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Leszczynska A, Nowicka D, Pillunat LE, Szepietowski JC. Five decades of the use of botulinum toxin in ophthalmology. Indian J Ophthalmol 2024; 72:789-795. [PMID: 38317306 PMCID: PMC11232847 DOI: 10.4103/ijo.ijo_1030_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024] Open
Abstract
Botulinum toxin (BoNT) has been known for over 50 years. It has conquered many areas of medicine and has become indispensable in contemporary medicine. Now, BoNT is used to treat at least 26 conditions in six medical specialties. Although the use of BoNT began in strabology, it became the gold standard for many ophthalmologic pathologies. The present review of the literature focuses on the use of BoNT in ophthalmology and treatment of the following conditions: blepharospasm, facial hemispasm, facial palsy, spastic entropion, strabismus, endocrine orbitopathy, convergence spasm, and facial trauma. We conclude that nearly half a century of experience in utilizing BoNT in ophthalmology ensured a satisfactory level of effectiveness and safety for patients with many pathologies. Areas of future research include the application of BoNT in new selected indications, the development of the route of application without injections, and the development of long-acting BoNT forms for patients who require repeated long-term treatment.
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Affiliation(s)
- Anna Leszczynska
- Department of Ophthalmology, University of Dresden, Dresden, Germany
| | - Danuta Nowicka
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - Lutz E Pillunat
- Department of Ophthalmology, University of Dresden, Dresden, Germany
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Ting MA, Manta AI, Samia-Aly E, Lai M, de Carvalho ER, Buttery P, Ezra DG. Blepharospasm Secondary to Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson Disease: Clinical Characteristics and Management Outcomes. J Neuroophthalmol 2023:00041327-990000000-00534. [PMID: 38117577 DOI: 10.1097/wno.0000000000002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for patients with motor symptoms of Parkinson disease but can be complicated by disabling blepharospasm and apraxia of eyelid opening (ALO). Currently, there is no clear consensus on optimal management, and addressing these issues is further hindered by systemic morbidity and resistance to treatments. We aim to describe the different phenotypes of these eyelid movement disorders, to report our management approach and patient responses to treatment. METHODS A retrospective case series of all patients with blepharospasm/ALO secondary to STN-DBS that were treated at a tertiary center between 2011 and 2020. Data collected included date of Parkinson diagnosis, date of DBS surgery, date of development of blepharospasm/ALO symptoms, STN-DBS stimulation settings, and treatment given. Patients' symptoms before and after treatment were measured using the blepharospasm disability index and Jankovic Rating Scale. RESULTS Five patients were identified with eyelid movement disorders secondary to STN-DBS. All patients had moderate-to-severe symptoms at presentation. Four patients received periocular botulinum toxin injections. Three patients underwent surgery in the form of frontalis suspension or direct brow lift with or without upper lid blepharoplasty. All reported an improvement in symptoms following treatment. CONCLUSIONS A multimodality, patient-specific approach is required in the treatment of blepharospasm/ALO secondary to STN-DBS. Botulinum toxin injections can be effective, but patients may require surgery if toxin treatment alone becomes ineffective. Tailoring treatment to individual needs can result in a measurable improvement in symptoms.
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Affiliation(s)
- Michelle A Ting
- Oculoplastic Department, (MAT, AIM, ES-A, ERC, DGE), Moorfields Eye Hospital, London, United Kingdom; Department of Neuro-ophthalmology (ML, ERC), National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Neurology (PB), Addenbrooke's Hospital, Cambridge, United Kingdom; and UCL Institute of Ophthalmology NIHR, Department of Biomedical Research Centre for Ophthalmology (DGE), London, United Kingdom
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Kesimal B, Kesimal U, Keven A, İlhan HD, Karaali K. Evaluation of ocular blood flow by Doppler ultrasound in patients with essential blepharospasm. J Ultrasound 2022; 25:507-511. [PMID: 34855186 PMCID: PMC9402877 DOI: 10.1007/s40477-021-00613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/16/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Benign essential blepharospasm (EB) is a focal facial dyskinesia that occurs with the involuntary contraction of muscles around the eyes. In the literature, studies on blepharospasm focus on elucidating the pathophysiology of this condition in the brain. To the best of our knowledge, there is no research evaluating the orbital imaging findings of patients with EB. Therefore, the current study aimed to determine whether there was any change in the blood supply of muscles around the eye or ocular blood flow in patients with blepharospasm and investigate flow changes that may be caused by spasm. METHODS Thirty patients with EB and 30 controls were included in the study. Orbital Doppler ultrasound was performed in all cases to measure ophthalmic and temporal artery peak systolic velocity and end diastolic velocity and calculate resistive index values. Superior ophthalmic vein blood flow velocity (SOVBFV) was also measured. RESULTS There was no significant difference between the groups in terms of age and gender distribution (P = 0.345 and 0.870, respectively). SOVBFV was found to be significantly higher in the EB group (P = 0.001). No significant difference was observed in the remaining investigated parameters. CONCLUSIONS In conclusion, our study suggested that ocular spasm in patients with EB had no effect on blood flow other than SOVBFV. When SOVBFV was compared between the EB and control groups, it was found to be increased in the EB group. We consider that this statistical difference may be clinically and pathophysiologically significant.
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Affiliation(s)
| | - Uğur Kesimal
- Recep Tayyip Erdoğan University Education and Research Hospital, Rize, Turkey
| | - Ayşe Keven
- Akdeniz University School of Medicine, Antalya, Turkey
| | | | - Kamil Karaali
- Akdeniz University School of Medicine, Antalya, Turkey
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Scorr LM, Cho HJ, Kilic-Berkmen G, McKay JL, Hallett M, Klein C, Baumer T, Berman BD, Feuerstein JS, Perlmutter JS, Berardelli A, Ferrazzano G, Wagle-Shukla A, Malaty IA, Jankovic J, Bellows ST, Barbano RL, Vidailhet M, Roze E, Bonnet C, Mahajan A, LeDoux MS, Fung VS, Chang FC, Defazio G, Ercoli T, Factor S, Wojno T, Jinnah HA. Clinical Features and Evolution of Blepharospasm: A Multicenter International Cohort and Systematic Literature Review. DYSTONIA 2022; 1. [PMID: 36248010 PMCID: PMC9557246 DOI: 10.3389/dyst.2022.10359] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: Blepharospasm is a type of dystonia where the diagnosis is often delayed because its varied clinical manifestations are not well recognized. The purpose of this study was to provide a comprehensive picture of its clinical features including presenting features, motor features, and non-motor features. Methods: This was a two-part study. The first part involved a systematic literature review that summarized clinical features for 10,324 cases taken from 41 prior reports. The second part involved a summary of clinical features for 884 cases enrolled in a large multicenter cohort collected by the Dystonia Coalition investigators, along with an analysis of the factors that contribute to the spread of dystonia beyond the periocular region. Results: For cases in the literature and the Dystonia Coalition, blepharospasm emerged in the 50s and was more frequent in women. Many presented with non-specific motor symptoms such as increased blinking (51.9%) or non-motor sensory features such as eye soreness or pain (38.7%), photophobia (35.5%), or dry eyes (10.7%). Non-motor psychiatric features were also common including anxiety disorders (34–40%) and depression (21–24%). Among cases presenting with blepharospasm in the Dystonia Coalition cohort, 61% experienced spread of dystonia to other regions, most commonly the oromandibular region and neck. Features associated with spread included severity of blepharospasm, family history of dystonia, depression, and anxiety. Conclusions: This study provides a comprehensive summary of motor and non-motor features of blepharospasm, along with novel insights into factors that may be responsible for its poor diagnostic recognition and natural history.
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Affiliation(s)
- Laura M. Scorr
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Hyun Joo Cho
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Gamze Kilic-Berkmen
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - J. Lucas McKay
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Christine Klein
- Institute of Neurogenetics and Department of Neurology, University of Luebeck and University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Tobias Baumer
- Institute of Neurogenetics and Department of Neurology, University of Luebeck and University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Brian D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Joel S. Perlmutter
- Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St Louis, MO, United States
| | - Alfredo Berardelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Aparna Wagle-Shukla
- Fixel Institute for Neurological Disease, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Irene A. Malaty
- Fixel Institute for Neurological Disease, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Steven T. Bellows
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Richard L. Barbano
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Marie Vidailhet
- Paris Brain Institute, Inserm, CNRS, AP-HP, Salpetrière Hospital, Sorbonne University, Paris, France
| | - Emmanuel Roze
- Paris Brain Institute, Inserm, CNRS, AP-HP, Salpetrière Hospital, Sorbonne University, Paris, France
| | - Cecilia Bonnet
- Paris Brain Institute, Inserm, CNRS, AP-HP, Salpetrière Hospital, Sorbonne University, Paris, France
| | - Abhimanyu Mahajan
- Rush Parkinson’s Disease and Movement Disorders Program, Department of Neurological Sciences, Rush University, Chicago, IL, United States
| | - Mark S. LeDoux
- Department of Psychology, Veracity Neuroscience LLC, University of Memphis, Memphis, TN, United States
| | - Victor S.C. Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Florence C.F. Chang
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Tomaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Stewart Factor
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Ted Wojno
- Emory Eye Center, Emory University, Atlanta, GA, United States
| | - H. A. Jinnah
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA, United States
- Correspondence: H. A. Jinnah,
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Dinjar K, Zubčić V, Kopić A, Kopić V, Popić B, Holik D. SURGICAL ASPECT OF BLEPHAROSPASM TREATMENT: A CASE REPORT. Acta Clin Croat 2020; 59:377-381. [PMID: 33456129 PMCID: PMC7808224 DOI: 10.20471/acc.2020.59.02.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Blepharospasm is an idiopathic condition characterized by involuntary eyelid closure mainly caused by bilateral tonic-clonic contractions of the orbicularis oculi muscle. It results in patient inability to open their eyes, thus significantly impairing their ability to perform activities of daily living. First-line treatment for blepharospasm are primarily botulinum toxin type A injections. However, surgical procedure as a treatment option can also be taken in consideration. In this overview, we present a case of a 75-year-old female patient who received surgical treatment as per Anderson's method after being treated with botulinum toxin type A for 3 years. This form of therapy proved to be an extremely successful permanent solution in the treatment of severe cases of refractory blepharospasm, without any long-term complications, especially ectropion and lagophthalmos.
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Affiliation(s)
| | - Vedran Zubčić
- 1Faculty of Medicine in Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
| | - Andrijana Kopić
- 1Faculty of Medicine in Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
| | - Vlatko Kopić
- 1Faculty of Medicine in Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
| | - Bruno Popić
- 1Faculty of Medicine in Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
| | - Dubravka Holik
- 1Faculty of Medicine in Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Maxillofacial and Oral Surgery, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
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Sweeney AR, Dermarkarian CR, Williams KJ, Allen RC, Yen MT. Polytetrafluoroethylene frontalis suspension in blepharospasm with eyelid apraxia: an effective and well-tolerated adjunct to botulinum toxin therapy. Orbit 2020; 40:39-43. [PMID: 32172614 DOI: 10.1080/01676830.2020.1739081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To report the efficacy of polytetrafluoroethylene (PTFE) frontalis suspension for blepharospasm with eyelid apraxia and postoperative botulinum toxin requirements. Methods: Retrospective chart review of patients with blepharospasm and eyelid apraxia who underwent frontalis suspension. The primary outcome was a surgical success, defined by surgeon- and patient-reported success in postoperative eyelid opening. Comparative statistical analyses of botulinum toxin dosage and treatment intervals were performed amongst patients before and after frontalis suspension ptosis repair. Results: Five patients (10 eyelids) met the study criteria, of which 40% were female. Mean age was 63.2 years. All patients had successful surgical outcomes based on physician-reported and patient reported satisfaction with the postoperative eyelid opening. Average follow-up was 14 months. Preoperative botulinum toxin treatments averaged 80.4 units (range 32-110, SD 33.2) to the periocular region over an average of 9.6-week intervals. Postoperative botulinum toxin treatments averaged 61.4 units (range 24-110, SD 34.7) to the periocular region over an overage of 9.8-week intervals. No patients experienced postoperative exposure keratopathy, extrusion of the sling, or postoperative infection. Conclusions: Frontalis suspension using PTFE suture in the setting of blepharospasm with eyelid apraxia was found to be a safe and effective procedure. Frontalis suspension in this population is not a substitute for botulinum toxin treatment but may allow for reduced treatment dosage. Frontalis suspension appears to increase patient functionality with improved eyelid opening in patients with blepharospasm with eyelid apraxia.
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Affiliation(s)
- Adam R Sweeney
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine , Houston, Texas, USA
| | | | - Katherine J Williams
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine , Houston, Texas, USA
| | - Richard C Allen
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine , Houston, Texas, USA
| | - Michael T Yen
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine , Houston, Texas, USA
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Dressler D, Karapantzou C, Rohrbach S, Schneider S, Laskawi R. Frontalis suspension surgery to treat patients with blepharospasm and eyelid opening apraxia: long-term results. J Neural Transm (Vienna) 2016; 124:253-257. [PMID: 27816991 DOI: 10.1007/s00702-016-1641-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/31/2016] [Indexed: 11/25/2022]
Abstract
Blepharospasm may be accompanied by eyelid opening apraxia (EOA) reducing the efficacy of botulinum toxin (BT) therapy. The frontalis suspension operation (FSO) is then the only effective treatment option available. We want to report the first long-term results with FSO. We studied 15 patients with blepharospasm and EAO unresponsive to BT therapy (9 females, 6 males, age 61.9 ± 11.5 years). FSO was performed by applying 2 polytetrafluoroethylene threads (PTFE, Gore-Tex®) per eye connecting the frontalis muscle to the upper eye lid. Tension of the two carrés was set to produce a palpebral fissure width of 2-3 mm. Therapy outcome was monitored by a quality-of-life questionnaire (QoL-Q) and a self-assessment calendar reviewing postoperative days 0-9 (T1), 10-89 (T2), 90-179 (T3), 180-365 (T4), and >365 days (T5). Altogether, 40 FSO were performed. Postoperatively, all patients reported improved eyelid opening, 4 (27%) complete remission of symptoms. At T1, this improvement was 74.6 ± 26.4% on the self-assessment scale, after 1 year 68.2 ± 27.5%. Throughout the observation period (T1-T5), the improvement was 71.9 ± 25.6%. All 19 items on the QoL-Q (except for presence of involuntary eye lid closure) showed postoperative improvement. Adverse effects included circumscript upper eyelid haematomas, suture extrusion, suture granuloma, lacrimation, and infections. In all patients, BT therapy had to be continued to treat orbicularis oculi contractions. Our first long-term results demonstrate that FSO is a benign procedure producing robust and stable therapeutic effects on EOA in blepharospasm.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Chrisanthi Karapantzou
- Department of Ear-, Nose and Throat, Universitätsmedizin Göttingen (UMG), Göttingen, Germany
| | - Saskia Rohrbach
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin, Berlin, Germany
| | - Simon Schneider
- Department of Medical Statistics, Universitätsmedizin Göttingen (UMG), Göttingen, Germany
| | - Rainer Laskawi
- Department of Ear-, Nose and Throat, Universitätsmedizin Göttingen (UMG), Göttingen, Germany
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Karapantzou C, Dressler D, Rohrbach S, Laskawi R. Frontalis suspension surgery to treat patients with essential blepharospasm and apraxia of eyelid opening-technique and results. Head Face Med 2014; 10:44. [PMID: 25338619 PMCID: PMC4213496 DOI: 10.1186/1746-160x-10-44] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We describe the results of 15 patients suffering from essential blepharospasm with apraxia of eyelid opening who underwent frontalis suspension surgery. MATERIAL AND METHODS Patients with apraxia of eyelid opening and unresponsive to botulinum toxin injections were studied. Bilateral frontalis suspension surgery was performed (sling operation) using polytetrafluoroethylene (Gore-Tex®) sutures. The patients reported the degree of improvement using a subjective rating scale to evaluate the benefit of the operation at two times after surgery (0-10 days and 180-360 days). RESULTS The patients reported a high degree of subjective improvement. In the early postoperative period (0-10 days) the mean degree of subjective improvement was 74.6% (standard deviation (SD) 26.4%). At 180-360 days after surgery the mean improvement was 70.0% (SD 26.7%). Small hematomas of the upper lid occurred postoperatively in all patients. Other complications were suture extrusions (9.1%), suture granulomas (6.1%), lacrimation (5.0%) and local infections (7.5%). Postoperatively, all patients needed additional botulinum toxin injections for optimal outcome. CONCLUSION Frontalis suspension surgery is a minimally invasive and effective treatment option for apraxia of eyelid opening in patients with essential blepharospasm unresponsive to botulinum toxin injections alone.
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Affiliation(s)
| | | | | | - Rainer Laskawi
- ENT-Department, University of Göttingen Medical Center, Göttingen, Germany.
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Abstract
Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual's quality of life.
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Affiliation(s)
- Mary Ann Thenganatt
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030 USA
| | - Joseph Jankovic
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030 USA
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Delnooz CCS, van de Warrenburg BPC. Current and future medical treatment in primary dystonia. Ther Adv Neurol Disord 2012; 5:221-40. [PMID: 22783371 PMCID: PMC3388529 DOI: 10.1177/1756285612447261] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dystonia is a hyperkinetic movement disorder, characterized by involuntary and sustained contractions of opposing muscles causing twisting movements and abnormal postures. It is often a disabling disorder that has a significant impact on physical and psychosocial wellbeing. The medical therapeutic armamentarium used in practice is quite extensive, but for many of these interventions formal proof of efficacy is lacking. Exceptions are the use of botulinum toxin in patients with cervical dystonia, some forms of cranial dystonia (in particular, blepharospasm) and writer's cramp; deep brain stimulation of the pallidum in generalized and segmental dystonia; and high-dose trihexyphenidyl in young patients with segmental and generalized dystonia. In order to move this field forward, we not only need better trials that examine the effect of current treatment interventions, but also a further understanding of the pathophysiology of dystonia as a first step to design and test new therapies that are targeted at the underlying biologic and neurophysiologic mechanisms.
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Affiliation(s)
- Cathérine C S Delnooz
- Radboud University Nijmegen Medical Centre, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, the Netherlands
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Ross AH, Elston JS, Marion MH, Malhotra R. Review and update of involuntary facial movement disorders presenting in the ophthalmological setting. Surv Ophthalmol 2010; 56:54-67. [PMID: 21093885 DOI: 10.1016/j.survophthal.2010.03.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 03/28/2010] [Accepted: 03/30/2010] [Indexed: 11/28/2022]
Abstract
We review the existing literature on the involuntary facial movement disorders-benign essential blepharospasm, apraxia of eyelid opening, hemifacial spasm, and aberrant facial nerve regeneration. The etiology of idiopathic blepharospasm, a disorder of the central nervous system, and hemifacial spasm, a condition involving the facial nerve of the peripheral nervous system, is markedly different. We discuss established methods of managing patients and highlight new approaches.
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Affiliation(s)
- Adam H Ross
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, Sussex, UK
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Borodic GE. Orbicularis oculi myo-osseous fixation: a new treatment for benign essential blepharospasm and blepharospasm associated with diffuse facial dystonia (meige syndrome). Ophthalmic Surg Lasers Imaging Retina 2010; 41:360-9. [PMID: 20507022 DOI: 10.3928/15428877-20100430-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This article describes a novel surgical procedure, myo-osseous fixation, as an adjunct therapy for patients with reduced or poor response to repeated botulinum toxin injections for essential blepharospasm and Meige syndrome. PATIENTS AND METHODS The small-incision, rapidly healing, rapidly performed technique uses self-drilling titanium screws tightly engaged with a compression wrench. The screws fixate the periorbital orbicularis oculi muscle to bone, creating mechanical resistance to outer portions of the orbicularis muscle involved in debilitating involuntary contractions. RESULTS Eleven of the treated 12 patients experienced immediate improvement in function. Each responding patient noted enhanced effect of subsequent botulinum toxin injections at previously ineffective doses. The benefit was substantial and sustained for 6 months in 9 of 12 patients. Decreased brow depression during forced closure, forced frown, and brow elevation at rest was apparent in all patients postoperatively. Although the brow elevation effect was reduced after 6 months, reduced brow depression during forced closure still was easily demonstrated in most patients. Complications included a nodular bump over the brow, more commonly found when large titanium screws were used, transient headache, and easily removed dislodged screw. CONCLUSION Initial data suggest that this procedure appears safe, well tolerated, and useful in the treatment of patients with essential blepharospasm and Meige syndrome responding poorly to botulinum toxin therapy.
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Affiliation(s)
- Gary E Borodic
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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14
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Patil B, Foss AJE. Upper lid orbicularis oculi muscle strip and sequential brow suspension with autologous fascia lata is beneficial for selected patients with essential blepharospasm. Eye (Lond) 2008; 23:1549-53. [PMID: 18927593 DOI: 10.1038/eye.2008.314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Severe cases of blepharospasm resistant to botulinum toxin represent a challenging clinical problem. Over the last 10 years, we have adopted a staged surgical management of these cases with an initial upper lid orbicularis myectomy (combined with myectomy of procerus and corrugator supercilius as appropriate) and then 4-6 months later a brow suspension with autologous fascia lata. The aim of this study was to assess the outcome of this staged surgical approach. MATERIALS AND METHODS A questionnaire was sent to all patients who had undergone the procedure and the clinical records reviewed. RESULTS Fourteen patients had undergone the procedure of which 13 were alive. They were sent a questionnaire and 10 of them responded. All had both procedures. Eight of the 10 reported great benefit from the surgery, one some benefit, and one was worse off. All patients still required botulinum toxin injections after the surgery. CONCLUSIONS Majority, but not all, of the patients in our series greatly benefitted from this staged surgical approach.
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:605-9. [DOI: 10.1097/aco.0b013e3282f355c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cetinkaya A, Brannan PA. What is new in the era of focal dystonia treatment? Botulinum injections and more. Curr Opin Ophthalmol 2007; 18:424-9. [PMID: 17700237 DOI: 10.1097/icu.0b013e3282be9032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The treatment options for the management of dystonias continue to evolve and improve. Clinical outcomes, however, are not predictably consistent using a single treatment regimen in all patients. RECENT FINDINGS Botulinum toxin is still considered the best treatment option for the treatment of focal dystonias: blepharospasm, hemifacial spasm, and apraxia of eyelid opening. New findings indicate that physicians may be a little more aggressive with the dosage when the disease progresses. A new formulation of botulinum toxin has been produced that includes no proteins and may address the immunoresistance that can occur with prolonged use. Additional systemic medications may be helpful as adjuncts only in selected cases. Improved surgical techniques are now more successful and cause fewer complications. Therefore, many refractory cases are now offered a surgical approach alone or in combination with botulinum toxin. SUMMARY There have been recent therapeutic developments in the treatment of ocular dystonias.
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Affiliation(s)
- Altug Cetinkaya
- Department of Ophthalmology, University of Cincinnati, Cincinnati Eye Institute, Cincinnati, Ohio, USA.
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Bibliography. Current world literature. Pediatrics and strabismus. Curr Opin Ophthalmol 2007; 18:434-6. [PMID: 17700239 DOI: 10.1097/icu.0b013e3282f0361d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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