Treatment Of Blepharospasm Research Articles

Stable Convergent Polyneuronal Innervation and Altered Synapse Elimination in Orbicularis oculi Muscles from Patients with Blepharospasm Responding Poorly to Recurrent Botulinum Type-A Neurotoxin Injections

Botulinum neurotoxin type-A (BoNT/A), which blocks quantal acetylcholine (ACh) release at the neuromuscular junction (NMJ), has demonstrated its efficacy in the symptomatic treatment of blepharospasm. In 3.89% of patients treated for blepharospasm at Tenon Hospital, BoNT/A was no longer effective in relieving the patient’s symptoms, and a partial upper myectomy of the Orbicularis oculi muscle was performed. We used surgical waste samples from 14 patients treated with repeated injections of either abobotulinumtoxinA (Dysport®) or incobotulinumtoxinA (Xeomin®). These muscle fragments were compared to others from 4 normal subjects, naïve of BoNT/A. The morphological study was performed blinded to the BoNT/A treatment and between treated and control samples. Neuromuscular specimens analyzed by confocal laser scanning microscopy, using fluorescent staining and immune-labeling of presynaptic proteins, revealed that the pattern of innervation (e.g., polyneuronal and convergent innervation), the muscle nicotinic ACh receptors (nAChRs), and the NMJs exhibited marked differences in BoNT/A-treated muscles (regardless of the toxin clinically used), with respect to controls. BoNT/A-treated junctions exhibited profuse polyneuronal innervation in which 2–6 axons innervated 74.84% of single muscle fibers, while 99.47% of control junctions were mono-innervated. Another new finding was the stable convergent innervation, in which several motor axons end onto the same endplate. Morphological signs of synapse elimination included the presence of retraction bulbs in axons and nerve terminals and a reduced extension of postsynaptic nAChRs. These outcomes suggest that synapse elimination is altered and raise questions on the origin and factors contributing to the plasticity changes observed and the functioning of NMJs.

Combination of Pretarsal and Preseptal Botulinum Toxin Injections in the Treatment of Blepharospasm: A Prospective Nonrandomized Clinical Trial

PurposeTo compare the efficacy of two botulinum toxin (BoNT) injection methods, pretarsal (PT) combined with preseptal (PS) injection (PT-PS) and conventional PT injection, in the treatment of benign essential blepharospasm (BEB). DesignProspective nonrandomized clinical trial. MethodsFrom January 2023 to April 2024, 95 BoNT injections into orbicularis oculi were performed in 45 BEB patients, including 52 PT-PS injections s and 43 PT injections. Jankovic Rating Scale (JRS) and Blepharospasm Disability Index (BSDI) were used to assess motor symptoms. The efficacy of two injection methods for BEB was compared in terms of latency to response (LTR), latency to the peak response (LPR), duration of peak response (DPR), duration of response (DOR), satisfaction degree, and possible complications. ResultsBoth injection methods significantly improved JRS and BSDI scores in patients with BEB. However, PT-PS injections showed a shorter LTR [(4.00(3.00,6.00) vs 5.00(4.00,7.00) days, p=0.024] and LPR [23.50(16.00,26.00) vs 26.00(20.00,30.00) days, p=0.040], a longer DPR [88.00(80.50,104.75) vs 75.00(65.00,92.00) days, p=0.003] and DOR [135.00(118.50,153.75) vs 121.00(107.00,135.00) days, p=0.003] than PT injections. Patients with PT-PS injections were more satisfied than those with PT injections [9.50(8.50,10.00) vs 8.00(7.50,9.00), p<0.001], and around 2/3 of patients were more willing to receive the combined injection method later. Among patients receiving PT-PS injections, only one case experienced ptosis, and there were no significant differences in other complications such as lacrimation, dry eyes, and blurred vision between the two injection methods. ConclusionsPT-PS injections of BoNT showed more advantages in the treatment of BEB than PT injections in terms of both their efficacy and patients’ satisfactions.

Computed tomography navigation radiofrequency ablation for Meige's syndrome: A game-changer in treatment

BackgroundMeige's syndrome severely impacts quality of life. Current treatments struggle to balance cost, risk, and effectiveness. MethodsPatients with blepharospasm were treated with facial nerves partial radiofrequency ablation guided by CT. Treatment efficacy, complications, and recurrences were evaluated during follow-up. Results116 facial nerves in 58 patients with Meige's syndrome were treated using CT guidance. The average temperature at the end of radiofrequency treatment was 77.93 ± 9.8 °C, and the procedure lasted an average of 30.79 ± 7.69 min. Spasms stopped after treatment, but mild facial paralysis remained. Follow-ups ranging from 12 to 57 months showed that facial paralysis improved in an average of 3.12 ± 0.94 months. Nine patients had unilateral recurrence within 6–13 months, and three had bilateral recurrence at 14, 18, and 22 months. ConclusionsPartial radiofrequency ablation of the facial nerve through percutaneous access to the bilateral stylomastoid foramen using CT navigation is an effective, safe, promising treatment for blepharospasm in Meige's syndrome patients.

12-year effectiveness and safety of botulinum toxin type A for the treatment of blepharospasm and hemifacial spasm

12-year effectiveness and safety of botulinum toxin type A for the treatment of blepharospasm and hemifacial spasm

Understanding Clinical Effectiveness and Safety Implications of Botulinum Toxin in Children: A Narrative Review of the Literature.

Since its first approval by the Food and Drug Administration in 1989 for strabismus, botulinum toxin indications of use have been widely expanded. Due to its anticholinergic properties, this toxin is currently approved in adult patients for the treatment of a wide range of neuromuscular, otolaryngologic, orthopedic, gastrointestinal, and urologic disorders. Approved pediatric indications of use include the treatment of blepharospasm associated with dystonia, strabismus, lower-limb spasticity, focal spasticity in patients with cerebral palsy, and neurogenic detrusor overactivity. Alongside these approved indications, botulinum toxin is extensively used off-label. Although several clinical studies have shown that botulinum toxin is effective and well-tolerated in children, uncertainties persist regarding its long-term effects on growth and appropriate dosing in this population. As such, further research is needed to better define the botulinum toxin risk-benefit profile and expand approved uses in pediatrics. This narrative review aimed to provide a broad overview of the evidence concerning the clinical effectiveness and safety of BoNT with respect to its principal authorized and non-authorized pediatric therapeutic indications, as well as to describe perspectives on its future use in children.

Beyond the aesthetic purposes of the botilinum toxin A; The dry eye syndrome with essential blepharospasm

Botulinum A toxin injection is a method used in clinical conditions such as blepharospasm, hemifacial spasm, strabismus, migraine, hyperhidrosis, torticollis and migraine, in addition to its use for cosmetic purposes. It works by reducing the release of acetylcholine at the neuromuscular junction, and as a result, a type of paralysis occurs in the applied area for a while. Botox applied around the tear collection ducts can provide dual benefits by reducing tear loss and relieving blepharospasm. In this study, botulinum toxin A injection was applied to 33 patients with essential blepharospasm and also dry eye syndrome. Schirmer test measurement, tear breakup time (BUT) and rose bengal disappearance test were measured before the injection and at the 1st week, 1st month and 3rd month after the injection. At the same time, sampling was performed for impression cytology before the injection and at the 1st and 3rd months after the injection. Symptoms and signs of blepharospasm decreased in all patients treated with botulinum toxin A. However, the patients' Schirmer test measurements were measured immediately one week after the injection and decreased in other measurements. Tear breakout time (BUT) increased in the 1st week after the injection but decreased in the 4th week measurements. Rose bengal disappearance score increased in the 1st week after injection and returned to its previous state in the 4th week. As a result of impression cytology, no change in conjunctival cell morphology was observed before and after injection. In conclusion, essential blepharospasm and dry eye are two independent diseases, but they can occur simultaneously. Botulinum toxin A injection is a very effective method in the treatment of blepharospasm. Although it has been stated in different studies that it has a positive effect on dry eye syndrome, it was observed that it did not have such an effect in our study.

Effects of onabotulinum toxin type A injections in patients with Meige's syndrome.

Meige's syndrome is a type of facial dystonia characterized by the simultaneous occurrence of blepharospasm and oromandibular dystonia. Although botulinum toxin type A (OBTA) injections are the standard treatment, evidence of their effectiveness and safety in this scenario is still lacking. Our research aimed to evaluate the improvement and occurrence of side effects following injections of onabotulinum toxin type A (OBTA) in patients with Meige's syndrome. Patients with Meige's syndrome undergoing botulinum toxin injections were enrolled in this study. We assessed dystonia intensity before and 14 days after OBTA injection using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) to measure the response of symptoms in the eyes (blepharospasm) and mouth (oromandibular dystonia). Other variables, such as dosage, side effects, and demographic data, were also recorded. The study included 41 participants, with a mean age of 67.7 years and a female-to-male ratio of 3.5:1. The mean BFMDRS score before the injections was 8.89, and after 14 days, it was 2.88. The most reported side effect was ptosis, with a 7.3% incidence. OBTA significantly reduced dystonia severity (p < 0.0001). The clinical response for the blepharospasm component was superior to the oromandibular dystonia component. Our results support that OBTA seems to be an effective and safe therapeutic option for treating Meige's syndrome. The effect of OBTA was more pronounced in the treatment of blepharospasm than in oromandibular dystonia.

BOTULINUM TOXIN A FOR BLEPHAROSPASM WITH DRY EYE: A SYSTEMATIC REVIEW

Introduction &amp; Objectives : Essential blepharospasm is a neurological condition that is defined by uncontrolled and abnormal eyelid closure from a central cerebral disorder. Between 40%-85% of blepharospasm occurs in conjunction with dry eye symptoms. Botulinum neurotoxin (BoNT) injections are commonly used treatment for reducing spasms in blepharospasm. Furthermore, it is often suggested for dry eye therapy due to their ability to reduce lacrimal drainage. The purpose of this review is to assess the effectiveness of BoNT treatment for blepharospasm with dry eye symptoms.&#x0D; Methods : A literature research was conducted on online databases such as PubMed, Cochrane library and Google scholar. All studies of BoNT and dry eye with full-text journals published in English within the last 10 years were included. We assessed Tear Breakup Time (TBUT), Schirmer Test, and Blepharospasm Disability Index (BSDI).&#x0D; Results : 204 patients from 6 publications were analyzed. In five trials, the BoNT treatment statistically significant increased TBUT (p&lt;0,5), with mean final TBUT 5,7 ±1.1 s. Furthermore, the Schirmer test also increased with the mean final score 6,29 ± 4,6 mm. The mean BSDI score dropped by 6,05 ± 3,7 in two studies.&#x0D; Conclusion : It is confirmed that BoNT injection is an effective treatment for essential blepharospasm with dry eye symptoms. Clinicians should be screened for dry eye in all blepharospasm patients prior to BoNT treatment.

Facial phantom model: a low-cost and safe tool for teaching botulinum toxin application in neurology residencies.

The application of botulinum toxin (BoNT) in the treatment of blepharospasm and hemifacial spasm (HS) is a well-established practice. However, neurology residency programs often rely on real patients for training, which has limitations in terms of patient availability and skill acquisition. Assess the efficacy of a new facial phantom model for acquiring motor skills in BoNT application. An anthropomorphic facial phantom model was developed in collaboration with a medical training simulator start-up. A group of seven neurologists and one ophthalmologist with expertise in BoNT application evaluated the model using an adapted learning object review instrument (LORI). The instrument assessed aspects such as: content quality, alignment of learning objectives, feedback and adaptation, motivation, presentation design, and accessibility. The facial phantom model received high scores in the LORI evaluation, with the highest ratings given to alignment with learning objectives and motivation. The model also scored well in terms of accessibility, content quality, and presentation design. However, feedback and adaptation received a lower score due to the static nature of the model. The facial phantom model shows promise as a valuable tool for teaching and developing competence in BoNT application for HS and blepharospasm. The model reduces the reliance on real patients for training, providing a broader and safer learning experience for neurology residents. It also provides a realistic learning experience and offers portability, cost-effectiveness, and ease of manufacturing for use in various medical training scenarios. It is an effective and accessible tool for teaching BoNT application.

Efficacy of Botulinum Neurotoxin in the Treatment of Blepharospasm and Hemifacial Spasm

Efficacy of Botulinum Neurotoxin in the Treatment of Blepharospasm and Hemifacial Spasm

Evaluation of nerve innervation distribution of orbicularis oculi muscle for botulinum neurotoxin application using Sihler's method

BackgroundBlepharospasm is the involuntary and forced closure of the eyelids due to spasm-like contraction of the orbicularis oculi muscle around the eye. The study aimed to reveal the nerve innervation of the orbicularis oculi muscle for Botulinum neurotoxin (BoNT) treatment of blepharospasm by Sihler’s staining technique. MethodsThis study used six cephalus (12 orbicularis oculi muscles) with an average age of 69,6 (62−88) years. Then, the orbicularis oculi muscles were removed by dissection, and Sihler's staining technique was applied to the muscles. The limit for dissection of the muscle is the orbital opening level, where the nerves enter the muscle, and the muscle attaches to the bone. ResultsIn the region above the palpebral fissure, the nerves entering the muscle were densely located in the superolateral quadrant between 9 and 12 o′clock in the right eye and between 12 and 3 o′clock in the left eye. In the region under the palpebral fissure, the nerves’ density in the orbicularis oculi muscle was higher between 4 and 7 o′clock in the right eye and between 5 and 8 o′clock in the left eye. ConclusionThis study unveiled the nerve branches associated with the orbicularis oculi muscle. It pinpointed precise crossing points of these nerve branches, which can be targeted for applying BoNT in treating blepharospasm. Consequently, by utilizing minimal BoNT, it is anticipated that the quantity of toxin administered will decrease, leading to more efficient outcomes and reduced expenses. Furthermore, this approach can aid in averting potential undesired complications during BoNT administration.

Data of P. Stradins Clinical University Hospital Dystonia Register: time from symptoms to diagnosis and treatment of blepharospasm

Data of P. Stradins Clinical University Hospital Dystonia Register: time from symptoms to diagnosis and treatment of blepharospasm

The efficacy and safety of nerve loop blocking in the treatment of blepharospasm in Meige syndrome

Objective: To evaluate the efficacy and safety of nerve loop blocking in the treatment of blepharospasm caused by Meige syndrome. Methods: It was a retrospective case series study. Patients with Meige syndrome characterized by blepharospasm or blepharospasm-oromandibular dystonia who underwent nerve loop blocking in the Ophthalmology Department of Henan No. 3 Provincial People's Hospital from April 2018 to January 2020 were included. Before and after surgery, blepharospasm was graded, and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to score the symptoms of ocular and oral dystonia. The improvement rate of ocular spasm was calculated after surgery according to the scores. The postoperative complications were observed. The Wilcoxon rank test was used to compare the BFMDRS movement subscale scores before and after surgery. The independent sample Mann-Whitney U test was used to compare the improvement rates of eye spasm between male and female patients and between patients with and without combined oromandibular dystonia. Results: Among the 199 patients included, 64 (32.2%) were males, and 135 (67.8%) were females, aged 58 (51, 64) years (22-79 years). The postoperative follow-up period was 24 (21, 28) months. Preoperatively, blepharospasm was graded as grade 3 in 12 patients (6.0%) and grade 4 in 187 patients (94.0%), while the postoperative blepharospasm grades were grade 0 in 100 patients (50.3%), grade 1 in 64 patients (32.2%), grade 2 in 31 patients (15.6%), and grade 3 in 4 patients (2.0%). There was statistically significant difference in the BFMDRS scores of ocular dystonia before and after surgery [8.0 (8.0, 8.0) vs. 0.0 (0.0, 1.0); Z=-12.41, P<0.001]. The improvement rate of blepharospasm in all patients was 100% (87.5%, 100%), ranging from 43.8% to 100%, with no statistically significant difference between patients of different genders and between patients with and without combined oral dystonia (both P>0.05). Statistically significant difference existed in the scores of oral dystonia before and after surgery [2.0 (0.5, 4.5) vs. 1.0 (0.5, 2.0); Z=-4.38, P<0.001], with 25 of 65 patients (38.5%) having their oral symptoms improved. Postoperative complications included eyelid valgus (7.5%, 15/199), frontal numbness (100%, 199/199) and tearing (89.9%, 179/199). Conclusion: Nerve loop blocking is a relatively safe and effective method in the treatment of blepharospasm symptoms of Meige syndrome.

Oxymetazoline hydrochloride ophthalmic solution, 0.1%, boosts the effects of botulinum toxin on blepharospasm: a case series

BackgroundOxymetazoline hydrochloride ophthalmic solution (0.1%) is a medication used to treat blepharoptosis. Patients who suffer from blepharoptosis have low-lying eyelids that can hinder their vision. Oxymetazoline hydrochloride ophthalmic solution (0.1%) is prescribed to patients to improve their vision by lifting the upper eyelids. Blepharospasm consists of involuntary, bilateral orbicularis oculi muscle movements that result in twitching and eyelid closure. Botulinum toxin is a treatment used to treat blepharospasm by preventing muscle contraction; but it is not always effective.Case presentationThe effects of treatment with both oxymetazoline hydrochloride ophthalmic solution (0.1%) and botulinum toxin are assessed in three patients: (1) Patient A, a 58-year-old Filipina woman; (2) patient B, a 62-year-old Korean woman; and (3) patient C, A 57-year-old Vietnamese woman. All patients had been diagnosed with blepharoptosis as well as blepharospasm. Each patient was given an opportunity to complete an optional survey to assess not only the efficacy of oxymetazoline hydrochloride ophthalmic solution (0.1%) together with botulinum toxin but also their perceived stress during the past month.ConclusionsAdministering botulinum toxin for the treatment of blepharospasm in patients A and B yielded the expected results; adding oxymetazoline hydrochloride ophthalmic solution (0.1%), a medical treatment for ptosis, to the treatment regimen yielded an unexpected reduction of blepharospasm. We propose that botulinum toxin and oxymetazoline hydrochloride ophthalmic solution (0.1%) can have a synergistic effect on reducing blepharospasm when used concomitantly. We present three cases in which combined use of botulinum toxin with oxymetazoline hydrochloride ophthalmic solution (0.1%) reduced blepharospasm, and propose possible reasons for such effects. We also discuss previous literature in agreement with the results of our cases.

A dual dopaminergic therapy with L-3,4-dihydroxyphenylalanine and chlorpromazine for the treatment of blepharospasm, a focal dystonia: Possible implications for striosomal D1 signaling

Impairment of balanced activity between dopamine D1 and D2 receptor functions in the striatum, particularly in striatal functional subdivisions (i.e., striosome and matrix compartments), has been proposed to underlie dystonia genesis. This study was undertaken to examine the therapeutic effect of dual dopaminergic modulation with L-3,4-dihydroxyphenylalanine (L-DOPA) and chlorpromazine (CPZ) in patients with blepharospasm, a focal dystonia. For this purpose, Dopacol tablets™ (L-DOPA 50 mg plus carbidopa 5 mg) and Wintermin™ (CPZ phenolphthalinate 180 mg/g) were used. Clinical evaluations were performed before and after an 8-week drug treatment interval using the Visual Analog Scale (VAS), Blepharospasm Disability Index (BSDI), modified VAS (mVAS), and Jankovic Rating Scale (JRS). The data were analyzed using non-parametric statistics. Results showed that in patients (n = 7) with blepharospasm, dystonia symptoms were significantly alleviated by the administration of both Dopacol tablets™ (one tablet × 3/day) and CPZ (5 mg × 3/day), as determined using the VAS, BSDI, mVAS, and JRS. In contrast, there was no improvement of dystonia symptoms in patients (n = 7) who ingested Dopacol tablets™ (one tablet × 3/day) alone, nor in those (n = 7) who ingested CPZ (5 mg × 3/day) alone. Thus, dual pharmacotherapy with L-DOPA and CPZ can exert a therapeutic effect on blepharospasm, suggesting that dystonia symptoms can be attenuated through dopaminergic modulation with inducing an increase in striatal D1-signals. Since dopamine D1 receptors are heavily enriched in the striosome compartment in the “human” striatum, our results also suggest that striosomal loss of D1-signaling may be important in the pathogenesis of dystonia.

Blink index as a response predictor of blepharospasm to botulinum neurotoxin-A treatment.

PurposeWe investigated the blink profiles and blink index using ocular surface interferometer in the patients with blepharospasm (BSP) and identified points to consider predictive factor after BSP treatment.MethodsIn total, 117 eyelids of 59 elderly patients and 20 eyelids of 10 age‐matched control group were studied. All BSP patients applied botulinum toxin‐A (BoNT‐A) injection for treatment of BSP. An ocular surface interferometer (LipiView; TearScience, Morrisville, NC, USA) was used to measure blink profile and blink index; total and incomplete blinks/20 s, and the partial blink ratio (PBR). Eyelid blink time (including lid closing time, closure time, lid opening time), interblink times (IBT), closing speeds (OS), and opening speeds (OS) were analyzed using 600 blinks recorded over 20 s.ResultsTotal blink rate was significantly higher in BSP patients compared to the age‐matched control group (p = .029) but other time‐related and speed‐related index including interpalpebral fissure, PBR, blink time, closure time (CT), interblink time, CS, and OS were not significantly different. In the responder of BSP patients, the average age was higher, CT was shorter, CS was faster than nonresponder (age; p = .016, CT; p < .001, CS; p = .042).ConclusionThe blink index by analyzing the blink profile using ocular surface interferometer, and this blink index may be used as a predictive factor for evaluating the clinical response after BoNT‐A injection in blepharospasm patients.

Duration and onset of effect of incobotulinumtoxinA for the treatment of blepharospasm in botulinum toxin-naïve subjects

Objective Blepharospasm is a focal dystonia whereby excessive eyelid muscle contractions cause involuntary eye closure. Botulinum neurotoxin type A (BoNT-A) injections are an approved treatment. This randomized placebo-controlled trial (NCT01896895; EudraCT number 2012-004821-26) assessed the efficacy, safety, and treatment effect duration of incobotulinumtoxinA (Xeomin, Merz Pharmaceuticals GmbH), a BoNT-A formulation without complexing proteins, in BoNT-A-naïve adults with blepharospasm. Methods Subjects received incobotulinumtoxinA 50 U, 25 U (total dose) or placebo during a main study period (MP; 6–20 weeks). Patients needing a second injection received incobotulinumtoxinA ≤70 U in an open-label extension period (EP; 6–20 weeks). Treatment effect durations were time from first injection to EP injection or final MP visit and from EP injection to end-of-study visit. Times to effect onset and to waning of effect (MP) were time from injection to first subject-assessed onset effect and time from injection to subject-reported waning of effect, respectively. Results Of 61 subjects, 39 entered the EP. During the MP, median duration of treatment effect was longer with incobotulinumtoxinA 50 U (20 weeks) versus incobotulinumtoxinA 25 U (11 weeks) or placebo (6 weeks). Median duration of treatment effect was 20 weeks during the EP. Median time to effect onset was 5, 7, and 14 days with 50 U, 25 U, and placebo, respectively (p = .022 for 50 U versus placebo). Median time to waning of treatment effect was comparable between groups. Conclusion Subjects reported an effect onset from 5 days after injection lasting up to 20 weeks (maximum observation period). Data indicate that incobotulinumtoxinA re-treatment of blepharospasm may not be required at fixed 12-week intervals and provide evidence for a patient-tailored approach.

Smell and taste in idiopathic blepharospasm

The pathophysiology of blepharospasm is incompletely understood. Current concepts suggest that blepharospasm is a network disorder, involving basal ganglia, thalamus, cortex, and, possibly, the cerebellum. Tracing, imaging, and clinical studies revealed that these structures are also concerned with olfaction and taste. Because of this anatomical overlap, dysfunction of the chemical senses in blepharospasm is expected. Injections of botulinum toxin into the eyelid muscles are the first-line treatment of blepharospasm. Yet, the effects of botulinum toxin on the chemical senses have not been systematically assessed. To contribute to a better understanding of blepharospasm, olfactory and gustatory abilities were assessed in 17 subjects with blepharospasm and 17 age-/sex-matched healthy controls. Sniffin Sticks were used to assess odor threshold, odor discrimination, and odor identification. Results of these three Sniffin Sticks subtests were added to the composite olfactory score. The Taste Strips were applied to assess taste. In an adjacent study, we assessed the sense of smell and taste in eight subjects with blepharospasm before and 4 weeks after botulinum toxin treatment. Subjects with blepharospasm had significantly lower (= worse) scores for odor threshold and for the composite olfactory score than healthy controls, while odor discrimination, odor identification, and the composite taste score were not different between groups. The adjacent study revealed that botulinum toxin did not impact the chemical senses. In this study, subjects with blepharospasm had a lower (= worse) odor threshold than healthy controls. As olfaction is important in daily life, findings justify further research of olfaction in blepharospasm.

A ROLE OF AYURVEDIC MANAEGEMENT IN BLEPHAROSPASM w.s.r. NIMESHA - A CASE STUDY

Ayurveda can provide effective and harmless relief for certain diseases which sometimes can’t be cured with modern medicine. Nimesha is a condition, pertaining to Shalakya Tantra in which eye lids starts blinking involun- tary due to influence of Vata Dosha. In this condition patients can’t be able to focus things properly and having lots of discomfort. It can be correlated to blepharospasm i.e., an abnormal contraction of eye lid muscles, which is also refers to benign essential blepharospasm. It is thought to be rare, affecting about 16–133 cases per million. There is no cure for blepharospasm in modern practice. Generally, doctors inject botox injection into eyelid mus- cles which need to get injected in every 4-6 month, rather than permanent benefits it has lots of side effects like diplopia ectropion etc. Ayurveda can be useful in the treatment of blepharospasm and its complication that it is a Vataj Vyadhi all Vatashamak therapies could be effective for its treatment. A 61 years old male patient known case of bilateral blepharospasm was visited in OPD of Government Autonomous Dhanwantari Ayurveda Hospi- tal, Ujjain. He had complained of excessive blinking with tired eye muscles, heaviness around eyes, headache, anxiety and irritation etc. for 3 years. He was on regular allopathic medicine along with botox injection around each eye which is repeated in every 6 months, but after few shots of treatment pt. didn’t receive any benefits.Therefore, he came to us and after Ayurvedic treatment patient showed marked improvement in symptomatology, with limited abnormal eye lid movement and with negligible side effects. Here was 70% relief after Ayurvedic treatment. Keyword: Ayurveda, Nimesha, Blepharospasm, Botox

Benign essential blepharospasm: epidemiology, clinical manifestations, pathophysiology, botulinum toxin therapy

Blepharospasm (BPS) is a variant of focal dystonia manifested by involuntary eyelid spasms with eye closure and/or increased spontaneous blinking. Along with motor symptoms, this condition is characterized by sensory, affective, and cognitive disorders. Patients with BPS are found to have changes in the basal ganglia, cerebellum, primary/secondary sensorimotor and visual areas according to functional magnetic resonance imaging. This may reflect the involvement of above regions in suppressing defective movement and sensorimotor disintegration. Botulinum toxin therapy is the most effective treatment for BPS. The advantage of Xeomin ® that does not contain complexing proteins, is characterized by a low probability of antibody production, is the ability to vary between-injection intervals. Probably, botulinum toxin therapy has a pathogenetic and modifying impact on BPS.