Objective: To compare the efficacy of combined facial exercise with BTX-A injection with BTX-A injection alone measured by the total HFS-30 (tHFS-30) score.

Background: Hemifacial spasm (HFS) is troublesome peripheral myoclonus involving half of the face[1,2]. Botulinum toxin A (BTX-A) is a treatment of choice. The previous preclinical study showed the promising of voluntary muscle exercise may increase the efficacy of BTX-A[3]. However, in clinical studies, there were few studies which showed some positive trend toward the exercise group[4]. Our study is intended to evaluate the efficacy of facial exercise on top of the BTX-A injection compared to BTX-A injection alone in HFS patients.

Method: An eight-month prospective, randomized controlled crossover study was conducted involved forty HFS patients. All patients were randomly allocated to either facial exercise immediately after BTX-A injection or BTX-A injection-alone group then did the crossover at the end of forth month. For the facial exercise group, the patients will be asked to perform the facial exercise which composed of active facial squeezing and passive facial massaging technique using the video-guided program immediately after receiving BTX-A for 7 minutes. We evaluated the short-term effect of facial exercise on top of the BTX-A injection at one month after the intervention. The primary outcome was the mean change of quality of life (QoL) measured by the tHFS-30 score compared between two groups, and the secondary outcomes were the severity of facial muscles spasm using the SMC severity grading scale, time-to-onset of action, time-to-peak effect, self-reported global clinical response, and adverse effects.

Results: Thirty-eight patients completed the study. Mean change of tHFS-30 score significantly improved by 6-point which was lower in the group of facial exercise (95%CI=1.4-10.6; p-value=0.01). The sub-items of the HFS-30 score which showed significant improvement were emotional well-being (p-value=0.002), stigma (p-value=0.03), and cognition (p-value=0.04). There was no statistically significant difference in all secondary outcomes and adverse effects between the two groups (Table 1).

Conclusion: Combined facial exercise with BTX-A injection may enhance the short-term efficacy on QoL of HFS patients measured by the HFS-30 score.

References: 1. Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment. Muscle Nerve 1998;21:1740–7. 2. Jankovic J. Peripherally induced movement disorders. Neurol Clin 2009;27:821–32. 3. Simpson LL. Kinetic studies on the interaction between botulinum toxin type A and the cholinergic neuromuscular junction. J Pharmacol Exp Ther. 1980; 212:16-21. 4. O’ Reilly P, Ross J, Norris J, Malhotra R. A Comparison of Facial Muscle Squeezing versus Non-facial Muscle Squeezing on the Efficacy of BotulinumToxin-A Injections for the Treatment of Facial Dystonia. Orbit. 2012;31(6):400-3.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-short-term-effect-of-combined-facial-exercise-with-botulinum-toxin-a-injection-in-clinical-practice-in-thai-patients-with-hemifacial-spasm-a-randomized-controlled-pilot-crossover-study/