Dear Dr. Roach: I have blepharospasm (eye twitching, for those who have never heard of it). It鈥檚 terrible. I鈥檓 58 and have had it for 10 years, but it has gotten worse as I鈥檝e gotten older. Are there ANY treatments other than Botox that you have heard of? I鈥檝e read all that鈥檚 on the Internet, but have found no help or remedies.
B.S.
Blepharospasm is a localized form of dystonia, a movement disorder with repeated or sustained muscle contractions. In your case, it鈥檚 the muscles of the eyelid that repeatedly contract, and though I see it frequently, the cases I see generally are mild and go away after a few days.
I鈥檝e never seen a case as bad as you have described, but my sources clearly recommend botulinum toxin (Botox and others) for people with more severe blepharospasm. This bacterial toxin prevents muscles from contracting, and most people have benefit that lasts many years.
Since you specifically ask about other treatments, I have read about the use of deep-brain stimulation, and have read case reports and a small series of six patients who showed a 72 percent improvement in their symptoms. 聽
Oral medications usually are not effective, but there may be benefit from L-dopa-type drugs, from anticholinergic drugs (such as trihexyphenidyl) and from baclofen. All these have significant potential side-effects. 聽
The site blepharospasm.org is very helpful, with links to support groups and questions answered by clinicians with specific experience in this issue.
Dear Dr. Roach: In a recent column, you mentioned the use of topical steroid medications to treat rhinitis (stuffy nose) symptoms. I have had vasomotor rhinitis since I was very young (I am 84), and my doctor prescribed fluticasone (Flonase). Some time after starting to use it, I began having frequent nosebleeds. I did not connect the two until I happened to see the side- effects on the National Institutes of Health website. I stopped the fluticasone, and within a week or two the nosebleeds stopped completely. 聽
When I told my primary physician about this, he looked surprised, but after looking it up, confirmed that nosebleeds are a side-effect of fluticasone.
Since this seems not widely known, I thought your readers should be informed of this complication. My doctor suspects that other steroid nasal sprays likely would have the same effect.
G.D.T.
You are quite right that nosebleeds are a frequent side-effect of nasal sprays, and they sometimes lead to discontinuation of the product.
Fluticasone is poorly absorbed and very potent, relative to other steroid sprays.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
