Long‐term therapy with botulinum toxin in facial synkinesis: Retrospective data analysis of data from 1998 to 2018

Abstract

Objectives Treatment with botulinum toxin A (BoNT) is the therapy of choice for many patients with facial synkinesis. Repeated injections relieve hypertonicity and hyperkinesis of reinnervated mimic muscles. Aim of the study was to prove if the injection regime and dosage of BoNT change during long‐time therapy. Design Retrospective analysis of patients´ data, who were treated for synkinesis with BoNT from 1998 to 2018. Setting Tertiary referral facial nerve centre. Participants Injection pattern of BoNT was based on clinical symptoms, observations of the specialist and on previous treatment pattern. Onabotulinumtoxin (OnaBoNT), Incobotulinumtoxin (IncoBoNT) and Abobotulinumtoxin (AboBoNT) were available for treatment. Patients consulted our department for following treatment as soon as the symptoms re‐occurred. Main outcome measures Change in dosage and injection pattern, the time intervals between treatments over the entire therapy period. Results Seventy‐three patients were repeatedly injected. The median number of treatments was 18, the median treatment interval was 3.0 months. During the initial treatment, orbicularis oculi and the mentalis muscles were the most frequently injected muscles (94%). During repeated treatment, the number of injected muscles increased significantly (P < .0001), whereas the dose per muscle remained stable. The initial dose was 24 U (95%‐CI 22‐27 U) for OnaBoNT and IncoBoNT; 69 U for AboBoNT(95%‐CI 44‐94 U). We observed a significant increase in dosage for OnaBoNT and IncoBoNT (P < .0001) during the long‐term therapy. The time intervals between treatments were stable for all three BoNT preparations (P > .05). Conclusions We observed significant change in treatment dose and injection pattern of BoNT in patients with facial synkinesis. These results provide an orientation in dose finding and injection regimen of BoNT in the long‐term course of therapy.

Pathogenesis, diagnosis and therapy of facial synkinesis: A systematic review and clinical practice recommendations by the international head and neck scientific group

“…It is important to emphasize that synkinesis treatment is performed on the affected side. To achieve facial symmetry, injections of contralateral muscles (most frequent: procerus and/or corrugator, mentalis, and depressor anguli oris muscles) are also carried out ( 72 ). The contralateral treatment is not a synkinesis treatment.…”

“…There are three brands of botulinum toxin type A products that are commercially available in Europe and the United States, and all are used for facial synkinesis treatment ( 72 , 76 ): onabotulinumtoxinA (Botox, Allergan), abobotulinumtoxinA (Dysport, Ipsen, and Medicis), and incobotulinumtoxinA (Xeomin, Merz) (refer to Table 6 for dosages). Whether the selection of the brand has an effect on treatment intervals and dosage over time is not entirely clear ( 76 ).…”

“…The duration of effect is on average 3–4 months. Whereas the duration of the botulinum toxin effect seems to be stable over years, the number of injected muscles and the overall dosage needed seems to increase over time ( 72 ). There are no specific side effects of botulinum toxin used for facial synkinesis.…”

A utilização da toxina botulínica no tratamento da paralisia facial periférica

“…Ainda com relação a dados estatísticos, a maioria dos pacientes dos estudos são mulheres numa média de 45 a 66 anos, podendo indicar uma prevalência de acometimento no gênero feminino e na fase adulta. Alipour, et al (2021) relatou em seu estudo, que a etiologia da paralisia facial interfere tanto na dosagem quanto na frequência e resultado do tratamento.…”

“…Com exceção ao estudo de Kim (2013) em que foi realizado apenas uma aplicação por paciente. O intervalo de tempo entre as sessões variou-se de seis semanas (Rutzen, et al, 2016), três meses (Alipour, et al, 2021) e quatro meses (Akulov, et al, 2017). Choi, et al (2013), Risoud, et al (2015, Bennis, Duquennoy-Martinot e Guerresch (2016), Akulov, et al (2017), Shinn et al (2019), em seus estudos seguiram o protocolo de tratamento associando a injeção da toxina botulínica tanto no lado paralisado para reduzir espasmos e melhorar a força, quanto do lado não paralisado para diminuir hiperatividade muscular e reduzir assimetria.…”