General Questions with Answers Provided by Different Medical Practitioners and Sources
Respondents:
Various Medical Practitioners and Sources
Questions:
- What is the difference between focal and segmental blepharospasm?
- Does apraxia of eyelid opening always occur with blepharospasm or can it occur without it?
- Can there be a breathing dimension with dystonia?
- Is writer's cramp always severe cramping?
- I have a sniffing problem. Can you explain that?
- If you have blepharospasm are there any issues of concern for cataract surgery?
- Is the prevalence of blepharospasm increasing or are we just recognizing it more readily?
- What about glaucoma and blepharospasm?
- My doctor is trying to tell me that my blepharospasm is psychological. I developed it after a motor vehicle accident which resulted in multiple brain stem issues such as nerve palsy and convergence insufficiency. Is it possible it is psychological?
- What happens when a person switches lenses from dark to light?
- I have more difficulty on cloudy days and get some relief on sunny days. Why is this?
- I have been taking botulinum injections for blepharospasm for a number of years with good results. I became aware of a slight tremor in my right arm, which has increased very slowly and has been diagnosed as benign essential tremor. Is there a connection between blepharospasm and essential tremor? Can it be treated with toxin injections?
- Are blepharospasm patients more predisposed to Meige?
- Is there any indication that Lasik surgery could contribute to blepharospasm?
- Do geographic differences affect the incidence of blepharospasm?
- I sometimes have trouble swallowing. Could this be attributable to my Meige?
Q. – What is the difference between focal and segmental blepharospasm?
A. – Focal involves only the eyelids. Segmental blepharospasm is the term for blepharospasm combined with dystonia of a contiguous body part, such as the lower face, larynx or other body part.
Q. – Does apraxia of eyelid opening always occur with blepharospasm or can it occur without it?
A. – It is not always linked with blepharospasm. Apraxia of eyelid opening can occur with supranuclear palsy, Parkinson's disease or strokes. Blepharospasm is probably the most common condition associated with apraxia of eyelid opening.
Q. – Can there be a breathing dimension with dystonia?
A. – There may be diaphragm spasms. Segmented dystonia sometimes result in shortness of breath.
Q. – Is writer's cramp always severe cramping?
A. – There is always a spectrum, minor versus major; meaning that there is a lot of variability. Most cases are sporadic. It can be mild, as all of us experience some cramping after long periods of writing. It is the most common in a variety of action dystonia, such as musicians' cramps.
Q. – I have a sniffing problem. Can you explain that?
A. – Many patients have a tendency to do a lot of sniffing and involuntary movements in the upper airway. Meige syndrome shows us that you can have dystonia in more than one place. The dystonia may be more generalized than we realize. We cannot use BOTOX® for it but you might try an oral medication. Many children with Tourette's get tics, like sniffing and/or clearing throat. However, you may consider another diagnosis, particularly with a younger patient.
Q. – If you have blepharospasm are there any issues of concern for cataract surgery?
A. – You do not want to be squeezing after surgery, putting pressure on the wound. Try to have the surgery when your blepharospasm symptoms are under reasonable control. Time your cataract surgery 3 – 6 weeks after the last botulinum toxin shots.
Q. – Is the prevalence of blepharospasm increasing or are we just recognizing it more readily?
A. – There really is no evidence since no one has done any epidemiological studies until recently.
Q. – What about glaucoma and blepharospasm?
A. – Though not related to blepharospasm it can occur in a patient that has blepharospasm. It is very important to take your drops to treat the glaucoma, though some are irritating, Although the drops can cause disturbance on the external surface and conjunctiva of the eye, you need to take your drops because it is a very serious eye disease.
Q. – My doctor is trying to tell me that my blepharospasm is psychological. I developed it after a motor vehicle accident which resulted in multiple brain stem issues such as nerve palsy and convergence insufficiency. Is it possible it is psychological?
A. – As a physician who has seen a number of patients misdiagnosed with “psychogenic blepharospasm,” my knee jerk reactions is NO, but without a thorough evaluation, it is not responsible to provide this answer. However, a trial with a large series of patients with dystonia, including blepharospasm, was recently published by the European Dystonia Study Group. In this trial, risk factors in the blepharospasm subset included history of head or face trauma with loss of consciousness, family history of dystonia, and family history of postural tremor.
Based on these findings, it is quite likely that you have blepharospasm that is not “psychogenic” in origin. Furthermore, MRI abnormalities in the brainstem and thalamus have been correlated with the development of blepharospasm.
Q. – What happens when a person switches lenses from dark to light?
A. – One problem with dark lenses is that you really darken out. What happens is that when you go out into the light, it is even brighter. This is retinal adaptation. Your retina is not ready for light. If you wear dark glasses all the time, you will 'dark adapt'. We recommend wearing the lightest tint you can so that you do not dark adapt too much.
Q. – I have more difficulty on cloudy days and get some relief on sunny days. Why is this?
A. – We do not understand it. Blepharospasm is usually worse on sunny days.
Q. – I have been taking botulinum injections for blepharospasm for a number of years with good results. I became aware of a slight tremor in my right arm, which has increased very slowly and has been diagnosed as benign essential tremor. Is there a connection between blepharospasm and essential tremor? Can it be treated with toxin injections?
A. – Based on our long-term experience, it is believed that patients with blepharospasm are much more likely to have co-existent essential tremor. There are many effective medications for ET and you need to consult your physician about the treatments.
Q. – Are blepharospasm patients more predisposed to Meige?
A. – Yes, though most people do not progress. Blepharospasm in some people, about 8 – 10%, will progress to involve the lower part of the face and/or voice. Nothing we now know can prevent the progression.
Q. – Is there any indication that Lasik surgery could contribute to blepharospasm?
A. – We have no studies or evidence that it does.
Q. – Do geographic differences affect the incidence of blepharospasm?
A. – A number of epidemiological studies suggest different prevalence rates. However, in general it is believed that the reasons for the differences are more methodological than anything else, including geographic location. Studies are hard to do and biases are introduced that give rise to different results.
Q. – I sometimes have trouble swallowing. Could this be attributable to my Meige?
A. – It very well could, but I would suggest you have a swallowing test so dysphagia can be ruled out.
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