{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T00:26:43Z","timestamp":1760228803862,"version":"build-2065373602"},"reference-count":19,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T00:00:00Z","timestamp":1653264000000},"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>The aim of this study was to show our therapeutic outcome of botulinum injection to the facial muscles and thereby to find the best therapeutic concept which should be embraced. The decision to treat the lower eyelid with 1-point or 2-points injection was randomly taken as there is no consensus regarding this debate. Injections of the lateral end of the upper eyelid were performed more laterally to the conventional injection point, just lateral to the conjunction of the upper and lower eyelids. Twenty-three patients (12 hemifacial spasm, 6 blepharospasm, 5 post facial palsy synkinesis) were enrolled. Data were retrieved from 112 visits between 2019 and 2022. Overall, 84.9% of the treatments had moderate or marked improvement. The most common side effect was facial weakness (11.8%). Neither ptosis nor diplopia were noted. Two-points regimen in the lower eyelid was associated with a lower risk of facial weakness (p = 0.01), compared to 1-point regimen, with a better therapeutic outcome as reflected by more favorable PGI-C scores (p = 0.04). Injection of the pretarsal segment of the upper eyelid, just onto or even lateral to the conjunction of the upper and lower eyelids, lowers the risk of ptosis.<\/jats:p>","DOI":"10.3390\/toxins14050362","type":"journal-article","created":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T05:12:27Z","timestamp":1653455547000},"page":"362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Therapeutic Approach to Botulinum Injections for Hemifacial Spasm, Synkinesis and Blepharospasm"],"prefix":"10.3390","volume":"14","author":[{"given":"Gilad","family":"Yahalom","sequence":"first","affiliation":[{"name":"Department of Neurology, Shaare Zedek Medical Center, Jerusalem 9103102, Israel"},{"name":"The Movement Disorders Clinic, Shaare Zedek Medical Center, Jerusalem 9103102, Israel"},{"name":"The School of Medicine, The Hebrew University, Jerusalem 91905, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Janah","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shaare Zedek Medical Center, Jerusalem 9103102, Israel"},{"name":"The School of Medicine, The Hebrew University, Jerusalem 91905, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Rajz","sequence":"additional","affiliation":[{"name":"The School of Medicine, The Hebrew University, Jerusalem 91905, Israel"},{"name":"Department of Neurosurgery, Shaare Zedek Medical Center, Jerusalem 9103102, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roni","family":"Eichel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shaare Zedek Medical Center, Jerusalem 9103102, Israel"},{"name":"The School of Medicine, The Hebrew University, Jerusalem 91905, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1136\/jnnp.59.3.309","article-title":"Pretarsal application of botulinum toxin for treatment of blepharospasm","volume":"59","author":"Aramideh","year":"1995","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/j.1468-1331.2008.02507.x","article-title":"Outcome predictors, efficacy 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_3","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1016\/j.bjps.2017.05.048","article-title":"An objective assessment of botulinum toxin type A injection in the treatment of post-facial palsy synkinesis and hyperkinesis using the synkinesis assessment questionnaire","volume":"70","author":"Neville","year":"2017","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.toxicon.2009.03.010","article-title":"Xeomin is free from complexing proteins","volume":"54","author":"Frevert","year":"2009","journal-title":"Toxicon"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/PL00007849","article-title":"Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm","volume":"249","author":"Cakmur","year":"2002","journal-title":"J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1016\/j.jocn.2015.02.032","article-title":"Botulinum toxin injections for the treatment of hemifacial spasm over 16 years","volume":"22","author":"Sorgun","year":"2015","journal-title":"J. Clin. Neurosci."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Yi, K.-H., Lee, J.-H., Hu, H.-W., and Kim, H.-J. (2022). Anatomical Proposal for Botulinum Neurotoxin Injection for Glabellar Frown Lines. Toxins, 14.","DOI":"10.3390\/toxins14040268"},{"key":"ref_8","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_9","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/BF00181883","article-title":"Botulinum toxin treatment in patients with hemifacial spasm","volume":"251","author":"Laskawi","year":"1994","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/S0161-6420(97)30220-6","article-title":"Blepharospasm and hemifacial spasm. Randomized trial to determine the most appropriate location for botulinum toxin injections","volume":"104","author":"Price","year":"1997","journal-title":"Ophthalmology"},{"key":"ref_11","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":"2010","journal-title":"Eye"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1111\/jocd.13869","article-title":"An unusual adverse event of botulinum toxin injection in the lower face","volume":"20","author":"Souto","year":"2021","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_13","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_14","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1016\/j.jfo.2021.05.009","article-title":"Tear osmolarity, dry eye syndrome, blepharospasm and botulinum neurotoxin","volume":"44","author":"Girard","year":"2021","journal-title":"J. Fr. Ophtalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/1353-8020(95)00003-8","article-title":"Placebo-controlled double-blind cross-over study of botulinum A toxin in hemifacial spasm","volume":"1","author":"Poungvarin","year":"1995","journal-title":"Park. Relat. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Kent, R., Robertson, A., Quinones Aguilar, S., Tzoulis, C., and Maltman, J. (2021). Real-World Dosing of OnabotulinumtoxinA and IncobotulinumtoxinA for Cervical Dystonia and Blepharospasm: Results from TRUDOSE and TRUDOSE II. Toxins, 13.","DOI":"10.3390\/toxins13070488"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3389\/fneur.2017.00035","article-title":"Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin","volume":"8","author":"Contarino","year":"2017","journal-title":"Front. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Scaglione, F. (2016). Conversion Ratio between Botox\u00ae, Dysport\u00ae, and Xeomin\u00ae in Clinical Practice. Toxins, 8.","DOI":"10.3390\/toxins8030065"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"273","DOI":"10.2147\/CCID.S156851","article-title":"Botulinum neurotoxin formulations: Overcoming the confusion","volume":"11","author":"Samizadeh","year":"2018","journal-title":"Clin. Cosmet. Investig. Dermatol."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/5\/362\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:16:46Z","timestamp":1760138206000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/5\/362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,23]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["toxins14050362"],"URL":"https:\/\/doi.org\/10.3390\/toxins14050362","relation":{},"ISSN":["2072-6651"],"issn-type":[{"type":"electronic","value":"2072-6651"}],"subject":[],"published":{"date-parts":[[2022,5,23]]}}}