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Blepharospasm – Botulinum Toxin — SCE Neurology MCQ

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EasyMovement DisordersBlepharospasm – Botulinum ToxinSCE Neurology

A 48-year-old woman presents with episodic involuntary sustained contraction of the right eyelid causing eye closure (blepharospasm). It is bilateral, worsened by bright light and stress, and absent during sleep. There are no other neurological abnormalities. What is the first-line treatment?

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Correct answer: D — Botulinum toxin A injections to the orbicularis oculi

Blepharospasm is a focal dystonia characterised by involuntary bilateral (though it may start unilaterally) closure of the eyelids due to spasmodic contraction of the orbicularis oculi. Botulinum toxin A injection into the orbicularis oculi is the first-line treatment, providing relief for 3–4 months per cycle. A: Oral anticholinergics are second-line. C: Baclofen has limited efficacy. D: DBS is reserved for severe refractory generalised dystonia. E: Diazepam is not effective.

Reference: ABN Dystonia Guidelines; NICE IPG76 Botulinum Toxin for Dystonia