[Blepharospasm; results of treatment with botulin].
OBJECTIVE
Discussion of clinical symptoms and differential diagnosis of blepharospasm and treatment with botulinum A toxin. Blepharospasm is an involuntary spasmodic contraction of the eyelids. Within a few years 35%-70% of the patients becomes severely disabled.


METHODS
Prospective, open study.


METHODS
Academical Medical Centre, Amsterdam.


METHODS
In the period 1985-1992 we have seen 85 patients with blepharospasm. Of these 69 were treated with botulinum toxin, a total of 436 treatments, with a mean dose of 25 IU for each eye.


RESULTS
The cause of blepharospasm was unknown in 71 patients. Secondary blepharospasm occurred in: peripheral facial palsy (one patient), herpes zoster infection of the trigeminal nerve (2), brain infarct (1), use of neuroleptics (2), progressive supranuclear palsy (2), Shy-Drager syndrome (1), kernicterus (1), and morbus Sjögren (4). There were 18 patients with autoimmune diseases. 77 (91%) patients had a (very) severe form of blepharospasm. Electromyographic registration revealed a dysfunction of M. levator palpebrae in 7 patients. More than 70% of the patients were free of symptoms for a mean period of two months after each treatment. Local side effects were seen in 61 (14%) of the 436 treatments: ptosis, haematoma, dry eyes, and diplopia.


CONCLUSIONS
Blepharospasm is a disabling disease and occurs sometimes in association with other neurological and ophthalmological diseases. Botulinum A toxin is a safe and effective therapy. Electrophysiological investigation is important in the differential diagnosis; it is unnecessary to do CT or MRI routinely.
Aramideh
M
M
Onderzoeksschool Neurowetenschappen, Academisch Medisch Centrum, Amsterdam.
Devriese
P P
PP
Ongerboer de Visser
B W
BW
Brans
J W
JW
Speelman
J D
JD
D000368:Aged; D001764:Blepharospasm / Q000188:drug therapy* / Q000209:etiology; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D001905:Botulinum Toxins
Blefarospasme; resultaten van behandeling met botuline.