Objective: To compare the clinical characteristics, along with the treatment outcomes of botulinum neurotoxin (BoNT) between HFS patients with and without the BBK-2 sign as well as evaluation of the prevalence of the BBK-2 sign in our HFS population.

Background: The Babinski-2 (BBK-2) sign or the other Babinski sign is an additional clinical data helping diagnosis of hemifacial spasm (HFS) and differentiating it from blepharospasm. However, there has never been a study investigating the aspect of clinical utility of the BBK-2 sign in HFS.

Methods: A prospective single-center cohort study was performed in HFS patients registered to BoNT clinic at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Baseline characteristics of the patients with and without the BBK-2 sign were obtained, and the prevalence of the BBK-2 sign was calculated. The disease severity was assessed by the SMC grading scale which was categorized into non-troublesome (SMC grade I-II) and troublesome (SMC grade III-IV) groups. Treatment outcomes were evaluated by self-reported percentage of improvement during peak onset using a visual analogue scale, latency onset of action, time-to-peak onset of action, duration of improvement, quality of life using a 6-point disability rating scale and adverse events. Association between all parameters and the BBK-2 sign were assessed using binary logistic regression. The multivariable model was built by including all variables identified as potentially important (p<0.1) in the univariate analysis.

Results: A total consecutive 185 HFS were included. The prevalence of the BBK-2 sign was 74.6% (n=138). Of all parameters, the troublesome group was the only factor that showed the strong correlation of the BBK-2 sign in multivariable analysis (adjusted odds ratio of 3.51; 95%CI 1.76-6.99). However, other demographic data, the disease duration, and the treatment outcomes showed no significant difference between the two groups.

Conclusions: This is the first study that shows the strong association between the severity of HFS and the presence of the BBK-2 sign. We imply that the BBK-2 sign may be the marker of higher severity of the disease. However, the presence of the BBK-2 sign did not associate with the disease duration and the treatment outcomes of BoNT injection.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-clinical-characteristics-and-treatment-outcomes-of-botulinum-neurotoxin-in-routine-clinical-practice-between-hemifacial-spasm-with-and-without-the-babinski-2-sign-in-thai-patients-an-ex/