 64 patients [7.8%]), and yawning (5 of 64 patients [7.8%]). Patients with blepharospasm who used alleviating maneuvers scored higher on the Jankovic Rating Scale (median score, 5 vs 4; Hodges-Lehmann median difference, 1 [95% CI, 0-2]; P = .01) and the Blepharospasm Disability Index severity score (median score, 11 vs 4; Hodges-Lehmann median difference, 4 [95% CI, 1-7]; P = .01) than patients with blepharospasm who did not use alleviating maneuvers. Patients with hemifacial spasm who used alleviating maneuvers scored higher on the 7-item Hemifacial Spasm Quality of Life scale (median score, 7 vs 3; Hodges-Lehmann median difference, 4 [95% CI, 1-7]; P = .01) and the SMC Severity Grading Scale (median score, 2 vs 2; Hodges-Lehmann median difference, 0 [95% CI, 0-1]; P = .03) than patients with hemifacial spasm who did not use alleviating maneuver. The severity of dystonia correlated with botulinum toxin treatment for patients with blepharospasm (r = 0.23; P = .049) and patients with hemifacial spasm (r = 0.45; P = .001). There was no difference found in botulinum toxin treatment between patients who used alleviating maneuvers and those who did not, in either the blepharospasm group (150 vs 125 units; Hodges-Lehmann median difference, 20 units [95% CI, -10 to 70 units]; P = .15) or the hemifacial spasm group (58 vs 60 units; Hodges-Lehmann median difference, 0 units [95% CI, -15 to 20 units]; P = .83).


CONCLUSIONS
Half of the patients with periocular facial dystonias used alleviating maneuvers. Their use was associated with more severe disease but not with increased use of botulinum toxin. This may help to guide future therapies, such as advice on maneuver augmentation or tailored devices.
St Mary's Hospital, London, England.
Caroline L S
CL
Kilduff
Adnexal Department, Moorfields Eye Hospital, London, England.
Edward J
EJ
Casswell
Adnexal Department, Moorfields Eye Hospital, London, England.
Tahrina
T
Salam
Adnexal Department, Moorfields Eye Hospital, London, England.
Dov
D
Hersh
Instituto Clinic de Oftalmologia, Hospital Clinic, Barcelona, Spain.
Santiago
S
Ortiz-Perez
Adnexal Department, Moorfields Eye Hospital, London, England.
Daniel
D
Ezra
D000368:Aged; D001764:Blepharospasm / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004421:Dystonia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005152:Facial Muscles / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D019569:Hemifacial Spasm / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A