Table 1.

Studies of BoNT treatment of essential blepharospasm (limited to controlled studies of any size and open-label studies with ≥50 patients)^a

References	Study design	BoNT	Number of blepharospasm patients	Efficacy outcome measure(s)	Results/remarks
(Fahn et al. 1985)	Within subjects, placebo controlled	Botox	8	Electrophysiology	BoNTA significantly reduced evoked potentials, contractions at rest, and maximally forced contractions versus placebo
(Frueh et al. 1988)	Randomized, double-blind, placebo-controlled	Botox	26	Patient subjective improvement (no scale mentioned)	Similar effects in lower eyelid with BoNTA and placebo
(Grandas et al. 1988)	Retrospective	Dysport	151	% Improvement (in 25% increments)	62% reported at least 50% improvement, with 36% indicating restoration of relatively normal vision
(Girlanda et al. 1996)	Prospective, placebo controlled	Botox	6	Electrophysiology, JRS severity scale	Similar improvements on both measures with placebo and BoNTA
(Mauriello et al. 1996)	Retrospective	Botox	222	Duration (definition not specified)	Mean duration 14.9 weeks
(Nussgens and Roggenkämper 1997)	Randomized, double-blind, crossover	Botox versus Dysport	212	Duration (definition not specified)	Mean duration 8 weeks both BoNTAs (no significant difference)
(Price et al. 1997)	Randomized, different injection sites	Not specified	50	Duration (definition not specified)	Standard injection sites led to longer duration than brow or inner/outer orbital injection sites
(Sampaio et al. 1997)	Randomized, comparison	Botox versus Dsyport	42	Duration (interval from treatment to patient-reported weaning of effect)	No significant differences in duration (blepharospasm results not separated from cervical dystonia results)
(Mezaki et al. 1999)	Randomized, comparison	Chiba A versus F versus A + F	54	JRS frequency scale, Patient-rated severity (0–100)	Peak effects similar in all groups, but duration longest with BoNTA alone
(Roggenkämper et al. 2006)	Randomized, double-blind comparison	Botox versus Xeomin	300	JRS, BSDI, Patient Global, Investigator Global	Both BoNTAs improved scores on all measures; no significant differences between BoNTAs
(Rieder et al. 2007)	Randomized, double-blind comparison	Botox versus Prosigne	8	Subjective global improvement, duration	Both BoNTAs led to subjective global improvement; no significant differences between BoNTAs
(Truong et al. 2008)	Randomized, double-blind, placebo-controlled multi-dose	Dysport	120	BDS, SRS, FIM, Global impairment (VAS)	Significant improvement with BoNTA on all measures
(Boyle et al. 2009)	Randomized, different dilutions	Botox	16	Pain, bruising, redness rated on 1–10 scale, duration of symptom relief	58% greater reduction in pain with high concentration than low concentration; no difference on other measures
(Quagliato et al. 2010)	Randomized, double-blind comparison	Botox versus Prosigne	21	SF-36, duration	Both BoNTAs improved scores on SF-36 emotional aspects domain, no significant differences between BoNTAs
(Yoon et al. 2009)	Randomized, double-blind comparison	Botox versus Meditoxin	60	Rating scales for severity of spasm, eyelid closing force, functional visual status	Both BoNTAs improved scores on all measures; no significant differences between BoNTAs
(Wabbels et al. 2010)	Randomized, double-blind, comparison	Botox versus Xeomin	65	BSDI, JRS, Patient global assessment	Both BoNTAs improved scores on all measures; no significant differences between BoNTAs in main analyses

BoNTA botulinum toxin type A, BSDI Blepharospasm Disability Index, FIM functional independence measure, JRS Jankovic Rating Scale, SRS Severity Rating Scale, VAS visual analog scale

^aBased on a search of PubMed database; key words: botulinum and blepharospasm, limited to English or German language. Articles identified in the search were limited to those that were either randomized, controlled trials or open-label trials with at least 50 subjects. Additional articles identified are available in the Appendix to this paper