Botulinum A Toxin Treatment for Blepharospasm and Meige Syndrome : Report of 100 Patients
NIPHON POUNGV ARIN, M.D., F.R.C.P. (LONDON)*, VORAPUN DEV AHASTIN, M.D., M.R.C.P. (UK)*, RUNGSUN CHAISEVIKUL, M.D.*, NARAPORN PRAYOONWIWAT, M.D.*, ADULYA VIRIYA VEJAKUL, M.D., F.R.C.P. (LONDON)*
Affiliation : * Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Abstract
One hundred patients (9 .09 per cent) with blepharospasm from a grand total of 1, 100
patients (at the Movement Disorders Clinic at Siriraj Hospital) who had been treated with botulinum
A toxin (BTX-A) injection between 1989 and 1996 were analysed. The 100 patients comprised 65
females and 35 males with a female to male ratio of 1.86:1. Their mean age was 53.3 years (S.D.
12.03). Sixty patients had idiopathic blepharospasm, 31 patients were diagnosed with Meige
syndrome (blepharospasm plus oromandibular dystonia) and nine patients with segmental dystonia
(Meige syndrome plus cervical dystonia). The mean duration of suffering was 39.22 months (S.D.
44.83). Each patient received 30-50 IU of BTX-A injections according to the standard Siriraj
injection pattern. Nine patients were lost to follow-up.
The results of BTX-A injection were classified as: excellent result (an improvement of
more than 75 per cent) in 83.51 per cent; a good response (an improvement of 50-75 per cent) in
13.19 per cent; a moderate response (an improvement of 25-50 per cent) in 2.20 per cent; and mini-
mal or no response in 1.10 per cent. The complications of BTX-A injection were transient minimal
ptosis (9.89 per cent), transient double vision (1.10 per cent) and excessive lacrimation (1.10 per
cent). The efficacy of BTX-A injection lasted one to two months in 1.10 per cent, two to three
months in 23.08 per cent, three to four months in 45.05 per cent, four to five months in 16.48 per
cent, five to six months in 4.40 per cent and more than six months in 9.89 per cent.
Botulinum A toxin injection is a simple and effective out-patient treatment for patients
with blepharospasm, causing no systemic side-effects and minor transient local complications. The
only drawback of this treatment is its high cost (100 IU cost 300 US dollars).
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