Posted by ed_uk on November 25, 2004, at 13:29:49
In reply to Re: Lou's response to Jeroen-obtaining the article-B, posted by Jeroen on November 25, 2004, at 13:15:26
Your life is not over. You're young, so even if it is TD it will probably improve in time. Anyway, blepharospasm can be treated, your neurologist can tell you more. Botox is one of the treatments for blepharospasm. Here is some information about Botox (botulinum toxin)......
The symptomatic treatment of blepharospasm and hemifacial spasm.
There are over 20,000 known patients with adult onset focal dystonias in the UK. These dystonias are characterised by uncontrolled muscle spasm leading to involuntary movements of the eyes (blepharospasm), face (hemifacial spasm) and other parts of the body. In most cases no cause is apparent and it has been estimated that two thirds of patients have not been treated successfully.
Drug treatment, surgery, hypnosis, biotherapy and physiotherapy have all been used to manage blepharospasm with variable success. In hemifacial spasm surgery is successful in more than 90% of patients but is obviously associated with certain risks.
Botulinum toxin has been used investigationally for many years for a variety of neurological disorders associated with inappropriate muscle contractions or spasms. Trials have generally been uncontrolled and conducted in a small number of patients.
In the treatment of blepharospasm botulinum toxin injected subcutaneously into the obicularis oculi muscle around each eye is associated with improvement in 70-80% of patients. In 30% of these patients the condition is resolved completely, in the remainder a return of useful vision, without complete abolishment of the blepharospasm occurs.
In the treatment of hemifacial spasm, botulinum toxin is again injected into the obicularis oculi muscle and any other affected facial muscles. Careful and precise siting of the injectioin is likely to be important. Temporary relief is seen in over 90% of patients although some patients remain troubled by an almost invisible residual spasm.
Long term efficacy over 7 years in both these conditions has been demonstrated.
Following injection most patients report local swelling and bruising around the injection site. Mild ptosis is seen in about 50% of patients and lasts 2-3 weeks, lacrimation and irritration are also common. Complete failure of eye closure can occur and pending recover may require protective measures.
Overdose can result in generalised weakness. General supportive care is advised with respiratory support if necessary. The antitoxin is not a reliable antidote.
No useful economic data on the treatment of focal dystonias with botulinum toxin is apparent in the literature. Quality of life issues have also not been addressed.
Botulinum toxin is effective in the treatment of both blepharospasm and hemifacial spasm. Administration should be performed by those with a thorough knowledge of the anatomy and pathophysiology of the condition being treated, with experience of selecting and administering the appropriate dose and managing potential adverse effects. It is not therefore suitable for general prescribing in general practice.