TY - JOUR T1 - Effect of combined facial exercise with botulinum toxin A on health-related quality of life in Thai adults with hemifacial spasm: a randomised controlled pilot cross-over trial JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 337 LP - 339 DO - 10.1136/jnnp-2020-323604 VL - 92 IS - 3 AU - Yuvadee Pitakpatapee AU - Pannathat Soontrapa AU - Arpakorn Suengtaworn AU - Jindapa Srikajon AU - Tanita Sangpeamsook AU - Chulalak Komoltri AU - Prachaya Srivanitchapoom Y1 - 2021/03/01 UR - http://jnnp.bmj.com/content/92/3/337.abstract N2 - Botulinum toxin type A (BTX-A) is the treatment of choice for hemifacial spasm (HFS) with a transient effect of around 3 to 4 months. Its efficacy might be enhanced by active muscle exercise immediately after an injection. Enhanced neuromuscular junction blocking effect of BTX-A in patients with writer’s cramp and spasmodic dysphonia was demonstrated.1 2 One small randomised controlled trial (RCT) of combined facial exercise and BTX-A in patients with abnormal facial movements reported no significant reduction in the severity and frequency of facial muscle spasm.3 However, only four patients with HFS were included.Thus, we conducted a pilot, randomised, cross-over trial to explore the efficacy and safety of the combined facial exercise with BTX-A injection versus BTX-A injection along with the feasibility for a future confirmatory trial.A 32-week, pilot, assessor-blinded, single-centred, randomised, controlled AB/BA cross-over design of combined facial exercise with BTX-A injection (treatment A) versus BTX-A injection alone (treatment B) in adult patients with HFS was performed.Participants aged 18–80 years with HFS of any degree of severity treated regularly with BTX-A every 16 weeks were recruited. Exclusion criteria were stroke, blepharospasm, dementia, blindness, physical dependence, taking anticoagulants and inability to perform the facial exercise following video guidance.Eligible participants were randomised to combined facial exercise with BTX-A injection, followed by BTX-A injection only (Group AB) or vice versa (Group BA). Both groups were injected with onabotulinumtoxinA (Botox; Allergan, Irvine, California, USA). In brief, the novel protocol involved 7 min of active and passive facial muscle squeezing of the muscles usually affected by … ER -