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The History Of Blepharospasm In Medicine

Eric B. Hamill, M. T. Yen
Published 2018 · Medicine

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In 1857, the Scottish ophthalmologist Sir WilliamMacKenzie published a case report describing a young female patient admitted to the Glasgow Asylum for the Blind with intractable “spasmodic closure of the eyelids so intense that, with the strongest effort of her will, she was unable to open here eyes in the slightest degree.”1 Although he knew little about the underlying pathogenesis, he speculated that the disease might have a psychosomatic component and hypothesized that the condition could be relieved by a sedative. Why not try chloroform? This inhaled anesthetic first synthesized less than a decade earlier was gaining popularity in the nascent field of surgical anesthesia. His results were profound. It took only a few treatments with inhaled chlorofrom to dampen her blink reflex and dramatically improve her symptoms for weeks. “She was,” he observed after treatment, “able to walk without being led and [see] everything around her, a striking contrast to the state of eclipse in which she had been.” His patient, as is known today, suffered from benign essential blepharospasm (BEB), a focal facial dystonia characterized by involuntary spasmodic closure of the periocular protractor muscles affecting approximately 30 of every 100,000 persons.2 Its root cause remains unknown but a simplistic schema places the problem within a defective blink reflex. Stimuli such as bright light, ocular surface irritation, pain, or emotional stress short-circuit the central control center, which likely lies within the basal ganglia.3,4 From here, these impulses are then translated into an exaggerated blink response via the facial nerve nucleus to muscles such as the orbicularis oculi, corrugator, and procerus. The result is a disfiguring and often disabling disease without cure that can significantly impair activities of daily living. Many BEB patients develop an aversion to social interaction and, if untreated or not responsive to treatment, become depressed or suicidal.5,6 Although MacKenzie may not have been the first to document BEB, as some attribute this to the 16th century Dutch painter Peter Brueghel
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