Developments in the Treatment of Benign Essential Blepharospasm

Michael T. Yen

Disclosures

Curr Opin Ophthalmol. 2018;29(5):440-444. 

In This Article

Oral Pharmacotherapy

Over the years, many oral medications have been reported to be beneficial in managing BEB; however, the effect is usually temporary, varies from patient to patient, and generally lacks long-term effectiveness. Although chemodenervation remains the preferred first-line treatment, oral pharmacotherapy can also be considered as an adjunct to other treatment modalities. Several classes of medications have been reported to be effective including dopaminergics, gamma-Aminobutyric acid (GABA) agonists, and anticholinergics.[10]

Dopamine deficiency has been implicated in BEB and other forms of dystonia. Dopamine agonists and dopamine uptake inhibitors have been reported to be effective in improving eyelid spasm control in BEB. Particularly, methylphenidate, which blocks presynaptic dopamine and norepinephrine reuptake and acts as a central nervous system stimulant, has been reported to reduce eyelid spasms and decrease disability scoring in BEB.[11,12] In the United States, methylphenidate is a schedule II controlled substance and does have the potential for abuse; therefore its use in BEB should be closely monitored.

GABA agonists, such as benzodiazepines, have been used in BEB patients for many years. These medications have sedating, anxiolytic, antiepileptic, and muscle relaxing properties. Although studies have shown partial responses to treatment with benzodiazepines, the main side effect is drowsiness which limits its desirability. Other side effects include ataxia, dizziness, and fatigue.[10]

Anticholinergics are a commonly used class of medications in BEB, although documented results are variable. Although some patients may report significant response, it is often transient and unpredictable. A significant side effect profile includes confusion, sedation, and hallucinations often limit patient tolerance to this treatment.[10]

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