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TITLE OF CASE

Standalone successful ayurvedic management of blepharospasm - a case report

Dr Anupama Deopujari

ABSTRACT

A 57-year-old female patient complained of repeated blinking of the right eye associated with dryness of the eye, difficulty in concentrating gaze and difficulty in reading since 7 years. At the onset of symptoms, she had consulted an allopathic doctor. As suggested by the allopathic doctor, an MRI Brain was done that did not reveal any anomaly and Acetylcholine Aeceptor Antibody test yielded non-significant results. The biomedical diagnosis was made as Blepharospasm based on the clinical evaluation. She underwent standard of care for 2 years, but the condition persisted. After a gap of 5 years, she decided to try Ayurvedic treatment. She approached Dr Anupama Deopujari. Based on clinical evaluation, the biomedical diagnosis was confirmed as Blepharospasm, and the ayurvedic diagnosis as Nimesha vyadhi. The line of treatment followed was vatanashaka, mamsabalavardhaka and balya. Formulations to strengthen the mamsa dhatu were included in the treatment. With one month of treatment, the complaint of dryness reduced, and blinking slightly reduced. With one month of treatment, the complaints of dryness reduced, and blinking slightly reduced. After 1 year and 8 months of treatment, there was a significant reduction in blinking frequency and the deviation of gaze was reduced. The dryness of eyes was completely cured and there was significant improvement in reading capacity. This case report demonstrates the successful ayurvedic management of a chronic case of blepharospasm in a 57-year-old female, who did not get relief inspite of taking standard of care for 2 years. 

KEYWORDS

Blepharospasm, nimesha vyadhi, blinking, akshitarpana, case report, Standalone

INTRODUCTION

Blepharospasm is a neurologic disorder that causes uncontrollable muscle movements that causes the eyelids to close or have difficulty opening (dystonia). This can affect patients’ ability to see. It's a rare disease and can be difficult to diagnose. Approximately 2,000 people are diagnosed with it each year. 

Symptoms and causes: Researchers are still working to confirm its cause. Blepharospasm may be due to abnormal electrical activity in the basal ganglia, structures deep within the brain that help control movement. Usually people get blepharospasm in middle age, but it can occur at any age. Sometimes dry eye may look like blepharospasm so it is important to get medical advise. Certain medications can cause blepharospasm. People with certain medical conditions can get blepharospasm. These conditions include: 

General dystonia. 

Meige syndrome. 

Tardive dyskinesia. 

Wilson's disease. 

In the early stages, you may have frequent blinking and the symptoms come and go. You’ll experience them during the day, and they’ll go away while you are sleeping. As the disease progresses, they become more severe with fewer periods of relief. 

The general symptoms are as follows: Constant blinking, Dry eyes, Eye narrowing, Tired, Irritated eyes and Difficulty keeping your eyes open. 

Diagnosis; Medical history and clinical evaluation are the main diagnostic criteria. There are no laboratory tests to confirm the diagnosis of Blepharospasm.

Treatment: Oral medications including drugs that block involuntary muscle movements (anticholinergics), but their effect is usually limited. 

Botulinum toxin injections, which weaken the eye muscles’ ability to twitch. Botulinum toxin is one of the most effective treatments for blepharospasm. There are several variations available. Surgery (myectomy), a procedure to remove part or all of the overactive eye muscles. The most common and most effective treatment is botulinum toxin. Medications are effective in a small number of people. But they often cause side effects such as memory problems, drowsiness and dry mouth.

Prognosis: It depends on the severity of your symptoms and response to therapy. When blepharospasm is not improved with medical therapy, surgery may be indicated.

PATIENT INFORMATION

In this case report, a 57-year-old female patient complained of repeated blinking of the right eye associated with dryness of the eye, difficulty in concentrating gaze and difficulty in reading since 7 years. In spite of taking standard of care for 2 years, the condition persisted.

No relevant family/genetic/surgical/psychosocial history.

CLINICAL FINDINGS

Samanya pariksha, sroto pariksha were done. 

Samanya Parikshana

Nadi - Vata Pitta Pradhan

Mala - Samanya

Mutra - Samanya

Jihwa - Niram

Sparsha – Koshna

Druk – Vartma chalan aniyantrit, Using Spects.

Akruti - Krush

Prakruti – Vata Pittaja

Sara - Asara

Samhanana – Madhyam

Satva – Madhyam

Abhyavaharana – Prakrut

Sharira Bala – Madhyam

Srotas Parikshana

Majjavaha Strotas and Netra Indriya – Repeated involuntary movements of right eyelid

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; Based on the clinical examination, previous MRI and ACHR reports (not submitted, but obtained from the Doctor’s notes), the biomedical diagnosis was confirmed as Blepharospasm. 

Video 1. Video of the patient before treatment dated 19.11.2021

https://youtube.com/shorts/-Ul4T_tdHPs

Image 2. MRI Brain and Serum ACHR report findings from Doctor’s Notes

Ayurvedic Assessment was done based on the presenting complaints and clinical evaluation. The treating physician confirmed the Ayurvedic diagnosis as Nimesha Vyadhi. 

Differential Diagnosis- Eyelid myokymia, Secondary to ocular irritation, Secondary to meningeal irritation, Tardive dyskinesia, Meige syndrome, Facial tics, Hemifacial spasm, Cerebral palsy, Focal seizures. In this case report, based on the previous treatment records and clinical findings the physician diagnosed the condition as blepharospasm

Prognosis- 90% of the patients improve symptomatically with botulinum injections, although continued injections are necessary. In this patient, in spite of taking the standard of care, the condition progressed in such a way that, the patient is unable to temporarily open his eyelids. With Ayurvedic treatment, frequent and rapid blinking reduced. After 6 months of treatment, the patient could fully open his eyelids and noted

THERAPEUTIC INTERVENTION

Refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

The patient had 4 follow ups in total, with a time gap of 1 year and 8 months. 

Subjective parameters: 

Clinician-based assessment; With one month of treatment, the complaint of dryness reduced, and blinking slightly reduced. After 1 year and  8 months of treatment, there was a significant reduction in blinking frequency and the  deviation of gaze was reduced. The dryness of eyes was completely cured and there was significant improvement in reading capacity.

Video 1. Video of the patient, after treatment dated 15.7.2023 

https://youtu.be/Shs5cbetB_4?si=tqPNMItwoaves5QI

Patient-assessed; Not relevant.

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- Subjective and objective parameters were the main assessment tools. 

Adverse and unanticipated events; None reported

DISCUSSION: 

Blepharospasm is a neurologic disorder that causes uncontrollable muscle movements that causes the eyelids to close or have difficulty opening (dystonia). This can affect patients’ ability to see. It's a rare disease and can be difficult to diagnose. 90% of the patients improve symptomatically with botulinum injections, although continued injections are necessary. In this patient, the disease had a history of 7 years, out of 2 years, the patient had taken allopathic medicines. She did not get relief. The next five years, she did not take any treatment, and after this gap of time, she decided to try Ayurveda. The line of treatment followed was vatanashaka, mamsabalavardhaka and balya. Formulations to strengthen the mamsa dhatu were included in the treatment.  

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case report demonstrates the successful standalone ayurvedic management of chronic Blepharospasm in a patient who was not getting satisfactory relief inspite of standard of care for 2 years.

INFORMED CONSENT

Written consent obtained from patient for publishing of the case report in the Portal 

ACKNOWLEDGEMENTS

None

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. https://my.clevelandclinic.org/health/diseases/21546-blepharospasm