Twelve cases of drug-induced blepharospasm improved within 2 months of psychotropic cessation

Figures & data

Table 1 Demographic data for twelve patients with psychotrophic-induced blepharospasm

Patient number	1	2	3	4	5	6	7	8	9	10^Table Footnote#	11^Table Footnote#	12^Table Footnote#
Age	45	60	36	65	67	69	57	58	63	61	76	68
Sex	F	F	M	F	F	F	F	F	F	F	F	F
Duration from the onset of blepharospasm to when the diagnosis was made (months)	4	12	3	9	2	4	24	42	1	24	3	1
Jankovic rating scale* at the initial presentation	3	3	3	3	3	3	3	3	2	3	3	3
Jankovic rating scale* after the dose reduction	1	0	0	0	0	1	1	0	0	0	1	0
The difference of the scale above	2	3	3	3	3	2	2	3	2	3	2	3
Prescribed psychotropics**	Clonazepam alprazolam brotizolam triazolam paroxetine	Diazepam quetiapine	Etizolam alprazolam diazepam sulpiride paroxetine	Brotizolam	Etizolam amoxapine	Etizolam	Etizolam	Bromazepam	Zolpidem	Clotiazepam zolpidem	Etizolam brotizolam	Alprazolam zolpidem triazolam paroxetine
Period of psychotropic medication (months)	24	60	9	36	12	120	45	60	3	108	66	24
Psychiatric diagnoses	Insomnia anxiety depression	Insomnia anxiety depression	Insomnia anxiety depression	Insomnia	Anxiety depression	Insomnia	Insomnia anxiety	Insomnia	Insomnia	Insomnia depression	Insomnia depression	Insomnia anxiety depression
Duration from the dose reduction to the improvement of blepharospasm (weeks)	1	1	4	8	2	3	8	4	1	3	8	4

Notes:

* There was no dominant side. Severity of blepharospasm was assessed using the rating scale developed by Jankovic: 0; none, 1; noticeable, 2; mild, 3; moderate, 4; severe.⁶

** Drugs in bold and italics; withdrawn drugs.

# The patients underwent single botulinum neurotoxin injection.

Table 2 Overview of the twelve patients

Mean age	60.4 (36–76)
Sex	11 F and 1 M
Mean duration from the onset of blepharospasm to when the diagnosis was made (months)	10.8 (1–42)
Jankovic rating scale* at the initial presentation	3:11 pts, 2:1pt
Jankovic rating scale* after the dose reduction	1:4 pts, 0:8 pts
Difference of the scale above	3:7 pts, 2:5 pts
The most prescribed psychotropics	Etizolam brotizolam alprazolam zolpidem
Mean period of psychotropic medication (months)	47.3 (3–120)
Mean duration from the dose reduction to the improvement of blepharospasm (weeks)	3.9 (1–8)

Notes:

* There was no dominant side. Severity of blepharospasm was assessed using the rating scale developed by Jankovic: 0; none, 1; noticeable, 2; mild, 3; moderate, 4; severe.⁶

Abbreviations: F, female; M, male.

Figure 1 Clinical course of twelve cases of psychotrophic-induced blepharospasm. After cessation, symptoms started to improve in 3.9 weeks on average (range 1–8 weeks). While the effect of the cessation was variable, symptoms improved to more than 2 on the Jankovic scale within 2 months in all cases.

*Cases 10 and 11 received a single botulinum neurotoxin injection 4 weeks after psychotropic cessation (▾), and Case 12 received an injection 8 weeks before the cessation.

Notes: The underlined number in italics indicates the case number.

JankovicJOrmanJBotulinum A toxin for cranial cervical dystonia: A double-blind, placebo-controlled studyNeurology19873746166233561773

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