{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T22:03:57Z","timestamp":1793916237245,"version":"4.8.0"},"reference-count":69,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T00:00:00Z","timestamp":1639008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Hemifacial spasm (HFS) is a movement disorder characterized by involuntary contractions of the facial muscles innervated by the seventh cranial nerve. Generally, it is associated with a poor quality of life due to social embarrassment and can lead to functional blindness. Moreover, it is a chronic condition, and spontaneous recovery is rare. Intramuscular injections of Botulinum Toxin (BoNT) are routinely used as HFS treatment. Methods: We reviewed published articles between 1991 and 2021 regarding the effectiveness and safety of BoNT in HFS as well as any reported differences among BoNT formulations. Results: The efficacy of BoNT for HFS treatment ranged from 73% to 98.4%. The mean duration of the effect was around 12 weeks. Effectiveness did not decrease over time. Adverse effects were usually mild and transient. The efficacy and tolerability of the different preparations appeared to be similar. Among the studies, dosage, injected muscles, intervals of treatment, and rating scales were variable, thus leading to challenges in comparing the results. Conclusions: BoNT was the treatment of choice for HFS due to its efficacy and safety profile. Further studies are needed to investigate the factors that influence the outcome, including the optimal timing of treatment, injection techniques, dosage, and the best selection criteria for formulations.<\/jats:p>","DOI":"10.3390\/toxins13120881","type":"journal-article","created":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T02:07:18Z","timestamp":1639102038000},"page":"881","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Botulinum Toxin for the Treatment of Hemifacial Spasm: An Update on Clinical Studies"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1497-4482","authenticated-orcid":false,"given":"Nicola","family":"Tambasco","sequence":"first","affiliation":[{"name":"Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, 06129 Perugia, Italy"},{"name":"Neurology Department, Perugia General Hospital and University of Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Filidei","sequence":"additional","affiliation":[{"name":"Neurology Department, Perugia General Hospital and University of Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2736-0095","authenticated-orcid":false,"given":"Pasquale","family":"Nigro","sequence":"additional","affiliation":[{"name":"Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5722-3967","authenticated-orcid":false,"given":"Lucilla","family":"Parnetti","sequence":"additional","affiliation":[{"name":"Neurology Department, Perugia General Hospital and University of Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Simoni","sequence":"additional","affiliation":[{"name":"Neurology Department, Perugia General Hospital and University of Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1002\/mds.23692","article-title":"The many faces of hemifacial spasm: Differential diagnosis of unilateral facial spasms","volume":"26","author":"Yaltho","year":"2011","journal-title":"Mov. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1136\/jnnp.64.6.751","article-title":"Long term results of botulinum toxin type A (Dysport) in the treatment of hemifacial spasm: A report of 175 cases","volume":"64","author":"Jitpimolmard","year":"1998","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1001\/archneur.59.3.418","article-title":"Botulinum toxin A treatment for primary hemifacial spasm: A 10-year multicenter study","volume":"59","author":"DeFazio","year":"2002","journal-title":"Arch. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/j.1468-1331.2008.02507.x","article-title":"Outcome predictors, ef-ficacy and safety of Botox and Dysport in the long-term treatment of hemifacial spasm","volume":"16","author":"Bentivoglio","year":"2009","journal-title":"Eur. J. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/j.1468-1331.2006.01670.x","article-title":"Microvascular decompression for hemifacial spasm: Postoperative neurologic follow-up and evaluation of life quality","volume":"14","author":"Heuser","year":"2007","journal-title":"Eur. J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/BF01979049","article-title":"Linksseitigerfacialiskrampf in folgeeinesaneurysma der arteria vertebralissinistra","volume":"65","author":"Schultze","year":"1875","journal-title":"Arch. Pathol. Anat."},{"key":"ref_7","first-page":"418","article-title":"H\u00e9mispasme facial p\u00e9riph\u00e9rique","volume":"Volume 18","author":"Babinski","year":"1905","journal-title":"Nouvelle Iconographie de la Salp\u00eatri\u00e8re"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1007\/s00415-011-6376-3","article-title":"Hemifacial spasm: Clinical characteristics of 321 Indian patients","volume":"259","author":"Batla","year":"2012","journal-title":"J. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"438","DOI":"10.3109\/02688697.2011.641613","article-title":"Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: A systematic review","volume":"26","author":"Miller","year":"2012","journal-title":"Br. J. Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1001\/archneur.63.3.441","article-title":"A Comparative Study of Primary and Secondary Hemifacial Spasm","volume":"63","author":"Colosimo","year":"2006","journal-title":"Arch. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00702-010-0416-5","article-title":"Hemifacial spasm non-motor and motor-related symptoms and their response to botulinum toxin therapy","volume":"117","author":"Szczudlik","year":"2010","journal-title":"J. Neural Transm."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/IIO.0000000000000203","article-title":"Botulinum Toxins for Treating Essential Blepharospasm and Hemifacial Spasm","volume":"58","author":"Ozzello","year":"2018","journal-title":"Int. Ophthalmol. Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1001\/archopht.1990.01070040101040","article-title":"Familial hemifacial spasm","volume":"108","author":"Carter","year":"1990","journal-title":"Arch. Opthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1002\/mds.870090310","article-title":"Familial hemifacial spasm","volume":"9","author":"Micheli","year":"1994","journal-title":"Mov. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.parkreldis.2007.06.001","article-title":"Bilateral hemifacial spasm: A series of 10 patients with literature review","volume":"14","author":"Borges","year":"2008","journal-title":"Park. Relat. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.neuchi.2017.12.003","article-title":"Diagnosis of primary hemifacial spasm","volume":"64","author":"Lefaucheur","year":"2018","journal-title":"Neurochirurgie"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1007\/s10072-019-03921-4","article-title":"Validation of the Hemifacial Spasm Grading Scale: A clinical tool for hemifacial spasm","volume":"40","author":"Tambasco","year":"2019","journal-title":"Neurol. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1136\/jnnp.2005.065656","article-title":"Validation of a short disease specific quality of life scale for hemifacial spasm: Correlation with SF-36","volume":"76","author":"Tan","year":"2005","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00702-021-02343-x","article-title":"Validation of a new hemifacial spasm grading questionnaire (HFS score) assessing clinical and quality of life parameters","volume":"128","author":"Wabbels","year":"2021","journal-title":"J. Neural Transm."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1159\/000008068","article-title":"Gabapentin as treatment for hemifacial spasm","volume":"42","author":"Bandini","year":"1999","journal-title":"Eur. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1056\/NEJM199907083410209","article-title":"One man\u2019s poison\u2014clinical applications of botulinum toxin","volume":"341","author":"Hallett","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1038\/nrmicro3295","article-title":"Botulinum neurotoxins: Genetic, structural and mechanistic insights","volume":"12","author":"Rossetto","year":"2014","journal-title":"Nat. Rev. Genet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.toxicon.2015.07.002","article-title":"Current gaps in basic science knowledge of botulinum neurotoxin biological actions","volume":"107","author":"Rossetto","year":"2015","journal-title":"Toxicon"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1124\/pr.116.012658","article-title":"Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology","volume":"69","author":"Pirazzini","year":"2017","journal-title":"Pharmacol. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1146\/annurev.pharmtox.44.101802.121554","article-title":"Identification of the major steps in botulinum toxin action","volume":"44","author":"Simpson","year":"2004","journal-title":"Ann. Rev. Pharmacol. Toxicol."},{"key":"ref_26","unstructured":"Kurstot, J., and Forsstr\u00f6m, M. (2010). The clinical aspects and the therapeutic use of botulinum toxin in dystonia. Dystonia: Causes, Symptoms and Treatment, Nova Science Publisher."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1098\/rstb.1999.0377","article-title":"Tetanus and botulinum neurotoxins: Mechanism of action and therapeutic uses","volume":"354","author":"Pellizzari","year":"1999","journal-title":"Philos. Trans. R. Soc. B Biol. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"I21","DOI":"10.1007\/PL00007813","article-title":"Botulinum toxin: Evidence-based medicine criteria in blepharospasm and hemifacial spasm","volume":"248","author":"Jost","year":"2001","journal-title":"J. Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s10072-011-0672-7","article-title":"Retrospective evaluation of the dose equivalence of Botox\u00ae and Dysport\u00ae in the management of blepharospasm and hemifacial spasm: A novel paradigm for a never ending story","volume":"33","author":"Bentivoglio","year":"2012","journal-title":"Neurol. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/ceo.12165","article-title":"Long-term efficacy and safety of botulinum toxin A injections to treat blepharospasm and hemifacial spasm","volume":"42","author":"Ababneh","year":"2014","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.toxicon.2012.12.004","article-title":"Evidence-based review and assessment of botulinum neurotoxin for the treatment of movement disorders","volume":"67","author":"Hallett","year":"2013","journal-title":"Toxicon"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s13760-014-0285-z","article-title":"Long-term therapy of benign essential blepharospasm and facial hemispasm with botulinum toxin A: Retrospective assessment of the clinical and quality of life impact in patients treated for more than 15 years","volume":"114","year":"2014","journal-title":"Acta Neurol. Belg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"947","DOI":"10.3171\/jns.1962.19.11.0947","article-title":"Concerning the Mechanism of Trigeminal Neuralgia and Hemifacial Spasm","volume":"19","author":"Gardner","year":"1962","journal-title":"J. Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1227\/00006123-198705000-00015","article-title":"Hemifacial Spasm in Young People Treated with Microvascular Decompression of the Facial Nerve","volume":"20","author":"Jho","year":"1987","journal-title":"Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e383","DOI":"10.1016\/j.wneu.2020.04.001","article-title":"Spasm Freedom Following Microvascular Decompression for Hemifacial Spasm: Systematic Review and Meta-Analysis","volume":"139","author":"Holste","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1212\/WNL.42.3.627","article-title":"Botulinum toxin therapy for limb dystonias","volume":"42","author":"Yoshimura","year":"1992","journal-title":"Neurology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.4238\/2015.February.6.17","article-title":"Evaluation of concentrations of botulinum toxin A for the treatment of hemifacial spasm: A randomized double-blind crossover trial","volume":"14","author":"Li","year":"2015","journal-title":"Genet. Mol. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1007\/s10072-017-3107-2","article-title":"A comparative crossover study on the treatment of hemifacial spasm and blepharospasm: Preseptal and pretarsal botulinum toxin injection techniques","volume":"38","author":"Lolekha","year":"2017","journal-title":"Neurol. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1017\/S0317167100010817","article-title":"Long-Term Efficacy of Botulinum A Toxin for Blepharospasm and Hemifacial Spasm","volume":"37","author":"Gill","year":"2010","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.jocn.2007.02.002","article-title":"Differences in improvement between patients with idiopathic versus neurovascular hemifacial spasm after botulinum toxin treatment","volume":"15","author":"Tunc","year":"2008","journal-title":"J. Clin. Neurosci."},{"key":"ref_41","first-page":"361","article-title":"Botulinum toxin treatment in patients with focal dystonia and hemifacial spasm. A multicenter study of the Italian Movement Disorder Group","volume":"14","author":"Berardelli","year":"1993","journal-title":"Neurol. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"334","DOI":"10.3346\/jkms.1993.8.5.334","article-title":"Botulinum a toxin treatment of hemifacial spasm and blepharospasm","volume":"8","author":"Park","year":"1993","journal-title":"J. Korean Med Sci."},{"key":"ref_43","first-page":"206","article-title":"Botulinum toxin treatment of hemifacial spasm and blepharospasm: Objective response evaluation","volume":"47","author":"Thussu","year":"1999","journal-title":"Neurol. India"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1002\/mds.21435","article-title":"Botulinum toxin type B (Myobloc\u00ae) in subjects with hemifacial spasm: Results from an open-label, dose-escalation safety study","volume":"22","author":"Trosch","year":"2007","journal-title":"Mov. Disord."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1038\/eye.2009.192","article-title":"Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: A multicentre study using two drug-dose escalation indexes","volume":"24","author":"Cillino","year":"2009","journal-title":"Eye"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"305","DOI":"10.3126\/kumj.v8i3.6217","article-title":"The role of the injection Botulinum Toxin A in cases of Essential Blepharospasm Syndrome, Hemifacial Spasm and Meige\u2019s Syndrome","volume":"8","author":"Bastola","year":"2012","journal-title":"Kathmandu Univ. Med. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1007\/s00702-010-0409-4","article-title":"Hemifacial spasm and reinnervation synkinesias: Long-term treatment with either Botox\u00ae or Dysport\u00ae","volume":"117","author":"Kollewe","year":"2010","journal-title":"J. Neural Transm."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1159\/000327534","article-title":"Is it always necessary to apply botulinum toxin into the lower facial muscles in hemifacial spasm? A randomized, single-blind, crossover trial","volume":"65","author":"Colakoglu","year":"2011","journal-title":"Eur. Neurol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"952","DOI":"10.3109\/00016489.2016.1165864","article-title":"Increasing the area and varying the dosage of Botulinum toxin a injections for effective treatment of hemifacial spasm","volume":"136","author":"Choe","year":"2016","journal-title":"Acta Oto-Laryngol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1017\/cjn.2016.262","article-title":"Real-World, Long-Term Quality of Life Following Therapeutic OnabotulinumtoxinA Treatment","volume":"43","author":"Jog","year":"2016","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"106632","DOI":"10.1016\/j.clineuro.2021.106632","article-title":"Real-world experience with botulinum toxin A for the treatment of hemifacial spasm: A study of 1138 injections","volume":"205","author":"Gutierrez","year":"2021","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e26481","DOI":"10.1097\/MD.0000000000026481","article-title":"Long-term stable efficacy of botulinum toxin A in facial movement disorders with no need for increasing dose","volume":"100","author":"Badarny","year":"2021","journal-title":"Medicine"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Kongsaengdao, S., Maneeton, N., and Maneeton, B. (2021). The Five-Year Prospective Study of Quality of Life in Hemifacial Spasm Treated with Abo-Botulinum Toxin A. Toxins, 13.","DOI":"10.3390\/toxins13030215"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/acn3.51225","article-title":"Long-term adherence and response to botulinum toxin in different indications","volume":"8","author":"Lee","year":"2021","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/jnnp.59.1.102","article-title":"Dose standardisation of botulinum toxin","volume":"59","author":"Marion","year":"1995","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1002\/mds.870120627","article-title":"DYSBOT: A single-blind, randomized parallel study to determine whether any differences can be detected in the efficacy and tolerability of two formulations of botulinum toxin type A\u2014Dysport and Botox\u2014Assuming a ratio of 4:1","volume":"12","author":"Sampaio","year":"1997","journal-title":"Mov. Disord."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1185\/030079905X36396","article-title":"Safety, effectiveness, and duration of effect of BOTOX after switching from Dysport for blepharospasm, cervical dystonia, and hemifacial spasm","volume":"21","author":"Bihari","year":"2005","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/01.WNF.0000236771.77021.3C","article-title":"A Double-blind, Randomized, Crossover Study of Prosigne Versus Botox in Patients with Blepharospasm and Hemifacial Spasm","volume":"30","author":"Rieder","year":"2007","journal-title":"Clin. Neuropharmacol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1468-1331.2009.02877.x","article-title":"Routine use of Xeomin\u00c2\u00ae in patients previously treated with Botox\u00c2\u00ae: Long term results","volume":"16","author":"Dressler","year":"2009","journal-title":"Eur. J. Neurol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/WNF.0b013e3181c46f61","article-title":"Prospective, Randomized, Double-Blind Study, Comparing Botulinum Toxins Type A Botox and Prosigne for Blepharospasm and Hemifacial Spasm Treatment","volume":"33","author":"Quagliato","year":"2010","journal-title":"Clin. Neuropharmacol."},{"key":"ref_61","first-page":"625","article-title":"Comparison of two different formulations of botulinum toxin A for the treatment of blepharospasm and hemifacial spasm","volume":"21","author":"Wu","year":"2011","journal-title":"Turk. Neurosurg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1111\/ceo.13829","article-title":"Switchover study of onabotulinumtoxinA to incobotulinumtoxinA for facial dystonia","volume":"48","author":"Bladen","year":"2020","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"106889","DOI":"10.1016\/j.clineuro.2021.106889","article-title":"Dose conversion ratio, comparative efficacy, and adverse events after switching from onabotulinum toxin A to abobotulinum toxin A for neurological conditions","volume":"209","author":"Ozer","year":"2021","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"106555","DOI":"10.1016\/j.clineuro.2021.106555","article-title":"Hemifacial spasm through the last three decades: From etiology to efficacy and safety of long-term botulinum toxin treatment","volume":"203","year":"2021","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.toxicon.2015.07.013","article-title":"Explanation of timing of botulinum neurotoxin effects, onset and duration, and clinical ways of influencing them","volume":"107","author":"Hallett","year":"2015","journal-title":"Toxicon"},{"key":"ref_66","first-page":"507","article-title":"Effect of dietary zinc and phytase supplementation on botulinum toxin treatments","volume":"11","author":"Koshy","year":"2012","journal-title":"J. Drugs Dermatol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"695","DOI":"10.2165\/00019053-199712060-00009","article-title":"Costs of Treating Dystonias and Hemifacial Spasm with Botulinum Toxin A","volume":"12","author":"Dodel","year":"1997","journal-title":"Pharmacoeconomics"},{"key":"ref_68","first-page":"427","article-title":"Treatment of hemifacial spasm with type A botulinum toxin (AGN 191622): A dose finding study and the evaluation of clinical effect with electromyography","volume":"51","author":"Mezaki","year":"1999","journal-title":"No Shinkei Brain Nerve"},{"key":"ref_69","first-page":"44","article-title":"Clinical application of botulinum toxin type B in movement disorders and autonomic symptoms","volume":"20","author":"Wan","year":"2005","journal-title":"Chin. Med. Sci. J."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/13\/12\/881\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:44:10Z","timestamp":1760168650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/13\/12\/881"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,9]]},"references-count":69,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["toxins13120881"],"URL":"https:\/\/doi.org\/10.3390\/toxins13120881","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,9]]}}}