Related Experiment Videos
Blepharospasm and Hemifacial Spasm
1Centre Hospitalier de l'Universite de Montreal, 3840 St-Urbain Street, Montreal, Quebec, H2W 1T8, Canada.
Abstract:
The main objective in the treatment of blepharospasm is to decrease or cease the unwanted, repeated forced closure of the eyelids. This is best achieved by the use of botulinum toxin. In a minority of patients, botulinum toxin is either ineffective or poorly tolerated. In this group of patients, a trial with oral medication in the following order is warranted: trihexyphenidyl, baclofen, clonazepam, and tetrabenazine. Before going to the next medication, each of these drugs should be administered at the highest tolerated dosage for a period of 1 or 2 months. If, as often happens, all pharmacologic treatment attempts fail, and the patient is too disabled to remain untreated, he or she can be referred to an experienced plastic surgeon for a myectomy of the eyelid protractors. For treatment of apraxia of eyelid opening, botulinum toxin should be administered as the first treatment. If this fails, and vision is significantly impaired, the patient may be referred to a plastic surgeon for a frontalis suspension of the eyelid. Treatments of hemifacial spasm are aimed at decreasing or ending the annoying twitches of one side of the face. In this disorder, interference with vision is not a problem unless the contralateral eye is amblyopic. Despite isolated reports of spasm relief by drugs such as carbamazepine, oral medication is unlikely to be helpful. Botulinum toxin is the preferred treatment in hemifacial spasm patients. In some patients, relief from spasms can only be obtained at the cost of an ipsilateral upper lip droop of varying severity. Patients who are dissatisfied with the results of treatment with botulinum toxin, and are not willing to tolerate their condition, can be referred to an experienced neurosurgeon for microvascular decompression of the facial nerve. Pending success of ongoing attempts to reduce adverse effects, we believe that doxorubicin chemomyectomy, a recent treatment that has been used for both facial spasm and blepharospasm, is best administered in a research setting.
Insights
Botulinum toxin is the primary treatment for blepharospasm and hemifacial spasm. For refractory cases, oral medications or surgical interventions like myectomy or microvascular decompression may be considered.
Area of Science:
- Neurology
- Ophthalmology
- Plastic Surgery
Background:
- Blepharospasm involves involuntary eyelid closure, while hemifacial spasm causes facial twitches.
- Apraxia of eyelid opening presents a distinct challenge in eyelid function.
Purpose of the Study:
- To outline effective treatment strategies for blepharospasm and hemifacial spasm.
- To provide a treatment algorithm for patients unresponsive to initial therapies.
Main Methods:
- Review of current treatment modalities for blepharospasm and hemifacial spasm.
- Sequential trial of oral medications (trihexyphenidyl, baclofen, clonazepam, tetrabenazine) for refractory blepharospasm.
- Surgical options including myectomy, frontalis suspension, and microvascular decompression.
Main Results:
- Botulinum toxin is the first-line treatment for both conditions.
- Oral medications offer an alternative for a minority of blepharospasm patients.
- Surgery is reserved for cases refractory to medical management.
Conclusions:
- A stepwise approach, starting with botulinum toxin and progressing to oral medications or surgery, optimizes outcomes.
- Surgical interventions provide solutions for patients with severe, intractable spasms.
- Doxorubicin chemomyectomy shows promise but requires further research.