Botulinum toxin for blepharospasm: challenges for rehabilitation nurses.

Blepharospasm is a chronic, progressive, involuntary spasmodic closure of the eyelids associated with abnormal facial and oromandibular movements. It is a neurologic disorder whose cause is unknown and whose pathophysiology is poorly understood. Without appropriate treatment, it can result in functional blindness and other disabilities. In the last decade, botulinum toxin has been found to be effective therapy for most individuals. The drug, which is given by local injection, has a denervation effect. It relieves symptoms for several months, allowing patients to resume their former lifestyles between treatments. This new therapy modality challenges rehabilitation nurses to bridge the gap between disabled persons in the community and this new technology. Casefinding, referrals, and patient education are among the interventions that can help meet this challenge. The major purpose of this article is to inform rehabilitation nurses about how to recognize the symptoms of neurologic blepharospasm and how to intervene to prevent disabilities that could result.

Blepharospasm, hemifacial spasm and the nurse's role.

Blepharospasm and hemifacial spasm are involuntary movement disorders that affect the facial muscles. They are classified as cranial dystonias. Their cause is unknown and the underlying pathophysiology is poorly understood. Both dystonias are more common in women than in men. It is the middle-aged group that is most frequently affected. Because of their high visibility, these disorders may cause considerable distress and embarrassment. Affected persons are often mistakenly considered to have psychiatric problems. In addition, both dystonias may result in severe disability. For example, the person with untreated blepharospasm may experience social isolation and functional blindness. Recently, therapy in the form of botulinum toxin became available in larger centers. Repeated injections of the toxin usually relieves symptoms and enable patients to resume a former lifestyle. Neuroscience nurses who are knowledgeable about cranial dystonias and the resources that are currently available can retard progression of disability and help restore the individual's quality of life. Informed neuroscience nurses can also play an important role in case-finding, counselling and referral. Two examples are presented in order to highlight some of the complexities inherent in the diagnosis and treatment of each type of cranial dystonia and to further clarify the nurse's role. These examples are based on the personal and professional experience of the authors.

Essential blepharospasm: nursing update.

Essential blepharospasm is a chronic, potentially disabling disorder for which there is no known cause or cure. The term blepharospasm derives from the Greek word 'blepharon' meaning eyelid and the word 'essential' implies unknown cause. In neurological literature blepharospasm is classed as a focal dystonia. Lack of recognition of the disease may cause patients to consult numerous physicians as well as acupuncturists, chiropractors, faith healers and others in an effort to find a cure to what they are sure is not just a psychological problem. Nurses who are knowledgeable about the disease entity can easily recognize the symptoms. They can also prevent disability by recommending appropriate professional help. Treatment for the control of symptoms has only recently become available. It is the purpose of this discussion to review current information about blepharospasm that has particular relevance for neuroscience nurses in their personal as well as professional lives.