Tardive Blepharospasm May Respond to Bilateral Pallidal Deep Brain Stimulation

Virgilio Gerald H Evidente,Margaret Lambert,Maris H Evidente,Francisco A Ponce,Robin Garrett

doi:10.5334/tohm.594

Abstract

Background:To date, there have been no reports of tardive blepharospasm being treated with deep brain stimulation (DBS), though there have been two reports of focal blepharospasm responding favorably to bilateral pallidal DBS.Case:A 34 year old man with tardive blepharospasm that was refractory to oral medications as well as botulinum toxin types A and B underwent bilateral pallidal DBS under general anesthesia. He had significant improvement of his severe blepharospasm by one and half months post-DBS which was sustained at last follow-up 30 months post-DBS. The best programming parameters included pulse widths of 90–100 µsec, frequencies of 140–150 Hz, and stimulating the ventral contacts in each side.Conclusion:Our case represents the first report of medically refractory tardive blepharospasm responding favorably to bilateral pallidal DBS.

Highlights

Blepharospasm is the second most common focal dystonia that arises from excessive contraction of the orbicularis oculi and adjacent muscles including the procerus and corrugator [1]
Our case represents the first report of medically refractory tardive blepharospasm responding favorably to bilateral pallidal deep brain stimulation (DBS)
There are several published studies that show the efficacy of pallidal deep brain stimulation (DBS) for Meige syndrome [5, 6], there are only two case reports of pallidal DBS for focal blepharospasm and no reported cases of tardive blepharospasm being managed with DBS [7, 8]

Summary

Conclusion

Our case represents the first report of medically refractory tardive blepharospasm responding favorably to bilateral pallidal DBS. Ironwood Square Drive, Suite 118, Scottsdale, AZ, USA 85258; Movement Disorder Center of Arizona, Scottsdale, AZ vevidente@movementdisorders. Us KEYWORDS: Blepharospasm; deep brain stimulation; DBS; pallidal DBS; GPi; Tardive. TO CITE THIS ARTICLE: Evidente VGH, Ponce FA, Evidente MH, Lambert M, Garrett R. Tardive Blepharospasm May Respond to Bilateral Pallidal Deep Brain Stimulation.

Findings

INTRODUCTION

DISCUSSION