Concluded Case

Sudden onset Cervical dystonia with blephrospasm

35/M painter by occupation came with c/o unable to keep eyes open with frequent blinking of eye (as much as that would interrupt daily activities) associated with continuous head nodding. Developed 1 year back with sudden onset and slowly progressive No h/o any trauma, fever, DM, Hypertension, Long term use of any medication. Normal Ophthalmological examination. Patient was diagnosed with blephrospasm with cervical dystonia... And was managed with several periorbital inj botox but without any improvement in blephrospasm 1) How would one explain the relation between cervical dystonia with blephrospasm. 2) Management of patient both for cervical dystonia as well blephrospasm?@

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Your 1st question. Blepharospasm and cervical dystonua are two familiar manifestations of primary dystonia. BLEPHAROSOASM & Cervical dystonia may occur in isolation or as part of more extensive anatomical involvement as segmental,multifocal or generalized dystonia.Also dystonia of cervical region may involve contiguous or non contiguous area( eye & upper face +/ lower face) +/ ( jaw and tongue)+/ larynx+/ tongue+/ neck. 2) your 2nd part. Oral pharmacotherapy.Treatment include Benzodiazipine ,tetrabenazine,anticholinergic agents,analeptic( modafinil),dopamine agonist( pramipexole),levodopa & muscle relaxant. Botulinum toxin A injection. Blepharospasm is difficult to treat , typically requiring myomectomy and substantial doses of botulinum toxin injection in to the pretarsal orbicularis ocular muscle.

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Blephrospasm is caused by abnormal brain function in the part of the brain that controls that muscles It can also be triggered by stress and being overly tired .or they can be triggered by neurological condition incudingTourette syndrome or Parkinsonism Blephrospasm can be controlled by inj Botuline CERVICAL DYSTONIA—most of the people cause is unknown, some people have family history due to gene mutation Also sometimes linked to head and neck or shoulder injuries Best medicine for cervical dystonia is Baclophen

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Your 1st question. Blepharospasm and cervical dystonua are two familiar manifestations of primary dystonia. BLEPHAROSOASM & Cervical dystonia may occur in isolation or as part of more extensive anatomical involvement as segmental,multifocal or generalized dystonia.Also dystonia of cervical region may involve contiguous or non contiguous area( eye & upper face +/ lower face) +/ ( jaw and tongue)+/ larynx+/ tongue+/ neck. 2) your 2nd part. Oral pharmacotherapy.Treatment include Benzodiazipine ,tetrabenazine,anticholinergic agents,analeptic( modafinil),dopamine agonist( pramipexole),levodopa & muscle relaxant. Botulinum toxin A injection. Blepharospasm is difficult to treat , typically requiring myomectomy and substantial doses of botulinum toxin injection in to the pretarsal orbicularis ocular muscle.

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