Botulinum Toxin Injection for Hemifacial Spasm and Benign Essential Blepharospasm: A Systematic Review and Meta-Analysis comparing Pretarsal and Preseptal Injection Techniques.
Author: Muhammad Ashhad Noor
Base Hospital / Institution: Manchester Royal Infirmary
Rapid fire oral presentation
Abstract ID: 24-112
Purpose
To compare the outcomes of pretarsal versus preseptal botulinum toxin injection techniques for patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS).
Methods
The study was pre-registered on PROSPERO (CRD42023479251). A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a search of electronic information was conducted to identify all Randomised Controlled Trials (RCTs), case control studies and cohort studies comparing the outcomes between the two techniques. The change in Jankovic Rating Scale (JRS) was denoted as the primary outcome. Secondary outcome measures included adverse events, duration to maximum response and latency to first response. Fixed and random effects modelling were used for the analysis.
Results
384 patients with 2657 injections for HFS patients and 1033 injections for BEB patients was reported across six studies. The mean difference analysis for the change in JRS scores in HFS patients reveals a statistically significant difference favouring the pretarsal group for improved JRS ratings (MD=0.47, CI= 0.19 to 0.75, P = 0.001) and change in JRS scores in BEB patients favoring the pretarsal group (MD=0.92, CI= 0.48 to 1.36, P 0.001). There was a significant difference favouring the pretarsal group in duration of maximum response in HFS (P= 0.0005) and fewer occurrences of ptosis (P=0.0009) with low amount of heterogeneity (I2= 0%, P=0.65). For all other secondary outcomes including post-procedure tearing, irritation and lagophthalmos both groups had similar results.
Conclusion
When compared to the preseptal approach, pretarsal botulinum toxin injection is a preferable alternative for BEB and HFS because it minimizes the extent and frequency of spasms, has less occurrences of ptosis, and has a greater duration of maximal response. More clinical trials are needed to validate the findings of this meta-analysis
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Ahmad | Abul | Manchester Royal Infirmary |
| Mohammad | Saleki | Manchester Royal Infirmary |
| Ali | Alkhabbaz | Manchester Royal Infirmary |
| Ali | Abel | Manchester Royal Infirmary |
| Mohammad | Karam | Manchester Royal Infirmary |
| Sarah | Al-Youha | Manchester Royal Infirmary |
