Subsai Kongsaengdao

Comparative evidence across repeated botulinum toxin treatment cycles for hemifacial spasm (HFS) remains limited. This 50-week double-blind randomized crossover trial compared Abobotulinumtoxin A 100 U (Abo-BoNT-A) with Neubotulinumtoxin A 33.33 U (Neu-BoNT-A) across multiple dimensions, including improvement frequency, magnitude, time course, patient impact, harms, and cost in 92 participants. Each formulation was scheduled for two consecutive 12-week periods, with a 2-week washout before crossover. Although Total Intensity Score did not demonstrate Neu-BoNT-A noninferiority, exploratory diary-defined HFS-free improvement during Days 2–14 occurred in 48.0% versus 34.1% of Abo-BoNT-A and Neu-BoNT-A treatment records (adjusted odds ratio, OR 1.89; 95% CI, 1.26–2.84; nominal p = 0.0021). Among responders, time to peak improvement and post-peak duration did not differ significantly. Selected exploratory symptom trajectories differed, whereas cycle-average burden and patient-reported outcomes showed no consistent differences. Eyelid ptosis occurred in 4.3% versus 0.5% of reported exposures (unadjusted paired p = 0.039). Under vial sharing, acquisition costs were USD 81.52 versus USD 30.78 per treatment. These multidimensional findings suggest an exploratory response–safety–cost trade-off beyond average symptom scores. Trial registration: NCT04589364.

Pain is a major contributor to disability in cervical dystonia (CD) and may persist despite improvement in abnormal head posture after botulinum toxin treatment. Whether increasing the dose of Neubotulinum toxin type A (Neu-BoNT-A) provides additional analgesic benefit without compromising safety remains uncertain. In this prospective, multicenter, randomized, double-blind, two-period crossover trial, 50 adults with CD were randomized 1:1 to Neu-BoNT-A 100 U followed by 50 U or 50 U followed by 100 U, with each treatment period lasting 12 weeks. The principal between-dose TWSTRS analysis used a crossover mixed-effects model including treatment, period, and randomized sequence, with participant as a random effect. TWSTRS total, severity, and disability did not differ significantly between regimens. Neu-BoNT-A 100 U produced greater improvement in TWSTRS pain (adjusted 100 U minus 50 U difference, −1.83 points; 95% CI, −2.93 to −0.73; p = 0.0011). The pain finding remained significant in a robust GEE sensitivity analysis (difference, −1.83 points; 95% CI, −3.04 to −0.62; p = 0.003). CDIP-58 psychosocial functioning also improved more with 100 U (nominal p = 0.001). In a Holm sensitivity analysis across all 24 efficacy comparisons, TWSTRS pain and CDIP-58 psychosocial functioning remained significant (adjusted p ≈ 0.025 and 0.024, respectively); no other comparison remained significant. No serious adverse events occurred. Neu-BoNT-A 100 U did not improve overall CD severity compared with 50 U but was associated with greater pain relief and improved psychosocial functioning without compromising tolerability. These secondary findings remained significant after multiplicity adjustment but should be interpreted in the context of the nonsignificant overall TWSTRS result and require confirmation.

Previous randomized controlled trials (RCTs) investigating Botulinum toxin A (BoNT-A) for treatment of hemifacial spasm (HFS) have primarily focused on symptom relief and quality-of-life improvement. However, head-to-head comparisons of different BoNT-A formulations, particularly in terms of onset, duration of action, and efficacy, remain limited. We conducted a 12-week prospective, randomized controlled trial comparing the efficacy and safety of 33.33 units of Neubotulinum toxin A (Neu-BoNT-A) with 100 units of Abobotulinum toxin A (Abo-BoNT-A) in the treatment of HFS. A total of 87 patients were enrolled between September and December 2024. Neu-BoNT-A and Abo-BoNT-A exhibited similar onset and duration of action [5.0 ± 0.9 vs. 6.2 ± 0.7 days, respectively (p = 0.33)]. After 12 weeks of treatment, Neu-BoNT-A demonstrated superior efficacy in reducing the daily duration of HFS (2.00 ± 0.06 vs. 1.42 ± 0.10 h/day, p < 0.001) and improving sleep duration (1.37 ± 0.01 vs. 1.06 ± 0.01 h/day, p < 0.001). However, Abo-BoNT-A was associated with significantly lower absolute daily disability time compared to Neu-BoNT-A (11.4 vs. 1.2 min/day, p < 0.001). No serious adverse events were observed. Both Neu-BoNT-A and Abo-BoNT-A were safe and effective in treating HFS. However, Neu-BoNT-A was more effective in HFS with minimal symptoms without disability and Abo-BoNT-A more effective in HFS with greater duration of disability.

Various types of botulinum toxin (BoNT) have been studied to treat cervical dystonia (CD). Although high-dose BoNT has proven efficacy, it increases the risk of adverse events. For this reason, this study was planned to identify the non-inferiority efficacy, tolerability, and safety of low-dose neubotulinum toxin A (Neu-BoNT-A) versus low-dose abobotulinum toxin A (Abo-BoNT-A) in CD treatment. The 48-week, prospective, randomized, controlled crossover design study of CD treatment, with 50-unit Neu-BoNT-A and 250-unit Abo-BoNT-A injections at 12-week intervals, was conducted over a 24-week treatment period. This study used the following standardized rating scales to assess the efficacy of BoNT: the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS); health-related quality of life (HRQoL); the Cervical Dystonia Impact Profile (CDIP-58); the Short Form 36 health survey questionnaire (SF-36); and, for the depressive symptoms of CD patients, the Center for Epidemiological Studies-Depression Scale (CES-D) and the Patient Health Questionnaire-9 (PHQ-9). Fifty-two CD patients were enrolled from October 2019 to January 2021. The mean scores of the TWSTRS total at the post-treatments in both Neu-BoNT-A and Abo-BoNT-A had a significant reduction from baseline (p = 0.008 and 0.002, respectively). However, the mean changes of the TWSTRS total at the 12- and 24-week treatments between the two treatment groups were not significantly different (p = 0.284 and 0.129, respectively). The mean scores of the HRQoL questionnaires (the CIDP-58 and the SF-36) and the depressive symptoms (the CES-D and the PHQ-9) in both treated groups at the post-treatments did not significantly decrease from baseline and were comparable. Two patients treated with Abo-BoNT-A (250 units) reported cervical tension and benign paroxysmal positional vertigo (BPPV). There were no serious adverse events reported. Though both low-dose BoNT-As were effective at improving clinical symptoms without significant side effects, both treatments did not predict change in quality of life and depression. With the non-inferiority criteria, low-dose Neu-BoNT-A has a similar efficacy, safety, and tolerability to Abo-BoNT-A.

This study aimed to determine the long-term quality of life (QoL) in hemifacial spasm (HFS) patients after treating with Abo-botulinum toxin A (Abo-BTX). The study assessed the disease-specific QoL (hemifacial spasm questionnaire 30 items; HFS 30), the involuntary movements (abnormal involuntary movement scale; AIMS), general health QoL (Medical Outcomes 36-Item Short Form Health Survey; SF-36), and Depression (the Center of Epidemiologic Studies-Depression questionnaire; CES-D). A total of 74 HFS patients were enrolled from 2012 to 2017. The disease-specific QoL; involuntary movements; and the general health domain of SF 36 were significantly improved after injections of Abo-BTX A in the first few years (p < 0.04), but significantly decreased at the fifth year of treatment without significant clinical resistance observed (p < 0.001). Only the general health domain of SF 36 showed persistent improvement over five years (p = 0.02). In summary, Abo-BTX A can improved quality of life in the first few years; however only the general health domain of SF-36 showed significant improvement over five years (p = 0.02). No clinical resistance was observed.

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Objective: This study aimed to identify possible improvements in disease-specific health-related quality of life (HRQoL) after multiple injections of botulinum toxin A over 24 weeks in Thai cervical dystonia (CD) patients. Materials and methods: A 24-week prospective study comparing HRQoL of Thai CD patients before and after multiple injections of botulinum toxin A at 3-month intervals was performed. Disease-specific HRQoL was assessed by using the Cervical Dystonia Impact Profile-58 questionnaire (CDIP-58) and the Craniocervical Dystonia Questionnaire-24 (CDQ-24). General HRQoL was assessed by using the Medical Outcomes’ 36-Item Short Form Health Survey (SF-36) and the EuroQoL 5-dimension questionnaire (EQ-5D). All the assessments were performed before and after the 24-week treatment period. Results: A total of 20 CD patients were enrolled in this study from April to December 2011. CDIP-58 and CDQ-24 scores, which assess disease-specific HRQoL, showed a significant improvement after 24 weeks of treatment by botulinum toxin A (P0.05). Conclusion: CD patients’ disease-specific HRQoL improved after being treated with multiple botulinum toxin A injections. However, general HRQoL was not improved.

Background. Northern Thailand's biggest botulism outbreak to date occurred on 14 March 2006 and affected 209 people. Of these, 42 developed respirato

The tsunami that struck the Asian subcontinent and Africa on December 26, 2004, caused the deaths of more than 200,000 people. In Thailand more than 10,000 people were treated in ambulatory health centers. After a tsunami, the effects on people occur in three phases. The injuries that are incompatible with life (e.g., severe cardiovascular events, head injury, and blunt injury) happen in the first minutes; then, over the following hours, complications such as massive hemorrhage, hemopneumothorax, and pulmonary embolism are seen. These are followed, in turn, by the late complications, including infectious diseases that develop over days to weeks.¹