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PubMed1989

Treatment of blepharospasm with botulinum toxin.

Many therapeutic modalities, including medications, excision of the muscles used in closure of the eyelids (myectomy), and selective extirpation of branches of the facial nerve (neurectomy), have been used for the management of blepharospasm. Because of limited effectiveness and undesirable side effects, none of these treatments has been completely satisfactory. Recent reports about injection of botulinum toxin indicate that it is safe and effective for most patients. Relief from blepharospasm, however, is usually transient, and repeated injections are usually necessary. The current availability of effective therapy for blepharospasm emphasizes the importance of prompt diagnosis and referral of affected patients to physicians knowledgeable in the use of botulinum toxin and other therapeutic approaches.

Blepharospasm↗
PubMed1991

Clinical doxorubicin chemomyectomy. An experimental treatment for benign essential blepharospasm and hemifacial spasm.

Doxorubicin (DXR) was injected as a treatment for benign essential blepharospasm and hemifacial spasm. The other eyelids were treated concurrently with botulinum toxin (BT). No DXR-treated eyelid has maintained 0 strength (commonly achieved with BT). Two patients with benign essential blepharospasm and four patients with hemifacial spasm have achieved major improvement, sustained for more than 6 months. Eyelids have been swollen and inflamed for up to 3 months. No spontaneously irreversible complication has occurred. A single injection at the maximum safe dose (1 mg in the upper lid and 1.5 mg in the lower lid) has not proven sufficient to produce cure. Treatment of each lower eyelid of a muscular male with severe blepharospasm may require cumulative doses of up to 4.0 mg, delivered in three injection events separated by at least 2 months, with each injection no greater than 1.5 mg DXR per site. At the present time, there is no assurance that a permanent cure will result.

Aged↗
PubMed1995

Long-term changes in duration of relief with botulinum toxin treatment of essential blepharospasm and hemifacial spasm.

PURPOSE: To determine long-term changes in duration of relief with serial treatments of botulinum A toxin (BAT) used to treat benign essential blepharospasm and hemifacial spasm, in view of conflicting reports as to whether BAT has an increasing, decreasing, or an unchanging duration of effect over a long period of treatment. METHODS: Thirty-two patients with facial dyskinesia (20 with essential blepharospasm, 12 with hemifacial spasm) were followed between 5 and 9 years through a mean of 18 (range, 12-32) BAT treatments with prospective documentation of intervals of relief from symptoms. Repeated measures and linear regression analyses were used to determine trends in each group. RESULTS: Marked inter- and intrapatient variability was found in the length of effect of BAT. Statistical analysis showed no significant changes in mean duration of relief within each group (P = 0.65 for essential blepharospasm, 0.36 for hemifacial spasm). There was a trend to slow decline in the interval of relief, especially in patients with an initial duration of effect greater than 150 days. No relation was found between duration of relief and age or sex of patient or grade and duration of disease before initial treatment. CONCLUSION: In the long term, the mean duration of relief from symptoms with BAT changes little over a period of serial treatments. Short-term fluctuations in the length of therapeutic effect did not indicate the development of a resistance to treatment.

Adult↗
PubMed2001

Ganglioglioma of the lateral ventricle presenting with blepharospasm - case report and review of the literature.

Gangliogliomas of the lateral ventricle are unusual tumours of the central nervous system. We report a 25-year-old female who presented with a 4-week history of generalized headaches associated with left-sided blepharospasm. Clinical examination revealed bilateral papilloedema but no focal neurological deficits. Computed tomography and magnetic resonance imaging demonstrated a large lesion within the left lateral ventricle. Gross total surgical resection of the lesion was performed through a para-sagittal, trans-callosal approach. Histopathological analysis revealed the diagnosis of ganglioglioma. The post-operative course was uneventful, with complete resolution of both the headaches and blepharospasm. The presentation with an ipsilateral blepharospasm has never previously been reported in the setting of a lateral ventricular tumour.

Adult↗
PubMed1991

[Magnetic stimulation in patients with essential blepharospasm].

In 31 patients with an essential blepharospasm investigations were undertaken with transcranial cortical and cisternal magnetic stimulation of the facial nerve. Cortical stimulation was performed contralaterally, whereas cisternal stimulation was ipsilateral; the latencies and amplitudes of the potentials were determined. However, the extracranial part of the facial nerve was stimulated in the region of the stylomastoid foramen for neuromyography electrically. In most measurements the response potentials in the orbicularis oculi muscle and the levator labii muscle were determined. Cisternal stimulation yielded normal latencies, whereas cortical stimulation showed an increase of latency in some blepharospasm patients. A difference between the orbicularis oculi muscle and the levator labii muscle as known in patients with hemifacial spasm (20) could not be observed. The mean values of all latencies after cortical stimulation were normal. The method of transcranial magnetic stimulation is an important part of the complete investigation of patients with facial hyperkinesias as shown here in blepharospasm patients.

Blepharospasm↗
PubMed2004

Impact on quality of life of botulinum toxin treatments for essential blepharospasm.

PURPOSE: To determine the impact on quality of life of Botulinum toxin therapy for essential blepharospasm. METHODS: A cross-sectional study was undertaken using the Glasgow Benefit Inventory, in the form of a postal questionnaire, to assess the subjective patient benefit of Botulinum toxin treatments for essential blepharospasm in 44 consecutive patients attending a specialist Botulinum toxin clinic. (The Glasgow Benefit Inventory generates a score from -100 (maximum harm) through 0 (no effect) to +100 (maximum benefit) for the intervention under investigation.) The Wilcoxon signed-ranks test was used to test the significance of the total scores and subdomain scores. RESULTS: A high response rate of 36 out of 44 (81.8%) was achieved. The median total benefit score was +29.2 (97.1% CI = 16.7 to 38.9, p < 0.0001). The median subdomain scores were: general +43.8 (97.1% CI = 20.8 to 54.2, p < 0.0001), social 0.0 (97.1% CI = 0.0 to 16.7, p = 0.0019) and physical 0.0 (97.1% CI = 0.0 to 0.0, p = 0.4810). CONCLUSIONS: This study demonstrates significant quality of life benefit from Botulinum toxin therapy for essential blepharospasm, and justifies continued treatment.

Aged↗
PubMed1985

Management of blepharospasm.

From 1950 through 1984, 123 patients underwent surgical treatment of blepharospasm at the Mayo Clinic. During this period, four different operations (proximal and distal neurectomy and two types of myectomy) were used. Significant recurrent or residual blepharospasm was observed more frequently (p less than 0.01) and need for subsequent operations was greater (p less than 0.01) among patients who had undergone distal neurectomy than among those who had had myectomy. These data support the view that myectomy is a more effective procedure than neurectomy. Initial results with botulinum toxin injection seem to indicate that it is an effective short-term treatment for blepharospasm. However, its long-term efficacy and safety need further study, as does the role it should play in combination with myectomy.

Adult↗
PubMed1994

Oculinum injection-resistant blepharospasm in young patients.

Botulinum toxin has recently been used as a nonsurgical treatment for blepharospasm and other facial dyskinesias. This report describes four patients between the ages of 32 and 37 years who failed to respond to botulinum injections for severe blepharospasm. Other than age, no other features could be identified in these patients that would differentiate this group. Particularly early age of onset for essential blepharospasm might be an indicator of failure to respond to the injections.

Adult↗
PubMed2001

Differential section of the seventh nerve as a tertiary procedure for the treatment of benign essential blepharospasm.

PURPOSE: To examine the efficacy of differential section of the seventh nerve in treatment of patients with blepharospasm refractory to botulinum toxin and eyelid protractor myectomy. METHODS: A retrospective noncomparative interventional case series consisting of a cohort of 228 patients with benign essential blepharospasm followed from 1987 to 1997 in a university ophthalmic plastic surgery referral practice. Patients were treated with botulinum toxin injections, eyelid protractor myectomy, and differential section of the seventh nerve in stepwise fashion as needed for symptomatic control. RESULTS: Thirty-four patients (15% of total) underwent eyelid protractor myectomy during this period. Eyelid protractor myectomy failed to control blepharospasm in 7 (21%) of these 34 patients, who then underwent differential section of the seventh nerve an average of 2 years after myectomy. Patients were followed up for an average of 36 months, with a success rate of 42% (3 of 7). The remaining 4 patients had repeat differential section of the seventh nerve with a 50% success rate, which brought the overall success rate from differential section of the seventh nerve to 71%. Lower eyelid ectropion requiring surgical repair complicated 27% of differential section of the seventh nerve procedures. CONCLUSIONS: Differential section of the seventh nerve is a reasonable alternative in the treatment of patients who have persistent disability despite treatment with botulinum toxin injections and eyelid protractor myectomy.

Adult↗
PubMed2003

Benign essential blepharospasm among residents of Olmsted County, Minnesota, 1976 to 1995: an epidemiologic study.

PURPOSE: To describe the incidence, patient demographics, and response to treatment of benign essential blepharospasm (BEB) in a population-based cohort. METHODS: In this epidemiologic study, we searched the Rochester Epidemiology Project database for patients diagnosed with blepharospasm or related disorders between 1976 and 1995. The incident rate denominator was based on a linear interpolation of decennial census data from Olmsted County. The 95% confidence interval for the incidence rate was based on the Poisson distribution. RESULTS: Olmsted County residents (n = 295) were diagnosed with blepharospasm or related disorders between 1976 and 1995. Of these, 8 patients met the criteria for BEB. The calculated incidence rate of BEB is 1.2 persons per 100,000 population per year (95% CI, 0.37 to 2.02). At the time of BEB diagnosis, the median patient age was 61.5 years, and symptoms had been present for a median of 24 months. Four patients were men and 4 were women. Four of the 8 patients had Meige syndrome. Three of 4 patients treated with oral medications reported symptomatic improvement. Botulinum toxin injection was offered to all patients, but only 4 elected treatment. All who were treated with botulinum toxin had temporary symptomatic improvement. No patient underwent surgical treatment for BEB. Two patients had resolution of symptoms within the follow-up period. CONCLUSIONS: BEB is a rare disorder. In this small, population-based sample, women and men were affected with equal frequency, and half of patients had lower facial dystonia (Meige syndrome). Only half of patients with BEB elected botulinum toxin injections, and none required surgery. Disease remission occurred in 2 of 8 patients.

Adult↗
PubMed2003

Orbicularis oculi muscle graft augmentation after protractor myectomy in blepharospasm.

PURPOSE: To evaluate the effectiveness of free orbicularis oculi muscle grafts in correcting volume deficit deformities after protractor myectomy in patients with essential blepharospasm. METHODS: Prospective case series. During the 13-month period from October 2000 through November 2001, all patients with essential blepharospasm undergoing primary eyelid protractor myectomy received an orbicularis oculi muscle graft to replace the volume deficit deformity created by the myectomy. Only patients who had at least 6 months of postoperative follow-up were included in the analysis. RESULTS: Forty-six patients underwent primary eyelid protractor myectomy and had a free orbicularis oculi muscle graft for volume replacement. All patients had significant functional improvement of their eyelid spasms after the myectomy. Of the 38 patients who underwent upper eyelid myectomy, 3 patients were overcorrected and no patients were undercorrected with the orbicularis muscle graft. Two of the overcorrected patients underwent surgical debulking of their muscle grafts. Of the 8 patients who underwent lower eyelid myectomy, no patients were overcorrected and 1 patient was undercorrected. None of the patients were observed to have any spasms, contractions, or other signs of muscular activity or aberrant innervation of the muscle graft. CONCLUSIONS: The orbicularis oculi muscle graft is a useful adjunct to protractor myectomy in improving the aesthetic outcomes for blepharospasm patients. Our study demonstrates the viability of the orbicularis oculi muscle graft and may lead to future applications of the graft in facial aesthetics.

Adult↗
PubMedDate not supplied

Tardive blepharospasm associated with cinnarizine use.

OBJECTIVE: To report a patient with chronic blepharospasm possibly induced by the calcium-channel blocker cinnarizine. CASE REPORT: A 53-year-old woman developed chronic blepharospasm during a prolonged therapy with calcium-channel blocker cinnarizine for the treatment of vertigo. CONCLUSIONS: "Tardive blepharospasm" should be considered as a possible adverse effect of cinnarizine.

Blepharospasm↗
PubMed2005

Remission of tardive dystonia (blepharospasm) after electroconvulsive therapy in a patient with treatment-refractory schizophrenia.

Tardive dystonia is a movement disorder dominated by involuntary muscle contractions that may be tonic, spasmodic, patterned or repetitive, associated with the use of dopamine-receptor blocking agents. Most of the patients with tardive dystonia present initially with blepharospasm. Treatment of dystonia is generally disappointing. A patient with chronic paranoid schizophrenia who developed blepharospasm is described here. Blepharospasm remitted after a course of electroconvulsive therapy. Remission was sustained until 3 months after stopping maintenance electroconvulsive therapy.

Adult↗
PubMed2003

The use of botulinum toxin A for treatment of possible essential blepharospasm in a dog.

A 3-year-old Great Dane with bilateral possible essential blepharospasm resulting in ocular complications is described. Conservative treatment was not successful and the disease was treated with local injections of botulinum toxin A into the orbicularis oculi muscle. Blepharospasm disappeared completely 5 to 6 days after injection and did not reappear until 3 to 4 months later, at which time the injection was repeated. After several treatments over a period of more than 3 years no side effects have occured. Botulinum toxin A appeared to be effective in the treatment of essential blepharospasm in this dog.

Animals↗
PubMed1988

Blepharospasm: a review of 264 patients.

The natural history and response to different treatments have been evaluated in 264 patients with blepharospasm. The mean age of onset was 55.8 years and there was a female preponderance of 1.8 to 1. Dystonia elsewhere was found in 78% of patients, usually in the cranial-cervical region, and appeared to follow a somatotopic progression. A family history of blepharospasm or dystonia elsewhere was found in 9.5% of cases, which suggests a genetic predisposition. Ocular lesions preceded the onset of blepharospasm in 12.1% of cases. The response to drugs was inconsistent, although initial improvement was experienced by one fifth of patients treated with anticholinergics. Twenty-nine bilateral facial nerve avulsion operations were performed with benefit in 27 cases; but recurrences appeared in 22, on average one year after surgery. Botulinum toxin injections were performed in 151 patients. Significant improvement was achieved in 118 cases. Mean duration of benefit was 9.2 weeks. Transient ptosis and diplopia were the commonest side effects.

Adolescent↗
PubMed1991

Neurophysiological observations on the effects of botulinum toxin treatment in patients with dystonic blepharospasm.

Botulinum toxin treatment improves dystonic blepharospasm by inducing transient paresis of the orbicularis oculi muscle. It is not known if it also reduces the enhanced brainstem neuronal excitability found in this disorder. We have performed conventional electromyography (EMG) and blink reflex excitability studies on fifteen patients with blepharospasm before and after botulinum toxin treatment. Denervation signs were found with needle EMG in all treated muscles. Amplitude of the facial compound muscle action potential (CMAP) and R1 response was reduced after botulinum toxin injections. In blink reflex excitability studies, the recovery of R2 response was enhanced after treatment even when patients were tested at the time of maximal benefit from botulinum toxin injections. The results suggest that there is little influence of botulinum toxin treatment upon the enhanced excitability of brainstem interneurons in patients with blepharospasm.

Adult↗
PubMed1981

Biofeedback in the treatment of blepharospasm: a case study.

Although biofeedback has been of value in treating spastic paresis and torticollis, its effectiveness in other movement disorders is less clear. Blepharospasm, which has no definitive treatment, often has a strong psychogenic component. The authors report the use of electromyographic and temperature biofeedback in a women with blepharospasm who had responded poorly to psychotherapy. Her improvement during biofeedback treatment further elucidated psychogenic factors contributing to the disorder. At 3-months follow-up it seemed that the patient's secondary gain from the blepharospasm diminished the maximum treatment response she could have had to biofeedback.

Biofeedback, Psychology↗