Treatment of Blepharospasm/Hemifacial Spasm

Abstract

The treatment of both hemifacial spasm (HFS) and blepharospasm (BEB) requires making the appropriate clinical diagnosis. Advance imaging and electrophysiologic studies are useful; however, one's clinical suspicion is paramount. The purpose of this review is to summarize current and emerging therapies for both entities. Botulinum toxin (BTX) remains the first-line therapy to treat both conditions. If chemodenervation has failed, surgery may be considered. Due to the risks associated with surgery, the benefits of this option must be carefully weighed. Better surgical outcomes are possible when procedures are performed at tertiary centers with experienced surgeons and advanced imaging techniques. Microvascular decompression is an efficacious method to treat HFS, and myectomy is an option for medication-refractory BEB; the risks of the latter may outweigh any meaningful clinical benefits. Oral agents only provide short-term relief and can cause several unwanted effects; they are reserved for patients who cannot receive BTX and/or surgery. Transcranial magnetic stimulation has gained some traction in the treatment of BEB and may provide safer non-invasive options for refractory patients in the future.

Postmarketing safety surveillance data reveals antidepressant effects of botulinum toxin across various indications and injection sites

“…As these conditions are chronic and burdensome, they are associated with secondary psychiatric comorbidities like depression, which are prevented by the relief in the primarily treated condition (e.g. for blepharospasm there is no really coequal oral medication 56 ). A specific antidepressant effect of BoNT may be overestimated in these conditions because of differential relief from the burden of disease between the BoNT and the control group.…”

Postmarketing safety surveillance data reveals protective effects of botulinum toxin injections against incident anxiety

“…This may include relief from pain, which is a symptom of some of the investigated indications, especially migraine. However, superior efficacy and tolerability is not a unifying explanation of our findings either, because in the blepharospasm indication, in which it is the most effective treatment, there is no protective effect of BoNT against anxiety, but rather an anxiogenic tendency 60 . This also applies for the other indications in which BoNT did not show a protective effect against anxiety.…”

Management of Visual Dysfunction in Patients with Parkinson’s Disease

“…Traditional interventions (not PD-specific) to ease symptoms include treatment of blepharitis with lid hygiene, and dry eye with artificial tears, moisture chambers, nutritional supplements, scleral lenses and tear duct occlusion [ 11, 12 ] and interested readers are referred to an excellent review detailing diagnosis and treatment of dry eye in general, including level of evidence for particular treatments [ 13 ]. Blepharospasm responds to botulinum toxin injection of the eyelids [ 14 ].…”