Objective: To evaluate the potential benefits of a post-injection telehealth follow-up visit for people with craniofacial dystonia.

Background: Craniofacial dystonias, including blepharospasm and oromandibular dystonia, are characterized by abnormal contractions of the muscles of the mouth, tongue, mandible, and face, which may result in significant distress, and/or functional impairment ^1-3.  Injection of affected muscles with botulinum toxin is first line therapy for craniofacial dystonias^1-4. Recurring injection visits typically occur approximately three months apart. Because physicians do not typically see patients between injection visits, physicians must rely on the patient’s memory to determine the benefits of the prior injection. Telehealth is convenient and cost-effective for patients and providers^5-6.  This study explores the potential benefits of follow-up telehealth visits between injection cycles.

Method: Participants with craniofacial dystonia treated with botulinum toxin at Vanderbilt University Medical Center provided informed consent (IRB 211675) and were assessed via telehealth 2-4 weeks post-injection over a minimum of two treatment cycles. To determine the value of the telehealth follow-up visit, the treating physician assessed on a scale of 0-4 (4=very helpful, 0= not at all helpful) how informative the telehealth visit was for muscle selection, toxin dose and type, the interval between treatments, and additional medication, referral, or tests. At the two subsequent injection visits, the clinician assessed if the telehealth follow-up visits informed decisions regarding the treatment.

Results: Participants (n=32) completed 49 telehealth visits, collectively, between December 3, 2021, and April 4, 2024. Clinicians rated the value of the telehealth visit as helpful or very helpful for muscle selection 96%, toxin dose 90%, toxin type 43%, interval between treatments 63%, and additional medication, referral, or tests 23%. At the subsequent injection visit, clinicians indicated that the telehealth follow-up visit informed decisions regarding treatment 77%.

Conclusion: For people with craniofacial dystonias, post-injection telehealth follow-up visits during peak effect are likely beneficial for informing treatment decisions such as muscle selection and toxin dose. Further investigation is needed to better understand the potential benefits of telehealth in the management of craniofacial dystonias.

References: 1. Kenney C, Jankovic J. Botulinum toxin in the treatment of blepharospasm and hemifacial spasm. J Neural Transm. 2008;115(4):585-591. doi:10.1007/s00702-007-0768-7
2. Karp B, Alter K. Botulinum Toxin Treatment of Blepharospasm, Orofacial/Oromandibular Dystonia, and Hemifacial Spasm. Semin Neurol. 2016;36(01):084-091. doi:10.1055/s-0036-1571952
3. Kollewe K, Mohammadi B, Köhler S, Pickenbrock H, Dengler R, Dressler D. Blepharospasm: long-term treatment with either Botox®, Xeomin® or Dysport®. J Neural Transm. 2015;122(3):427-431. doi:10.1007/s00702-014-1278-z
4. Costa J, Espírito-Santo CC, Borges AA, et al. Botulinum toxin type A therapy for hemifacial spasm. Cochrane Movement Disorders Group, ed. Cochrane Database of Systematic Reviews. Published online 2010. doi:10.1002/14651858.CD004899.pub2
5. Mair FS, Haycox A, May C, Williams T. A review of telemedicine cost-effectiveness studies. Journal of Telemedicine and Telecare. 2000;6(1_suppl):38-40. doi:10.1258/1357633001934096
6. Susan S. Gustke David C. Balch Vivian L. West Lance O. Rogers. Patient Satisfaction with Telemedicine. Telemedicine Journal. Published online 2004.

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/telehealth-follow-up-for-craniofacial-dystonias-treated-with-neurotoxin-injection-physician-outcomes/