{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:36:08Z","timestamp":1758638168168},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2006,5,16]],"date-time":"2006-05-16T00:00:00Z","timestamp":1147737600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2006,7]]},"abstract":"<jats:title>A<jats:sc>bstract<\/jats:sc><\/jats:title><jats:p><jats:bold>Background:\u2002<\/jats:bold> Botulinum toxin (Botox) is the mainstay treatment for benign essential blepharospasm. Current treatment practice appears restricted by several reports demonstrating adverse effects and resistance to high\u2010frequency, higher\u2010dose therapy. This study aimed to explore whether high\u2010dose, high\u2010frequency treatments could be used without developing secondary resistance and without significant side\u2010effects in patients refractory to conventional Botox doses.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> From a cohort of 120 patients being treated with Botox therapy for benign essential blepharospasm and idiopathic hemifacial spasm, case notes from six patients were retrospectively examined. In these patients, therapy had exceeded the recommended 50 units per side for a duration greater than 12\u2003months and at less than 3\u2003monthly intervals. Patterns in subjective severity grading and percentage of improvement as well as reported side\u2010effects were analysed.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> All patients described greater than 60% improvement and 0\u20132 severity grading over a 3\u2010 to 15\u2010year period with no evidence of secondary resistance. Side\u2010effects were minor, transient and less frequently reported at higher doses.<\/jats:p><jats:p><jats:bold>Conclusion:\u2002<\/jats:bold> In a select group of patients, Botox therapy can be used effectively at doses higher than recommended over long periods with minimal side\u2010effects and little evidence of secondary resistance.<\/jats:p>","DOI":"10.1111\/j.1442-9071.2006.01236.x","type":"journal-article","created":{"date-parts":[[2006,5,16]],"date-time":"2006-05-16T15:24:23Z","timestamp":1147793063000},"page":"441-444","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Use of high\u2010dose botulinum A toxin in benign essential blepharospasm: is too high too much?"],"prefix":"10.1111","volume":"34","author":[{"given":"Anna L\u2010Y","family":"Pang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"O\u2019Day","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,5,16]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(80)35127-0"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1159\/000047963"},{"key":"e_1_2_5_4_2","first-page":"219","article-title":"Structure, activity and immune recognition of botulinum neurotoxins","volume":"19","author":"Attasi MZ","year":"1999","journal-title":"Crit Rev Immunol"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870090216"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2003.035139"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000144349.95487.91"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2000.86"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(03)00075-8"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00055735-200112000-00006"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004397-200204000-00011"},{"key":"e_1_2_5_12_2","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1017\/S0317167100026159","article-title":"Botulinum toxin for benign essential blepharospasm, hemifacial spasm and age\u2010related lower eyelid entropion","volume":"14","author":"Curruthers J","year":"1987","journal-title":"Can J Neurol Sci"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(88)32977-5"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.4.834"},{"key":"e_1_2_5_15_2","unstructured":"YablonSA DaggettS.Toxin Neutralis\\zing Antibody Formation with Botulinum Toxin Type A Treatment.(Poster P01.153) 57th Annual Meeting of the American Academy of Neurology April 2005."},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.45.9.1743"},{"key":"e_1_2_5_17_2","doi-asserted-by":"crossref","unstructured":"DresslerD.Complete secondary botulinum toxin therapy failure in blepharospasm.J Neurol2000;247:809\u201310.","DOI":"10.1007\/s004150070100"},{"key":"e_1_2_5_18_2","unstructured":"23rd Annual Benign Essential Blepharospasm Research Foundation (BEBRF).International Conference University of Alabama 2004. Tape 7 Side B \u2018Why does botulinum toxin fail in some patients?\u2019"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(93)31384-9"}],"container-title":["Clinical &amp; Experimental Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1442-9071.2006.01236.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1442-9071.2006.01236.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T05:21:52Z","timestamp":1696915312000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1442-9071.2006.01236.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,5,16]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2006,7]]}},"alternative-id":["10.1111\/j.1442-9071.2006.01236.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1442-9071.2006.01236.x","archive":["Portico"],"relation":{},"ISSN":["1442-6404","1442-9071"],"issn-type":[{"value":"1442-6404","type":"print"},{"value":"1442-9071","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,5,16]]},"assertion":[{"value":"2006-05-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}