Essential blepharospasm is a focal distonia characterized by involuntary, spasmodic, bilateral contractions of eyelid protractors. This is a rare disease, which diagnosis is frequently late and symptoms may progress until functional blindness. In this article, we perform a review and describe the most important features of the disease, including historical aspects, epidemiology, etiology, clinical findings, differential diagnosis and treatment. Entre os anos de a , Nutt et al. Posteriormente, Bradley et al. Anderson et al.

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It is usually treated with botulinum toxin BTX. The classically described unilateral application of BTX results in an asymmetry similar to facial paralysis. The aim of this study was to standardize the treatment of HFS by applying BTX bilaterally to prevent the occurrence of iatrogenic facial asymmetry. On reassessment 15 days later, a complementary dose was administered to patients who exhibited some residual degree of spasm or asymmetry with the aim of determining the dose required to achieve satisfactory spasm control without causing facial asymmetry.

There was a significant difference between the doses applied to the zygomaticus, orbicularis oris, and orbicular oculi muscles on each hemiface. In general, application should be performed at a ratio of In the remaining muscles, the same dose should be administered on both sides and an additional dose can be applied 15 days later if some degree of spasm is present. The pretarsal region of the orbicularis oculi muscle is the only area for which BTX application on the healthy side is unnecessary.

All scientific articles published at www. Previous Article Next Article. Figure 1. Standardized points of application of botulinum toxin for the treatment of hemifacial spasm to avoid iatrogenic asymmetry. Pretarsal sites were added to the original protocol, seen in red.

Figure 2. A year-old patient with hemifacial spasm on the left side for 9 years before and after the application of botulinum toxin. The sites of application and dose used at each site are shown for the resting face upper photographs and smiling face lower photographs.

Note that after application, the resting face shows relaxation of the orbicularis oculi and softening of the left nasolabial fold, in addition to improved smile quality after treatment.






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