Das Krankheitsbild des Blepharospasmus gravis, Ursache und neuartige Behandlung mit Langzeitergebnissen*

Abstract

The etiology of essential blepharospasm is extraordinarily manifold and still not clarified in many instances. The therapeutic possibilities are equally manifold and not always satisfactory. A new method of surgical intervention consists in the dissection of the zygomaticotemporal nerve shortly after its separation from the stem of the facial nerve. In 10 cases with particularly severe blepharospasm, a permanent therapeutic result which was satisfactory in every respect was achieved in collaboration with an otorhinolaryngologist. For the ophthalmologist and otorhinolaryngologist a knowledge of the various therapeutic possibilities is important in order to adjust treatment accordingly.

The Facial Nerve

“…-House grading scale [6, 10, 18] -House-Brackman facial nerve grading system [5] -Portmann's classification [3] -Photographs [2,3,5,6,9,II,14] -Video [6,10] -Lines drawn on the face [7] -Psychological questionaire [19] Granger's evaluation method [II] -Seven-grade scale [11] -Nerve excitability test [16] As an effective intervention the following were mentioned: exercise therapy [2,3,7,11,17,19,20], biofeedback [5][6][7]10], massage [2,3,11,17,20] low-frequency electrotherapy [II,20], ultrasound [13,18], heat application [20], and magneto-therapy [9].…”

“…Previous experiments with denervated striated skeletal muscles indicated that a necessary prerequisite for the effectiveness of electrostimulation treatment are isometric muscle contractions and a certain muscle tension prior to the application of electric current [5,7,II,13,16,17,18]. These results suggested that electrostimulation therapy can only have limited or no effect at all on mimic muscles, because they cannot perform isometric contractions since they do not insert in bone.…”

“…As shown e1ectrophysiologically in cats, the early reflex response is conveyed via a three-neuronal disynaptic pathway [27.]. Morphologically, STN connections with the bulbar reticular formation (RF) [24] and RF interneurons projecting to the FN [II,25] have been shown. Efferent motor fibers activate the orbicularis oculi muscle, resulting in closure of the eye.…”

“…Following peripheral nerve fiber degeneration, regeneration in general tends to be vigorous, although it depends to a large extent on blood vessels and blood supply, the surrounding connective tissue elements, including specialized fibroblasts and perineurial cells, and on various other conditions such as the type of the lesion (see [II,17]), the species [7], and the age of the individual [18]. A number of local and distant, distal (peripheral) and proximal (central), factors are also of importance, e. g., nerve growth factors (see [6]), increased polyamines [15], local receptors, and the availability of adequate end drgans and central synaptic connections (see [19]).…”

“…Depending on the variety of the function of facial muscles, these representation areas vary greatly in size in different species [5,II]. 2.…”