Acupuncture For Blepharospasm Case Report from a Online Article

Medical Acupuncture

A Journal For Physicians By Physicians

Volume 14 / Number 1

“Aurum Nostrum Non Est Aurum Vulgi”

 

Table of Contents On-line Journal Index

Acupuncture For Blepharospasm

Mahesh R. Dave,MD

OBJECTIVE

To describe the use of needle acupuncture and microcurrent therapy for treatment of blepharospasm.

KEY WORDS

Blepharospasm, Microcurrent Therapy, Acupuncture

INTRODUCTION

Blepharospasm is an ocular condition in which involuntary spasms or closure of the orbicularis occulimuscles may cause frequent eye blinking or even the inability to open the eye. Various treatments have been recommended, including botulinum toxin injections,1-4 myectomy,1 and drug therapy.1 Each therapy has its own success and limitations. For example, serious cases of necrotizing fasciitis5 and ptosis have been reported with botulinum toxin injections.

Blepharospasm, hemifacial spasm, Parkinson’s disease,6 and other dyskinesic-dystonic movement disorders may share pathways through basal ganglia structures. Acupuncture may offer an important avenue to approach blepharospasm7 and other movement disorders.8 A case of essential blepharospasm that did not respond to conventional ophthalmologic treatments is presented herein.

History

The patient was a 51-year-old woman who developed facial and eye twitches which gradually increased over 1 year. Gabapentin, propranolol, and cyclobenzaprine were ineffective; spasms worsened. An ophthalmologist injected botulinum toxin 4 times. Her symptoms improved mildly, but then the twitches became more significant. Her eye blinks and facial twitches worsened, and she lost peripheral vision.

Clinical Information

Findings of the physical examination were within normal limits. Results of laboratory testing were in the normal range, including com-

plete blood cell count, urinalysis, thyroid profile, and muscle enzymes. Tourette’s disorder was ruled out. The patient was not taking any preparations such as methylphenidate, amphetamines, antipsychotics, or illicit drugs (which can cause tics). The neurologic examination revealed ocular and some facial twitches. The patient’s cranial nerves were intact and Bell’s palsy was ruled out.

TREATMENT

Treatment included needle acupuncture of ST 2, 3; SI 18; TE 22; LI 3; GB 34; and Extra Meridian points (Yin-Tang, GV 20 + shishenkong). Microcurrent therapy was administered on the right side of her face at 5 and 80 Hz, working with certain groups of facial muscles. Kidney channel tonification also was performed.9,10

Outcome

Patient consent was obtained and the patient tolerated all procedures well. There were no adverse effects. Total time span of treatment was slightly less than 2 months. The patient showed >95% improvement, sustained after 3 months of no further treatments.

CONCLUSION

Acupuncture can be an effective treatment in difficult cases of blepharospasm, particularly when partial paralysis of ocular muscles due to botulinum toxins is responsible for continuation of blepharospasm. Acupuncture may offer an important avenue for the treatment of certain movement disorders. Further research is necessary and desirable into the effectiveness of acupuncture for this condition.

REFERENCES

Anderson RL, Patel BC, Holds JB, Jordan DR. Blepharospasm: past, present, and future. Ophthal Plast Reconstr Surg. 1998;14:305-317.

Carruthers A. Update on botulinum toxin. Skin Therapy Lett. 1999;4:1-2.

. Boghen DR, Lesser RL. Blepharospasm and hemifacial spasm. Curr Treat Options Neurol. 2000;2:393-400.

Mezaki T, Kaji R, Brin MF, et al. Combined use of type A and F botulinum toxins for blepharospasm: a double-blind controlled trial. Mov Disord. 1999;14:1017-1020.

Latimer PR, Hodgkins PR, Vakalis AN, Butler RE, Evans AR, Zaki GA. Necrotising fasciitis as a complication of botulinum toxin injection. Eye. 1998;

12(pt 1):51-53.

Young R. Update on Parkinson’s disease. Am Fam Physician. 1999;59:2155-2167, 2169-2170.

. Nepp J, Wenzel T, Kuchar A, Steinkogler FJ. Blepharospasm and acupuncture: initial results of a treatment trial [in German]. Wien Med Wochenschr. 1998;148:457-458.

Jayasuriya A. Clinical Acupuncture. 7th ed. New Delhi, India: B. Jain Publishers Ltd; 1998:458, 477.

Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture Publishers; 1995.

Helms JM. Acupuncture for Physicians Course and Handbook. Bethesda, Md; January 1999.

AUTHOR INFORMATION

Dr Mahesh Dave specializes in Adult and Child Psychiatry, Addiction Medicine, and Forensic Psychiatry in Bryan, Texas.

Mahesh R. Dave, MD*

1201D Briarcrest Dr

Bryan, TX 77802

Phone: 979-776-5600 • Fax: 979-776-6280 • E-mail: mana@tca.net

*Address all correspondence and reprint requests regarding this article to Mahesh Dave, MD, at the address above.