IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery

• Published in: Journal of the neurological sciences Vol. 381; pp. 130 - 134
• Main Authors: Akulov, Mihail A., Orlova, Ol'ga R., Orlova, Aleksandra S., Usachev, Dmitrij J., Shimansky, Vadim N., Tanjashin, Sergey V., Khatkova, Svetlana E., Yunosha-Shanyavskaya, Anna V.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.10.2017
• Subjects: Acute Disease; Botulinum toxin type A; Botulinum Toxins, Type A - therapeutic use; Chronic Disease; Disability Evaluation; Facial Nerve Injuries - drug therapy; Facial Nerve Injuries - epidemiology; Facial Nerve Injuries - physiopathology; Facial Nerve Injuries - rehabilitation; Facial nerve injury; Facial Paralysis - drug therapy; Facial Paralysis - epidemiology; Facial Paralysis - physiopathology; Facial Paralysis - rehabilitation; Female; Humans; incobotulinumtoxinA; Male; Middle Aged; Neuromuscular Agents - therapeutic use; Neurosurgical Procedures; Postoperative Complications - drug therapy; Postoperative Complications - epidemiology; Postoperative Complications - rehabilitation; Prevalence; Single-Blind Method; Synkinesis; Synkinesis - drug therapy; Synkinesis - epidemiology; Synkinesis - physiopathology; Traction; Treatment Outcome; Facial nerve injury; SD; Botulinum toxin type A; SFG; incobotulinumtoxinA; FDI; IQR; Synkinesis
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2017.08.3244

This study evaluates the effect of incobotulinumtoxinA in the acute and chronic phases of facial nerve palsy after neurosurgical interventions. Patients received incobotulinumtoxinA injections (active treatment group) or standard rehabilitation treatment (control group). Functional efficacy was assessed using House-Brackmann, Yanagihara System and Sunnybrook Facial Grading scales, and Facial Disability Index self-assessment. Significant improvements on all scales were seen after 1month of incobotulinumtoxinA treatment (active treatment group, р<0.05), but only after 3months of rehabilitation treatment (control group, р<0.05). At 1 and 2years post-surgery, the prevalence of synkinesis was significantly higher in patients in the control group compared with those receiving incobotulinumtoxinA treatment (р<0.05 and р<0.001, respectively). IncobotulinumtoxinA treatment resulted in significant improvements in facial symmetry in patients with facial nerve injury following neurosurgical interventions. Treatment was effective for the correction of the compensatory hyperactivity of mimic muscles on the unaffected side that develops in the acute period of facial nerve palsy, and for the correction of synkinesis in the affected side that develops in the long-term period. Appropriate dosing and patient education to perform exercises to restore mimic muscle function should be considered in multimodal treatment. •Treatment of facial nerve palsy is challenging, requiring a multi-modal approach.•IncobotulinumtoxinA was effective in acute and chronic phases of facial nerve palsy.•Clinical effects were more rapid compared to traditional treatment approaches.•Facial asymmetry and rate of long-term contractures and synkinesis were reduced.•IncobotulinumtoxinA should be considered in multi-modal treatment of facial palsy.