Dear Dr. Roach: I have been contending with blepharospasm for years. I听got some relief from Botox for about four years, but then it stopped working and my doctor moved me to Dysport, which was horrible. It did not relax my symptoms, and it made me constantly very uncomfortable (with a feeling that my eyes were swollen all the time). I stopped the treatments and was able to cope, until six months ago. I am almost unable to read, look at a computer screen or drive. Do you have any suggestions? I use Ativan to try to relax the stress of the blinking, but even that has lost its effect. I have been discouraged from getting a limited myectomy because of the risks. My ophthalmologist said that a neurologist would be a waste of time. I am desperate for another opinion. B.B.
Blepharospasm is an uncontrollable muscle spasm around the eyes, often causing blinking and twitching. It ranges from occasional and mild to the more severe and disabling condition you report.
Treatment with botulinum toxin is effective for most people. Botulinum toxin, directly injected into muscle, weakens or paralyzes the muscle. There are three types of botulinum toxin A currently available in the United States: Botox, Dysport and Xeomin, as well as botulinum toxin B (Myobloc). I suspect your ophthalmologist changed brands because of concern about antibodies your body听may have developed to the Botox.
I would never say that a听neurologist would be a听waste of time. Blepharospasm is a limited form of dystonia, and neurologists are the experts in dystonia. The neurologist will have an opinion on trying a different form of botulinum toxin, as well as other treatments.
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Dear Dr. Roach: My sister was diagnosed with gestational trophoblastic neoplasia. What is it?
A.C.
Gestational trophoblastic disease is a type of tumour that comes from cells of the placenta, the structure that normally supports a developing pregnancy. The most common GTD is called a hydatidiform mole. This type of tumour occurs when two sperm fertilize an egg that has no female chromosomes (a complete mole) or half the normal amount (a partial mole). These are tumours, not a normal pregnancy, although it appears to be a normal pregnancy at first. The diagnosis is made by ultrasound, and there is a blood test (beta HCG) that leads to suspicion. They are usually treated surgically with a dilatation and curettage (D and C).
Gestational trophoblastic neoplasias are similar to hydatidiform moles, but are considered cancers, since they have the potential to spread. Choriocarcinomas and placental trophoblastic tumours are similar cancers, also related to abnormal fertilization events, not normal pregnancies. Fortunately, these cancers are usually cured by chemotherapy. A gynecologic oncologist is the expert in treating this condition.
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Dr. Roach regrets he can鈥檛 answer individual letters, but will incorporate them in the column when possible. Email [email protected]
