caa a22 4500 445376171 CHVBK 20180317143003.0 cr unu---uuuuu 170323e20110601xx s 000 0 eng 10.1007/s00702-010-0546-9 doi (NATIONALLICENCE)springer-10.1007/s00702-010-0546-9 Difficulties with differentiating botulinum toxin treatment effects in essential blepharospasm [Elektronische Daten] [Bettina Wabbels, Wolfgang Jost, Peter Roggenkämper] Blepharospasm is a focal dystonia in which the extraocular muscles contract repetitively, leading to excessive blinking and forced eyelid closure. Botulinum toxin type A (BoNTA) is the primary symptomatic treatment for blepharospasm and its effects have been evaluated using numerous rating scales. The main scales in use today were initially used to determine whether BoNTA treatment was superior to placebo, and most controlled trials have confirmed this. More recently, these scales have been used to determine whether there are efficacy differences between different BoNTs in blepharospasm. However, although the scales used in these trials are able to differentiate the effects of BoNT from placebo, they may not be sensitive enough to differentiate between BoNTs. Most of the scales include only four possible points for each item, which would necessitate a 25% greater improvement in one group than the other to detect any differences. Current scales are also relatively insensitive to patients with mild disability who may experience mainly psychosocial problems related to their blepharospasm. Clinical trials comparing BoNTs that include substantial numbers of mildly affected patients may be unlikely to find differences because the scales do not adequately measure mild symptoms. Additional challenges with evaluating blepharospasm include the lack of precision and objectivity of current measures, symptom variability, the need to evaluate aspects of the disorder that are most important to patients, and the different types of blepharospasm. Although no single scale may be able to capture all relevant aspects of blepharospasm, more sensitive and patient-centered scales are needed. The Author(s), 2011 Botulinum toxin nationallicence Blepharospasm nationallicence Dystonia nationallicence Jankovic Rating Scale nationallicence Blepharospasm Disability Index nationallicence Wabbels Bettina Department of Ophthalmology, University of Bonn, Abbestr. 2, 53127, Bonn, Germany aut Jost Wolfgang Department of Neurology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany aut Roggenkämper Peter Department of Ophthalmology, University of Bonn, Abbestr. 2, 53127, Bonn, Germany aut Journal of Neural Transmission Springer Vienna 118/6(2011-06-01), 925-943 0300-9564 118:6<925 2011 118 702 https://doi.org/10.1007/s00702-010-0546-9 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00702-010-0546-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Wabbels Bettina Department of Ophthalmology, University of Bonn, Abbestr. 2, 53127, Bonn, Germany aut NATIONALLICENCE 700 1- Jost Wolfgang Department of Neurology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany aut NATIONALLICENCE 700 1- Roggenkämper Peter Department of Ophthalmology, University of Bonn, Abbestr. 2, 53127, Bonn, Germany aut NATIONALLICENCE 773 0- Journal of Neural Transmission Springer Vienna 118/6(2011-06-01), 925-943 0300-9564 118:6<925 2011 118 702 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer