LONG-TERM EFFICACY OF LOCAL DOXORUBICIN CHEMOMYECTOMY IN PATIENTS WITH BLEPHAROSPASM AND HEMIFACIAL SPASM

Objective: This study examines the long-term follow-up of all patients treated with doxorubicin injections in the eyelids. Design: Nonrandom ized clinical trial. Participants: Eighteen patients with blepharospas m (12 female; 6 male) and nine patients with hemifacial spasm (4 femal e, 5 male), Intervention: Eyelids were repeatedly injected at interval s of 10 or more weeks until the spasms were ameliorated or the patient requested discontinuation. Main Outcome Measure: Clinical ''cure'' de fined as sufficient symptomatic relief to defer further paralytic trea tment. All patients have been followed for more than 1 year since the last injection. Results: Nine of 18 patients with blepharospasm comple ted the full course of treatment and are considered ''cured'' for more than 1 year (median, 3 years; maximum, 6 years). Six of nine patients with hemifacial spasm completed treatment. Five of these six patients are considered ''cures,'' lasting for more than 4.5 to 6 years, Two a dditional patients, one with blepharospasm and one with hemifacial spa sm, had significant amelioration and were untreated for more than 3 ye ars after the last doxorubicin injection, but occasionally request bot ulinum toxin supplementation. The minimum effective dose per treated e yelid ranged from 1.0 to 4.2 mg (median, 2.25 mg). The treatment-relat ed discontinuations and complications were related to skin inflammatio n. Four of the 14 ''cured'' patients required some surgical ''touch-up '' on 1 eyelid. However, all the patients who completed treatment are either cured or have had significant amelioration of symptoms. Conclus ions: Doxorubicin chemomyectomy is an evolving technique and an effect ive treatment for essential blepharospasm and hemifacial spasms sympto matically localized to the eyelids. Sixteen (59%) of the initial serie s of 27 patients completed the treatment, Of these, all are apparently cured or their symptoms significantly ameliorated, In the future, an even higher proportion would be expected to complete the treatment due to improvements in the selection criteria and treatment protocols dev eloped during this 8-year trial. While the treatment appears to be rea sonably safe compared with surgical myectomy in its present form, the authors are continuing to explore and introduce additional cotreatment s to minimize the acute skin changes and maximize the long-term effect iveness of the myectomy.