Testing the Effect of Zinc Supplementation to Improve the Treatment Effect of Botulinum Toxin for Oculofacial Spasm

• Treatment Duration Cycle [ Time Frame: The time frame will vary with each patient. The time frame is in fact the outcome measure being measured. On average the Botox treatment cycles last 3 months, however this average may be affected by zinc supplements. ] [ Designated as safety issue: No ]
  The number of days between the date of Botox injection to the date in which the symptoms have returned back to baseline.
• Blepharospasm Disability Index (BDI) [ Time Frame: 3 months post Botox injection ] [ Designated as safety issue: No ]
  BDI is a scale commonly used in the Blepharospasm literature to measure the magnitude of the burden of symptoms in patients with Blepharospasm. It has also been used to measure treatment effect by a reduction in patient's BDI.

The purpose of this study is to determine whether zinc supplements are effective in enhancing the treatment of oculofacial spasm disorders with botulinum toxin.

Botulinum Toxin (Botox) has been used for many years in the treatment of oculofacial dystonias such as blepharospasm and hemifacial spasm. It has also gained widespread use for cosmetic purposes. The efficacy and duration of its effect is not constant amongst all patients. Some patient respond very well, while others have no clinical benefit or the clinical benefit does not last as long as expected. Zinc is known to be an important co-factor in the molecular effects of Botox. The investigators hypothesize that one of the many factors that may contribute to the variability in the response to Botox may be the level of Zinc available within the neuromuscular junction of those patients. The investigators plan to to test whether or not giving patients supplemental Zinc with their Botox injections would help improve the magnitude and duration of the intended clinical effect.

• Blepharospasm
• Hemifacial Spasm

• Drug: Zinc Supplement
  The interventional group will be requested to take zinc supplements (50mg), once daily starting 5 days prior to Botox injections and to be continued for 5 days after injection.
• Drug: Sugar pill
  The control group will be requested to take placebo pills, once daily starting 5 days prior to Botox injections and to be continued for 5 days after injection.

• Placebo Comparator: Placebo
  Intervention: Drug: Sugar pill
• Experimental: Zinc Group
  Intervention: Drug: Zinc Supplement

Inclusion Criteria:

• greater than the age 18 years old
• patient with hemifacial spasm
• patient with benign essential blepharospasm.

Exclusion Criteria:

• patients who have received Botox within 3 months time,
• patients prone to malabsorption (i.e. those with Celiac disease, inflammatory bowel disease, liver disease, laxative use)
• patients who cannot tolerate zinc supplementation due to kidney disease, gastrointestinal disease, or any other medical condition.