BLEPHAROSPASM - PAST, PRESENT, AND FUTURE

To investigate causes, associations, and results of treatment with ble pharospasm, 1,653 patients were evaluated by extensive questionnaires to study blepharospasm and long-term results of treatment with the ful l myectomy operation, botulinum-A toxin, drug therapy, and help from t he Benign Essential Blepharospasm Research Foundation (BEBRF). The per cent of patients improved by the BEBRF was 90%, full myectomy 88%, bot ulinum-A toxin 86%, and drug therapy 43%. The patient acceptance rate for the BEBRF was 96%, full myectomy 82%, botulinum-A toxin 95%, and d rug therapy 57%. Blepharospasm is multifactorial in origin and manifes tation. A vicious cycle and defective circuit theory to explain origin and direct treatment rather than a defective specific locus is presen ted. All four forms of therapy evaluated are useful and must be tailor ed to the patient's needs. Mattie Lou Koster and the BEBRF have helped blepharospasm sufferers more than any other modality, and all patient s should be informed of this support group. The full myectomy is reser ved for botulinum-a toxin failures, and the limited myectomy is an exc ellent adjunct to botulinum-A toxin.