Assessment of the effectiveness of botulinum toxin type A in a comprehensive approach to treatment of patients with hemifacial spasm

Introduction: Botulinum toxin type A (BTA) injections are the treatment of choice for idiopathic hemifacial spasm However, some patients experience minimal or inadequate results from BTA monotherapy, causing doctors to continue exploring an integrated approach to treatment of these patients Such a comprehensive approach may include kinesiotherapy— including work with an instructor, as well as telerehabilitation—which can help to improve the well-being of patients during the period between BTA injections However, the effectiveness of these combined treatments has not yet been thoroughly investigated Methods: A small case control study was performed We compared the effectiveness of repeated BTA injections (group I, control, n = 27) and an integrated approach (repeated BTA injections, accompanied by kinesiotherapy (post-isometric relaxation) under full- and part-time video supervision by an instructor (group II, cases, n = 21) The visits were performed before BTA treatment, and at 2 weeks, and 3 months after treatment The study was performed in patients aged 41 to 80 years with confirmed hemifacial spasm The severity of hemifacial spasm was assessed on a scale of 0 to 20, mild to severe In addition, the subjective assessment of “waiting for the next injection”, expressed on a 10-point scale, was analyzed Results: During the study period and 2 weeks post-study, both groups were comparable on both scales After 3 months, both groups had positive results, but only the patients in group II showed significant improvement in hemifacial spasm severity (before treatment 15 97 ± 0 72 vs 11 41 ± 2 33) 3 months post-therapy (P<0 05) The assessment of “waiting for the next injection” was also significantly lower in this group than in the control group (5 11 + 1 72 vs 7 78 + 1 13 in group II and group I (control group), respectively (P<0 05) Conclusion: A comprehensive approach to treating patients with hemifacial spasm can be integrated into everyday practice to extend the interval between injections, improve patient quality of life, and reduce the financial burden of the disease Novel instruments can be used to assess the effectiveness of this therapeutic approach, in particular, the hemifacial spasm severity scale and the assessment of “waiting for the next injection” In addition, the effectiveness of indirect support of patients using telerehabilitation has been shown, which is especially important in the context of the COVID 19 pandemic and the increased demand on health care resources