Objective: To assess the effectiveness of botulinum toxin A (BoNTA) therapy in treating  hemifacial spasm (HFS) patients using Goal Attainment Scale (GAS).

Background: HFS is a chronic condition that often leads to social embarrassment and functional limitations. GAS provides a personalised approach to evaluate treatment outcomes based on individual patient goals and expectations, offering a more tailored assessment of therapeutic success.

Method: A cross-sectional study was conducted with HFS patients receiving regular BoNTA injections from June 2024 to February 2025. A single movement disorder specialist administered all injections. Patients identified three key goals affecting their condition, which were weighted by importance and the difficulty on a scale from 0 to 3 for both. Progress was self-rated on a scale from -2 to +2, with composite GAS scores converted to a standardised T-score. A T-score of 50 indicated expected goal achievement, with higher scores reflecting better outcomes.

Results: The study included 36 HFS patients (27 females, 9 males; mean age = 62.89 ± 11.35 years), with an average BoNTA treatment duration of 6.44 ± 3.87 years. Three patients had undergone microvascular decompression (Table 1). A total of 108 goals were identified, focusing on spasm symptoms, facial appearance, daily activities, and minimising injection-related complications (Table 2). Common goals included reducing eye spasms (23/36, 21.29%), achieving a symmetrical smile (18/36, 16.67%), and enhancing social comfort (16/36, 14.81%). The mean GAS T-score post-BoNTA injection was 66.50 (range: 50–77.2, SD = 6.64), with 97.22% (35/36) of patients scoring above 50.

Conclusion: This study highlights the effectiveness of GAS in addressing personalised treatment goals of HFS patients receiving BoNTA treatment. Emphasising patient-specific goals over clinical symptoms helps refine treatment strategies to better meet patient expectations.

Table1

Table2

Table3

References: 1.Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009 Apr;23(4):362-70.
2.Panyakaew P, Wongwan P, Bhidayasiri R. The Goal Attainment Scale Refines Patient-Centered Expectations in Botulinum Toxin Treatment of Cervical Dystonia. J Mov Disord. 2024 Oct;17(4):462-465.
3.Szabó M, Gárdián G, Szpisjak L, Salamon A, Gábor T, Klivényi P, Zádori D. The Application of Goal Attainment Scaling in Cervical Dystonia – An Exploratory Observational Pilot Study. Mov Disord Clin Pract. 2024 Aug;11(8):1013-1017.

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