title: Treatment of blepharospasm with apraclonidine.
abstract: OBJECTIVE
  To describe improvement in blepharospasm with apraclonidine.
  
  
  BACKGROUND
  Blepharospasm is a focal dystonia involving chiefly the orbicularis oculi and periocular muscles resulting in involuntary sustained eyelid closure. Botulinum toxin injection is the mainstay of treatment with meaningful improvement in over 85% of patients, but the effects often wear off within 3-4months. Apraclonidine is an alpha-2 adrenergic receptor agonist, which causes contraction of superior tarsal (Müller) muscle which may improve blepharospasm-related eyelid closure. We propose that apraclonidine may be a useful short-term treatment in patients with blepharospasm, particularly during wearing off from botulinum toxin injection.
  
  
  METHODS
  Patients who had pre-mature wearing off of botulinum injection effect were evaluated before and after the administration of 2 drops of apraclonidine 0.5%-1% solution to each eye. Subjective patient impressions and examiner's impression of symptoms pre and post-apraclonidine administration were recorded. A blinded rater evaluated the videos and provided an independent assessment of the severity of symptoms pre- and post-administration, using a 0-4 scale.
  
  
  RESULTS
  Our study included 7 patients (4 male) with a mean age of 61years and mean duration of blepharospasm of 3.6years. There was a subjective, albeit transient (about 2-4h) improvement in blepharospasm reported by all patients and by the examiner. The mean severity scores, based on blinded video ratings, showed a reduction from of 3.4 pre-administration to 2.3 post-administration of apraclonidine (p<0.025). No adverse effects were noted.
  
  
  CONCLUSIONS
  Apraclonidine is a potentially useful medication for short term management of blepharospasm symptoms while awaiting botulinum toxin injection.
authors.affiliation: Parkinson's Disease Center and Movement Disorder Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Dhanya
authors.initials: D
authors.lastname: Vijayakumar
authors.affiliation: Parkinson's Disease Center and Movement Disorder Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Subhashie
authors.initials: S
authors.lastname: Wijemanne
authors.affiliation: Parkinson's Disease Center and Movement Disorder Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States. Electronic address: josephj@bcm.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Jankovic
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D000368:Aged; D001764:Blepharospasm / Q000188:drug therapy*; D001905:Botulinum Toxins / Q000627:therapeutic use; D003000:Clonidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000627:therapeutic use
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D009498:Neurotoxins; C016986:apraclonidine; D001905:Botulinum Toxins; D003000:Clonidine
keywords: Apraclonidine; Blepharospasm; Botulinum toxin