Patient-Reported Outcomes of Botulinum Toxin Treatment in Hemifacial Spasm: Symptom Control and Quality of Life

Background: Botulinum toxin injection is a widely accepted treatment for hemifacial spasm (HFS), providing symptomatic relief for patients who are not candidates for, or decline, microvascular decompression. However, large-scale real-world data regarding patient-reported outcomes, treatment durability, and adverse events in HFS remain limited. Methods: We retrospectively analyzed survey data from 842 patients (220 men, 622 women; mean age 56.3 ± 11.6 years) with HFS who received botulinum toxin injections at our institution. Pre-treatment severity was assessed by daily spasm involvement (% of time affected of a day), distress (0–10), intensity (0–10), and daily life impact (0–10). Post-treatment outcomes included improvement in daily life, psychological well-being, and cosmetic appearance (%), as well as treatment duration (months). We also evaluated treatment experience, concerns regarding botulinum toxin, and adverse events. Correlation analyses were performed to explore associations between pre-treatment severity, improvement, and treatment durability. Results: The mean daily spasm involvement was 54.2%, and average pre-treatment scores were 5.9 for distress, 6.1 for intensity, and 5.6 for daily life impact. Following injection, patients reported improvements of 66% in daily life, 65% in psychological well-being, and 42% in cosmetic appearance. The mean treatment duration was 3.1 months, with a mean injection interval of 5.2 months. Adverse events included pain in 34.7%, bruising in 11.0%, cosmetic problems in 32.6%, and cost concerns in 20.0%. Longer injection intervals correlated with prolonged treatment duration (r = 0.46), while greater pre-treatment severity was modestly associated with lower improvement rates (r = –0.13 to –0.19). Conclusion: In a large HFS cohort, botulinum toxin injection was effective in improving daily and psychological functioning, with variable cosmetic benefit. Although adverse events were frequent, they were generally mild. The positive association between injection interval and treatment durability suggests that tailoring injection schedules may optimize long-term outcomes. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany