University Teaching Trust Botulinum toxin injections for hemifacial spasm Turnberg Building Neurology 0161 206 2562 All Rights Reserved 2017. Document for issue as handout.
About botulinum toxin injection for hemifacial spasm This is when the muscles on one side of the face go into spasm. Hemifacial spasm may develop gradually. Initially the muscles surrounding the eye may be affected by muscle spasms. The spasms may then spread to other muscles on the same side of the face. The cause of hemifacial spasm is not yet fully understood, but current medical opinion suggests that the condition may be mechanical and caused by irritation of the facial nerve. Treatment Surgery can be curative, although it is not suitable for most patients. Occasionally patients may benefit from treatment with drugs such as carbamazepine and clonazepam. Botulinum toxin injections, which weaken the muscles affected by spasm, are the best treatment option. Small doses of botulinum toxin are injected into the facial muscles causing the contraction. The effect of the injection lasts for two to three months only, for most patients, and repeated injections are often necessary for continued relief. In cases where little improvement results from the injections, it may be because slightly different muscles need to be targeted, or the dose needs adjusting. It may not be possible to stop the spasm completely. Before your procedure A neurologist will review you in the outpatients department. The procedure will be discussed and a decision will be made on the site and number of injections that are required. Details of your medical history will be taken, if necessary a clinical examination and investigations will be carried out. This is a good opportunity for you to ask any questions about the procedure or any concerns you may have. You will be asked if you are taking any prescribed medication or any tablets bought over the counter in a pharmacy. It helps if you bring your tablets to the appointment. The procedure does not involve the use of a general or local anaesthetic, and you do not need to fast. Botulinum toxin is not a suitable treatment if you are pregnant, breast feeding or trying for a baby. If you are taking any blood thinning medication (anticoagulants) please let your consultant or specialist nurse know as special precautions may need to be undertaken. These include: Warfarin, Dabigatran, Apixaba, Rivaroxaban. If you are having botulinum toxin injections for any other condition/reason you must let your consultant or specialist nurse know. The procedure is performed in the clinic and takes approximately five to ten minutes. During the procedure The initial set of injections will be given by the Consultant Neurologist. Once the response to the injections is apparent the doctor may refer you to the Dystonia Nurse Practitioner for all further injections. You will be reclined on a couch or seated in a chair for the injections around your eye. Depending on the severity of the spasm, small doses of botulinum toxin are injected just under the skin into the muscle surrounding the eye at 2-4 sites. The exact dose may be varied dependent on your response to previous treatments. After three to four days the injection causes temporary weakness to the muscle around the eye, which relieves the symptoms of spasm for approximately two to three months. 1 2
After the procedure When can you leave hospital? After the procedure you will be able to return home, back to normal activities. When can you resume normal activities including work? Most people who have had this procedure can resume normal working activities immediately after their injections. Special measures you need to take after the procedure: None, but try to avoid touching or rubbing the site that has been treated. Follow up: Before you leave the clinic you will be given details of your next appointment. This is usually in 3-4 months time. If you have any tests performed your consultant will inform your Doctor of the results. These results will be discussed on your return visit. You will be given the contact details of the dystonia nurse practitioner in case you have any problems, questions or concerns regarding your treatment. If you are unable to make your next appointment for any reason please contact the dystonia nurse practitioner to make alternative arrangements. Alternative procedures that are available A number of specialised surgical procedures are available for the treatment of hemifacial spasm. These are often effective, but may be associated with potentially serious side effects. These are generally reserved for patients with severe and disabling hemifacial spasm, for those who do not respond to treatment with botulinum toxin. Possible side effects of the botulinum toxin injections Following the procedure, the majority of individuals with eye spasm experience relief from their symptoms. However, side effects may occur, usually wearing off within a few days or weeks. Potential side effects include the following: l Occasionally bruising may develop around the injection site. l Sometimes the muscles around the eye become weaker than expected following your injection. Occasionally you may experience drooping of the eyelid and rarely double vision. The excessive weakness will resolve as the effects of the toxin in the muscle are only temporary. l Botulinum toxin contains human albumin which comes from human blood. As with any medicine which is created from human blood there is a possibility of passing on infections. To reduce this risk, blood donors are chosen very carefully. Furthermore, botulinum toxin is made in a way that should remove or destroy viruses. This may be of importance to Jehovah s witness when considering treatment. l On rare occasion s flu like symptoms, headaches, fever and feeling tired may occur. l Occasionally patients can develop antibodies against the toxin. l Antibody formation is more likely to form with high doses of botulinum toxin and if it is administered before a 12 week interval. If your body builds up antibodies to the botulinum toxin it will no longer work. 3 4
Information and support There are leaflets about the condition and botulinum toxin available at your appointment and in the waiting area. If you have any questions or anxieties, please feel free to discuss them with the consultant or dystonia nurse practitioner. Further information is also available from the: Dystonia Society Telephone: Website: 0845 458 6322 www.dystonia.org.uk There is a local branch of the dystonia society. This gives you an ideal opportunity to meet other people with dystonia. For details you can contact: Chris Smith Telephone: 0845 899 7131 The team Left to right: Dr Kobylecki, Dr Silverdale, Diane Ashton, Dr Garcia Del Carrizo, Dr Kellett Your Consultant Neurologist is: Your Dystonia Nurse Practitioner is: Diane Ashton Contact details: 0161 206 2562 diane.ashton@srft.nhs.uk Notes 5 6
G16110115W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2017 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: NOE 55 (16) Review Date: February 2019 University Teaching Trust For further information on this leaflet, it s references and sources used, please contact 0161 206 2562. Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Under the Human Tissue Act 2004, consent will not be required from living patients from whom tissue has been taken for diagnosis or testing to use any left over tissue for the following purposes: clinical audit, education or training relating to human health, performance assessment, public health monitoring and quality assurance. If you object to your tissue being used for any of the above purposes, please inform a member of staff immediately. Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients