Neurology - Botulinum toxin injections for Blepharospasm

About botulinum toxin injection for Blepharospasm

This is when the muscles around the eye are overactive and go into spasm. The condition usually affects both eyes. There may be excessive blinking or twitching of the eyes or prolonged closure of the eyes. It is believed to be the result of abnormal functioning of the basal ganglia, a small area deep within the brain which is involved in the control of movement.

To date, no cure has been found. Many drugs have been tried, and while some may provide benefit for some individuals, none is universally effective

Botulinum toxin injections, which weaken the muscles affected by spasm, are the most effective treatment. The effect of the injection lasts for two to three months only, and repeated injections are often necessary for continued relief.

In cases where little improvement results from the injections, it may be because different muscles need to be targeted, or the dose needs adjusting.

It may not be possible to stop the spasm completely.

Before your procedure

A neurologist will review you in the outpatient’s department. The procedure will be discussed, and a decision will be made on the site and number of injections that are required.

Details of your medical history will be taken, if necessary, a clinical examination and investigations will be carried out. This is a good opportunity for you to ask any questions about the procedure or any concerns you may have.

You will be asked if you are taking any prescribed medication, or any tablets bought over the counter in a pharmacy. It helps if you bring your tablets to the appointment.

The procedure does not involve the use of a general or local anaesthetic, and you do not need to fast.

Botulinum toxin is not a suitable treatment if you are pregnant, breast feeding or “trying” for a baby.

If you are taking any blood thinning medication (anticoagulants) please let your consultant or specialist nurse know as special precautions may need to be undertaken.  These include: Warfarin, Dabigatran, Apixaban, Rivaroxaban.

If you are having botulinum toxin injections for any other condition/reason you must let your consultant or specialist nurse know.

The procedure is performed in the clinic and takes approximately five to ten minutes.

During the procedure

The initial set of injections will be given by the consultant neurologist. Once the response to the injections is apparent the doctor may refer you to one of the Dystonia Nurses for further injections.

You will be reclined on a couch or seated in a chair for the injections around your eye/eyes.

Depending on the severity of the spasm, small doses of botulinum toxin are injected just under the skin into the muscle surrounding the eye/eyes at 2-4 sites.

The exact dose will vary dependent on your response to previous treatments.

After three to four days the injection will usually start to work causing a temporary weakness to the muscles around the eye, which relieves the symptoms of spasm for approximately two to three months.

After the procedure

When can you leave hospital?

After the procedure you will be able to return home, back to normal activities.

When can you resume normal activities including work?

Most people who have had this procedure can resume normal working activities immediately after their injections.

Special measures you need to take after the procedure:

None, but try to avoid touching or rubbing the site that has been treated.

Follow-up

Before you leave the clinic, you will be given details of your next appointment. This is usually in 3-4 months’ time. If you have any tests performed your consultant will inform your coctor of the results. These results will be discussed on your return visit.

You will be given the contact details of the Dystonia Nurse in case you have any problems, questions, or concerns regarding your treatment.

If you are unable to make your next appointment for any reason, please contact the Dystonia Nurse to make alternative arrangements.

Alternative procedures that are available

Many drugs have been tried, but while some of these may provide benefit for some individuals, none is universally effective.

Possible side effects of the botulinum toxin injections

Following the procedure, most individuals with eye spasm experience relief from their symptoms. However, side effects may occur, usually wearing off within a few days or weeks.

Potential side effects include the following:

• Occasionally bruising may develop around the injection site
• Sometimes the muscles around the eye become weaker than expected following your injection. Occasionally you may experience drooping of the eyelid and rarely double vision. The excessive weakness will resolve as the effects of the toxin in the muscle starts to wear off
• Botulinum toxin contains human albumin which comes from human blood. As with any medicine which is created from human blood there is a possibility of passing on infections. To reduce this risk, blood donors are chosen very carefully. Furthermore, botulinum toxin is made in a way that should remove or destroy viruses. This may be of importance to Jehovah’s witness’ when considering treatment
• On rare occasions flu like symptoms, headaches, fever and feeling tired may occur
• Occasionally patients can develop antibodies against the toxin. Antibody formation is more likely to form with high doses of botulinum toxin and if it is administered before a 12-week interval. If your body builds up antibodies to the botulinum toxin it will no longer work

Information and support

There are leaflets about the condition and botulinum toxin available at your appointment.

If you have any questions or anxieties, please feel free to discuss them with the consultant or Dystonia Nurse. Further information is also available from:

Dystonia UK
Telephone: 020 7793 3651
Website: www.dystonia.org.uk
There is a local branch of the dystonia society. This gives you an ideal opportunity to meet other people with dystonia.

For details you can contact:
Chris Smith - 0845 899 7131

Your consultant Neurologist is:

Your Dystonia Nurses are:

Diane Ashton - Telephone: 0161 206 2562
Email: diane.ashton@nca.uk

Marco Silingardi
Email: marco.silingardi@nca.nhs.uk

Jemela Danjuma - Telephone: 0161 206 5100
Email: jemela.danjuma@nca.nhs.uk