• Use of Alleviating Maneuvers for Periocular Facial Dystonia

    By Lynda Seminara and edited by Neil M. Bressler, MD

    Journal Highlights

    JAMA Ophthalmology, October 2016

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    Patients with periocular facial dystonia may seek treatment with botulinum toxin (BTX) and may perform alle­viating maneuvers such as touching their face or coughing to minimize symptoms. Kilduff et al. conducted a prospective cross-sectional obser­vational study to determine whether self-performed alleviating maneuvers are associated with BTX treatment or dystonia severity. They noted that performing such maneuvers correlated significantly with more severe facial dystonia and that BTX use was similar between patients who did and did not employ these maneuvers.

    Dystonia severity was assessed from questionnaires completed by 74 patients with benign essential bleph­arospasm (BEB) and 56 patients with hemifacial spasm (HFS). Patients with BEB completed the Jankovic Rating Scale and the Blepharospasm Disability Index. Patients with HFS completed the 7-item HFS Quality of Life Scale and the SMC Severity Grading Scale. All participants underwent clinical examination.

    Thirty-nine patients with BEB (53%) and 25 patients with HFS (45%) affirmed that they utilized sensory and motor stimulatory techniques to manage dystonia. Touching specific regions of the face was the most com­mon alleviating maneuver described, followed by covering the eyes, singing, and yawning. Regardless of spasm type, patients who used alleviating maneu­vers scored higher on grading scales than those who did not, denoting more severe dystonia in maneuver users. The alleviating maneuvers reduced at least 50% of involuntary movement for 65% of patients with BEB and 46% of pa­tients with HFS. The dose and frequen­cy of BTX were similar for patients who did and did not utilize the maneuvers.

    The authors concluded that use of alleviating maneuvers is associated with more severe disease but not with great­er use of BTX. Initiating the maneuvers may indicate worsening of the dystonia. However, by performing these maneu­vers, patients with BEB or HFS may be able to maintain a specific BTX dosage even if their condition worsens. These findings may aid in the development of new therapies for periocular facial dystonia. (See also invited commentary by Lee AG and Miller NR.)

    The original article can be found here.