Botox® - reduces muscle spasms

Heidi Jarecki, MD
Ophthalmology
Chippewa Valley Eye Clinic
Eau Claire

Our Facial dystonias are a broad group of disorders characterized by abnormal, involuntary movements of the facial muscles. While many of us have experienced a “twitchy” eyelid when very tired or stressed, individuals with benign essential blepharospasm (BEB), a form of facial dystonia, suffer from repeated involuntary spasms of the muscles around both eyelids. A variety of causes can lead to spasms in the face including medications (like clozapine and risperidone), tumors or lesions in the brain and spinal cord, and past trauma. A thorough medical history and physical are needed before BEB can be diagnosed.

LEFT: PATIENT EXPERIENCING INVOLUNTARY EYE MUSCLE SPASMS PRIOR TO TREATMENT RIGHT: BOTOX INJECTIONS REDUCES CONTRACTION OF EYE AREA MUSCLES AND RELATED SPASMS

First reported in 1870, BEB usually begins with increased blinking and/or eye irritation. Certain environmental, physical and social factors such as bright lights, fatigue and stress may make the symptoms worse. With time, eyelid spasms or chronic, forceful eyelid squeezing may develop. A small percentage of individuals with BEB will be unable to open their eyelids even when spasms are not active. Other signs and symptoms may include a drooping lid or a dry eye sensation. BEB affects women more frequently than men (approximately a 2:1 ratio), with symptoms appearing in those in their 50s and 60s, though it has been diagnosed in individuals as young as 10 and up into the 90s. While symptoms may begin on one side, BEB is always bilateral. Spasms of the midface (cheek area) may accompany eyelid spasms, a variant known as Meige syndrome. If the lower face and neck are involved as well, the disorder is known as Brueghel’s syndrome. BEB tends to be a progressive disorder with approximately 80% of individuals affected developing Meige or Brueghel’s syndrome over time.

The precise cause of BEB is unknown, though there is evidence suggesting dysfunction of a part of the brain called the basal ganglia. The basal ganglia work in the coordination of movements. Conditions that exacerbate BEB spasms include bright light, fatigue, emotional stress, driving, television watching, and perhaps caffeine use. Sleep, artificial tears, relaxation, looking downward, talking, whistling, singing or humming may improve symptoms. Unfortunately, BEB is disabling and nearly two thirds of individuals with BEB are unable to drive and a third are unable to work.

Treatment for BEB begins with conservative measures such as tinted glasses, artificial tears, treatment of any disease of the eye surface, and stress management. Approximately 25% of individuals with BEB will be helped to some degree by medication. Neuromuscular retraining, a form of biofeedback, has also been tried to redirect the energy of the spasm.

Botulinum toxin (Botox® or Myobloc™) injections, approved by the Food and Drug Administration in the treatment of BEB in 1989, are considered the first line treatment as 90% of patients will have improvement with this therapy. Botox® works by relaxing the muscles and decreasing the strength of the muscle contractions in the area where it is administered. Treatments need to be repeated approximately every three to four months to maintain their effect. For individuals who have persistent symptoms despite regular Botox® treatments, surgical options can be examined. Removing portions of the eyelid and eyebrow muscles reduces spasm intensity by decreasing the bulk and strength of the muscles directly involved in the spasm. Other surgeries, such as lifting the eyelid, may also be employed to alleviate the involuntary eyelid closing.

BEB is a chronic problem. Regardless of the severity of an individual’s symptoms, the benefit of information and support groups, such as is provided through the Benign Essential Blepharospasm Research Foundation, can be invaluable to the patient in understanding the disorder and learning to cope with its affects.

For more information or to schedule an appointment with Dr. Jarecki, Chippewa Valley Eye Clinic, call 715.832.8471 or visit www.cv-eye.com. Dr. Jarecki sees patients in Eau Claire and Bloomer.