Hemifacial dystonia

Bosco D, Plastino M, Marcello MG, Mungari P, Fava A. Acute hemifacial dystonia possibly induced by clebopride. Clin Neuropharmacol 2009 32 107-8. 

Botulinum neurotoxins are widely used as therapeutic agents to cause reduction or paralysis of skeletal muscle contraction. They are used to treat cervical dystonia, which causes regional involuntary muscle spasms often associated with pain. Moreover, they are used in strabism, blepharospasm, hemifacial spasm, and... 

Botulinum toxin is the treatment of choice for focal dystonias such as torticollis and writer s cramp and for hemifacial spasm, and may complement the management of spasticity. 

Benign essential blepharospasm (BEB) is a dystonia characterized by involuntary sustained (tonic) and spasmodic (rapid or clonic) repetitive contractions involving the orbicularis oculi, procerus, and corrugator musculature (Figure 22-15). When the muscles of facial expression that are innervated by the fecial nerve are similarly involved on only one side of the fece, a hemifacial spastic dystonia occurs. 

Indications Blepharospasm, hemifacial spasm, spasmodic torticollis, sialorrhea, hyperhidrosis, strabismus, oromandibular dystonia, cervical dystonia, spasmodic dysphonia. Cosmetic application for wrinkles... 

Food-borne botulism results from the ingestion of food contaminated with preformed toxins or toxin-producing spores from C. bo-tulinum. C. botulinum poisoning is relatively rare only 110 cases are reported per year in the United States. Botulism is almost always associated with improper preparation or storage of food. Seven distinct toxins (A to G) have been described. The toxins, which are produced by the bacteria and released on lysis, are the most potent biologic or chemical toxins known to humans. The toxin prevents the release of acetylcholine at the peripheral cholinergic nerve terminal. Toxin activity has prompted the use of minute locally injected doses to treat select spastic disorders, such as blepharospasm, hemifacial spasm, and certain dystonias. ... 

A total of 182 patients (73 male, 109 female) with various facial region disorders were retrospectively studied using botulinum toxin injection for the treatment of facial region disorders [19 j. Improvement in symptoms was marked and good in subjects treated for blepharospasm, hemifacial spasm, facial s5mkinesis and Meige syndrome, and moderate for oromandibular dystonia and hypersalivation. Ptosis was the most common side effect. 

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