Successful Treatment of Blepharospasm by Pallidal Neurostimulation

Tardive Blepharospasm May Respond to Bilateral Pallidal Deep Brain Stimulation

“…This is similar to reports of increasing benefit of pallidal DBS on dystonia over several months, which has been attributed to neuroplasticity changes that take place in the basal ganglia with time [13]. The effect of pallidal DBS is enduring for controlling blepharospasm, with our case having complete resolution of symptoms at 30 months follow-up and the case described by Santos et al having sustained benefit at 21 months [7]. Thus, tolerance to the programming parameters we employed was not observed at two and a half years post-DBS.…”

“…Santos et al reported in 2016 the first case of pallidal stimulation successfully done on focal blepharospasm, with their patient responding best to interleaving stimulation using pulse widths of 60–90 µsec and frequencies of 125–130 Hz [ 7 ]. This was soon followed in the same year by the report of Yamada et al of focal blepharospasm responding to bilateral pallidal DBS but at a very long pulse width of 450 µsec and frequency of 130 Hz [ 8 ].…”

“…However, some patients become resistant with chronic injections. Although 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 ]. We describe a case of tardive blepharospasm that responded long-term to bilateral pallidal DBS.…”

Unilateral pallidotomy for blepharospasm refractory to botulinum toxin injections

“…As the pathophysiology of blepharospasm is focal dystonia, pallidal surgery is expected to be effective. Bilateral GPi deep-brain stimulation for isolated blepharospasm was reported as an effective treatment [4] and, in Meige syndrome, pallidal surgery including a pallidotomy was frequently reported as effective [5,6]. For patients with blepharospasm refractory to BTX, an eyelid myectomy is a possible surgical treatment.…”

Intractable Blepharospasm Treated with Bilateral Pallidal Deep Brain Stimulation

“… 17 Reports of patients receiving DBS for isolated blepharospasm or primarily blepharospasm are rare. Santos et al 13 described pallidal stimulation for isolated blepharospasm, with loss of benefit unilaterally at 7 months postoperatively, which was attributed to a more laterally placed electrode in the GPe. Troubleshooting the electrode with interleaved programming resulted in 63% improvement in blepharospasm.…”