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Essential Blepharospasm:
"Blephro" comes from the Greek word for eyelids. Spasm means
"uncontrolled muscle contraction". Blepharospasm is a condition in
which there is involuntary blinking of the eyelid that may at times be
forceful and sustained (several seconds). Blepharospasm is a type of
"Dystonia", a term used to describe "abnormal, involuntary, sustained
muscle contractions and spasms".
In the more severe cases is called benign essential blepharospasm
(BEB) to distinguish it from the less serious secondary blinking
disorders. "Benign" indicates the condition is not life threatening,
and "essential" is a medical term meaning "of unknown cause".
Note that patients with blepharospasm have normal eyes. The visual
disturbance is due solely to the forced closure of the eyelids.
"How does Essential Blepharospasm present?
The average age of onset is 56 years with females being more commonly
affected than males by 3:1. Blepharospasm usually begins with a
gradual increase in the blink rate that eventually progresses to
forceful eyelid spasms frequently throughout the day. A fluctuating
course characterized by remission and exacerbations is usual. It may
be precipitated or aggravated by bright light, stress, fatigue,
driving, reading, watching TV, and a variety of other activities.
Sleep, relaxation training, walking and talking may improve the
spasms. Some patients learn to avoid situations that aggravate the
condition, while others develop certain behavioural techniques that
involve using other facial muscles or acts of mental concentration to
decrease the frequency and intensity of spasm. Examples include
humming, singing, whistling yawning, coughing, mouth opening, nose
pinching, chewing gum, talking continuously, rubbing the eyelids or
applying pressure to other areas of the face, covering one eye, and
solving puzzles or problems."
From "The Benign Essential Blepharospasm Canadian Research Foundation
Inc. (BEBCRF)" website:
http://www.blepharospasm.ca/Article1.html
"At present there is no cure for Essential Blepharospasm and related
dystonias. Systemic medications help some patients. Debilatating
spasms, however, continue in most cases, rendering patients
functionally blind. Botulinum A toxin injection is the best temporary
therapy and myectomy is the best long term therapy."
From "BLEPHAROSPASM" at "The Benign Essential Blepharospasm Canadian
Research Foundation Inc. (BEBCRF)" website:
http://www.blepharospasm.ca/index.shtml
"THERAPY
Blepharospasm can be treated with oral medication, injections of
Botulinum toxin or surgery. Drug therapy is effective in fewer than
10% of patients and may only give partial relief. The response is
unpredictable and side effects may outweigh the benefits. A variety of
medications have been tried including antipsychotics, affective
disorder agents, anxiolytic agents, sedatives, drugs for Parkinson's
disease, muscle relaxants, etc.
Botulinum toxin is produced by the bacteria "Clostridium botulinum".
Botulinum toxin interferes with acetylcholine release from peripheral
motor nerve terminals, resulting in temporary paralysis of the
injected muscles. Minute doses of botulinum toxin are injected around
the eyelid and facial area with a fine needle. The effect usually
occurs within the first few days and lasts an average of 3 to 4
months, at which time another injection is given. Muscle relaxants
(orphenadrine, baclofen) have been useful in several patients as the
effects of botulinum toxin start wearing off.
Long term follow up studies have shown botulinum toxin injection to be
very safe and effective treatment with as many as 90% of patients
obtaining significant relief of their spasms. Repeated treatment
generally remains effective over a prolonged period in most patients.
However, in some individuals, botulinum toxin injections may become
less effective over time, possibly because of a resprouting of motor
endplate receptors or the development of an antitoxin. Side effects
are infrequent and transient. They include ptosis, blurred vision,
double vision, ocular irritation and tearing. These side effects
resolve spontaneously in a matter of days to weeks.
SURGERY
Surgical removal of the eyelid and brow squeezing muscles (myectomy)
is available but generally reserved for those not responding to
Botulinum toxin injections. The myectomy procedure for the upper lids
involves a meticulous dissection and removal of the orbicularis,
corrugator and procerus muscles through an eyebrow incision. In some,
a lower eyelid myectomy is also required at a later date. The myectomy
procedure requires hospitalization or 2 or 3 days. The healing process
following a myectomy may take up to a year. In most cases, the
patients are able to keep their eyes open immediately following the
operation. However, considerable swelling, hematoma, lymphedema, and
ecchymosis (varying greatly from patient to patient) may be present
early in the postoperative period. Myectomy will improve the visual
disability in approximately 90% of cases. Botulinum toxin injections
may be required in some patients after the procedure for residual
spasms.
The side effects of myectomy include numbness of the forehead, chronic
lymphedema (lid swelling), exposure keratitis, ptosis, lid retraction,
and ectropion. Most of these problems resolve with time. Only a small
number of patients require touch-up procedures."
From "The Benign Essential Blepharospasm Canadian Research Foundation
Inc. (BEBCRF)" website:
http://www.blepharospasm.ca/Article1.html
More references about this can be found at the Benign Essential
Blepharospasm Research Foundation (BEBRF) pages:
"Current Forms of Therapy: Botulinum toxin injections; Medical (Drug)
Treatment; Surgery; Experimental Eyelid Injections with Doxil;
Supportive Forms of Treatment"
http://www.blepharospasm.org/#therapy
"Injection Techniques with Botulinum Toxin A in the Treatment of
Blepharospasm" By Mark Stacy, M.D.
http://www.blepharospasm.org/bot-tech.html#A1
"What Is Apraxia Of Eyelid Opening And How Do You Treat It?" by
Richard L. Anderson, M.D.
http://www.blepharospasm.org/apraxia.html
"Clinical Use of Botulinum Toxin" from National Institutes of Health (NIH):
http://odp.od.nih.gov/consensus/cons/083/083_statement.htm
"The DoxilŽ Blepharospasm Treatment Trial": Doxorubicin injections in
the eyelids are being studied as a way of relieving muscle spasms.
Patients who participated in this study have experienced symptom
relief since their last injection. No definite conclusions have been
reached at this time. For further information visit the University of
Minnesota Department of Ophthalmology website or contact:
Jonathan D. Wirtschafter, M.D.
Department of Ophthalmology University of Minnesota
FUMC Box 493
420 Delaware Street SE
Minneapolis, MN 55455-0501
(612) 625-4400
E-mail: wirtsch@tc.umn.edu
http://www.ahc.umn.edu/ahc_content/colleges/med_school/departments/ophthalmology/index2.cfm?nav=3968&parent=3966&type=F&content_path=colleges/med_school/departments/ophthalmology/centers_and_special_programs/Ophthalmic_Plastic_and_Reconstructive_Surgery/Doxil/&content_name=Doxil_Trial_Newsletter.htm&pic=none&gif=search_ophth
Finally I strongly suggest you to read the following article from
"Optometry Today", this article describes the clinical features,
differential diagnosis and management of BEB with particular emphasis
on the use of botulinum toxin and myectomy with images and tables for
Muscles affected by BEB, Differential diagnosis of BEB, Side effects
of BTX treatment of blepharospasm,etc.
"Benign essential blepharospasm - Diagnosis and management":
http://www.optometry.co.uk/articles/20030404/selva20030404.pdf
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The following links may be useful to you:
"Blepharospasm Support Groups", support groups from US, Canada and Australia:
http://www.blepharospasm.org/blephars.html#A1
"Blepharospasm Conferences and Support Group Meetings":
http://www.blepharospasm.org/blepharm.html#A1
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You can also contact the following organizations:
Benign Essential Blepharospasm Research Foundation, Inc.
637 North 7th Street Suite 102
P.O. Box 12468
Beaumont, TX 77726-2468
bebrf@sbcglobal.net
Tel: 409-832-0788
Fax: 409-832-0890
http://www.blepharospasm.org
Dystonia Medical Research Foundation
1 East Wacker Drive
Suite 2430
Chicago, IL 60601-1905
dystonia@dystonia-foundation.org
Tel: 312-755-0198
Fax: 312-803-0138
http://www.dystonia-foundation.org
Benign Essential Blepharospasm Canadian Research Foundation, Inc.
36 Chieftain Crescent
Toronto, Ontario M2L 2H4
Tel: 1-416-512-6610 1-866-890-2473
Fax: 1-416-512-6612
e-mail: general-delivery@blepharospasm.ca
http://www.blepharospasm.ca/index.shtml
National Institute of Neurological Disorders and Stroke (NINDS)
National Institutes of Health
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov/health_and_medical/disorders/blepharospasm.htm
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Search strategy:
"Essential Blepharospasm"
"Essential Blepharospasm" treatment
"Essential Blepharospasm" support
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I hope this helps. Please ask for any clarification needed before rate
this answer, I will glad to respond your requests.
Best regards.
livioflores-ga |
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