Long-term efficacy of neural circuit blockade for treating blepharospasm: a retrospective case series study

Background: Blepharospasm is a common symptom of Meige syndrome and often leads to functional blindness. Although current treatment options, such as oral medications, botulinum toxin injections, resection of periocular muscles, and deep brain stimulation, are available, no definitive method effectively eliminates blepharospasm. Objective: To address this unmet need, we developed a novel approach-neural circuit blockade (NCB). This study aimed to analyse its long-term efficacy for blepharospasm. Methods: NCB eliminates trigeminal nerve stimulation by facial expression muscles, reducing the production and input of sensory information, weakening feedback-based and plastic motor information functions, decreasing orbicularis oculi muscle tension, and alleviating blepharospasm. A retrospective analysis was conducted on 570 patients who underwent NCB treatment, with a median postoperative follow-up of 51 months. Therapeutic efficacy was evaluated by comparing preoperative and postoperative scores on the Shorr blepharospasm grading scale, Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-M), and Blepharospasm Disability Index (BSDI). Results: Based on the Shorr grading scale, preoperatively, 97.9% of patients were grade 4, whereas 2.1% were grade 3. Postoperatively, 87.5% achieved complete remission (grade 0), whereas 7.4, 3.7, 0.9, and 0.5% were grades 1, 2, 3, and 4, respectively. Pre- and postoperative BFMDRS-M scores significantly differed: eye (8.0 vs. 0.0), mouth (3.0 vs. 0.0), speech/swallowing (3.0 vs. 2.0), neck (3.0 vs. 1.5), and total (8.0 vs. 0.0). BSDI scores also significantly differed pre- and postoperatively. The results indicate that NCB effectively alleviates blepharospasm and addresses the lack of a definitive treatment, without causing severe local or systemic complications such as facial paralysis. Conclusion: NCB can safely and effectively alleviate blepharospasm, improve quality of life, and demonstrate stable long-term efficacy.