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Botulinum toxin treatment of synkinesia and hyperlacrimationafter facial palsy |
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| Authors: | B Boroojerdi A Ferbert M Schwarz H Herath J Noth |
| Affiliation: | Department of Neurology, University Hospital, RWTH Aachen, Germany. |
| Abstract: | OBJECTIVES—Toinvestigate the effects of injection of botulinum toxin type A (BTX A)into the orbicularis oculi muscle and lacrimal gland in patients withaberrant regeneration after facial palsy (facial synkinesias and hyperlacrimation). METHODS—The effect ofthe toxin injection (on average 75 mouse units of BTX A) into theorbicularis oculi muscle on facial synkinesias was assessed on a fivepoint (0 to 4) scale in 10 patients with aberrant regeneration offacial nerve fibres after a peripheral facial nerve palsy. Six patientsunderwent a videographic control, which was assessed by a blindedindependent investigator. In two patients with hyperlacrimation anextra dose of botulinum toxin (on average 20 mouse units BTX A) wasinjected into the lacrimal gland and the effect was assessed using theSchirmer test and on a three point scale. RESULTS—Botulinumtoxin type A had a good to excellent (grades 3 and 4) effect over anaverage of six months after 91% of injections. In 9% the injectionshad a moderate (grade 2) effect. Patients with hyperlacrimation showeda nearly complete recovery. There were no systemic side effects butfocal side effects due to a temporary weakness of the orbicularis oculimuscle were not uncommon. CONCLUSIONS—Botulinumtoxin type A is the treatment of choice in motor and autonomic effectsof aberrant regeneration of facial nerve after a peripheral palsy. Therequired dose is similar to or slightly lower than the dose usuallyrecommended for hemifacial spasm. |
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