Is blepharospasm associated with Multiple Sclerosis (MS)?

Association Between Blepharospasm and Multiple Sclerosis

Yes, blepharospasm can be associated with multiple sclerosis (MS), particularly in cases of relapsing-remitting MS, which is the most common cause of secondary paroxysmal dyskinesias including blepharospasm. 1

Pathophysiological Basis

Blepharospasm in MS patients is related to specific demyelinating lesions affecting key brain structures:

• The lesions of MS related to movement disorders typically involve the thalamus, lenticular nucleus, globus pallidus, and internal capsule 1
• These demyelinating lesions may result in increased axon sensitivity that causes symptoms such as blepharospasm 1
• The pathophysiology appears similar to that of essential blepharospasm, involving increased excitability of brainstem interneurons 2

Clinical Significance

When blepharospasm occurs in MS patients:

• It may present as part of a broader spectrum of movement disorders in MS 3
• It can sometimes be the presenting symptom, aiding in early diagnosis of MS 3
• Recognition is important as blepharospasm is a treatable feature in MS, which is otherwise often difficult to manage 2

Diagnostic Considerations

When evaluating a patient with blepharospasm:

• Consider MS as a potential underlying cause, particularly if other neurological symptoms are present 4
• Blepharospasm may occur in isolation or in combination with other facial dystonic movements (segmental craniocervical dystonia) 5
• In patients with known MS who develop blepharospasm, a positive response to a canalith repositioning procedure (CRP) has been documented in studies 1

Neuroimaging Findings

• MRI is the gold standard for MS diagnosis and can help identify the demyelinating lesions responsible for blepharospasm 1
• Lesions in the rostral brainstem have been specifically associated with bilateral blepharospasm in MS patients 4
• Brain volume changes on MRI can provide additional information about disease progression in MS patients who may develop movement disorders like blepharospasm 1

Management Approach

For MS patients with blepharospasm:

• Treatment should target both the underlying MS and the blepharospasm symptoms
• Medical treatment has been reported as helpful in some patients with MS-related blepharospasm 4
• In refractory cases, surgical interventions such as selective facial nerve procedures may be considered 4
• A multidisciplinary approach involving neurologists with expertise in both MS and movement disorders is often beneficial 3

Clinical Pitfalls and Caveats

• Don't miss a diagnosis of MS-related blepharospasm by attributing it solely to other causes
• Be aware that blepharospasm in MS may be more refractory to treatment than idiopathic forms
• Remember that blepharospasm can significantly impact quality of life, potentially causing functional blindness if severe 6
• Consider that MS patients often have multiple comorbidities that may complicate the diagnosis and management of blepharospasm 1

Understanding the association between blepharospasm and MS is crucial for proper diagnosis and management, as addressing this treatable symptom can significantly improve quality of life in patients with this otherwise challenging neurological condition.