Abstract
Objective
To examine the efficacy and safety of medical cannabis in benign essential blepharospasm (BEB).
Methods
This is a prospective, double-blind, placebo-controlled study. All consecutive adult BEB patients who had been treated with BTX-A injections without success between 3/2019 and 2/2020 were recruited. The study patients were randomly allocated into a treatment and a control (placebo) group in a 1:1 ratio. The treatment group used cannabis drops and the control group used cannabis oil drops during the first 6 weeks of the study, and both groups were treated with the medical cannabis drops during the second 6 weeks. The cannabis dose was gradually increased for each patient depending upon effect and tolerability.
Results
Three patients were included in each group (treatment and control groups). The mean duration of spasm attack during the first 6 weeks was 4.29 min in the treatment group and 73.9 min in the placebo group (P < 0.01). During the last 6 weeks, the treatment group used an average of 6.27 drops and the placebo group used an average of 5.36 drops (P = 0.478). There were 61 spasm events in the treatment group and 94 spasm events in the placebo group (P = 0.05). The mean duration of spasm attack was 1.77 and 8.96 min, respectively (P < 0.01). The side effects were mild, and they included general fatigue, dry mouth, and insomnia.
Conclusions
Medical cannabis can be an effective and safe treatment for BEB as a second line after BTX-A injections when used for 3 months. No significant ocular or systemic side effects was associated with the treatment.
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References
Elston JS, Marsden CD, Grandas F, Quinn NP (1988) The significance of ophthalmological symptoms in idiopathic blepharospasm. Eye (Lond) 2(Pt 4):435–439
Scott AB, Kennedy RA, Stubbs HA (1985) Botulinum A toxin injection as a treatment for blepharospasm. Arch Ophthalmol (Chicago, Ill 1960) 103:347–50
Kraft SP, Lang AE (1988) Botulinum toxin injections in the treatment of blepharospasm, hemifacial spasm, and eyelid fasciculations. Can J Neurol Sci 15:276–280
Mauriello JA, Dhillon S, Leone T et al (1996) Treatment selections of 239 patients with blepharospasm and Meige syndrome over 11 years. Br J Ophthalmol 80:1073–1076
Ben Simon GJ, McCann JD (2005) Benign essential blepharospasm. Int Ophthalmol Clin 45:49–75
Karp BI, Alter K (2016) Botulinum toxin treatment of blepharospasm, orofacial/oromandibular dystonia, and hemifacial spasm. Semin Neurol 36:84–91
Obermann M, Yaldizli O, De Greiff A et al (2007) Morphometric changes of sensorimotor structures in focal dystonia. Mov Disord 22:1117–1123
Yen MT (2018) Blepharospasm and hemifacial spasm. Int Ophthalmol Clin 58:1
Green KE, Rastall D, Eggenberger E (2017) Treatment of blepharospasm/hemifacial spasm. Curr Treat Options Neurol 19(11):41. https://doi.org/10.1007/s11940-017-0475-0
Basavarajappa BS, Shivakumar M, Joshi V, Subbanna S (2017) Endocannabinoid system in neurodegenerative disorders. J Neurochem 142:624–648
Benbadis SR, Sanchez-Ramos J, Bozorg A et al (2014) Medical marijuana in neurology. Expert Rev Neurother 14:1453–1465
Joshi N, Onaivi ES (2019) Endocannabinoid system components: overview and tissue distribution. In: Advances in Experimental Medicine and Biology. Adv Exp Med Biol, pp 1–12
Benarroch E (2007) Endocannabinoids in basal ganglia circuits: implications for Parkinson disease. Neurology 69:306–309
Chatterjee A, Almahrezi W, Fitzcharles, (2002) A dramatic response to inhaled cannabis in a woman with central thalamic pain and dystonia [3]. J Pain Symptom Manage 24:4–6
Uribe Roca MC, Micheli F, Viotti R (2005) Cannabis sativa and dystonia secondary to Wilson’s disease. Mov Disord 20:113–115
Kluger B, Triolo P, Jones W, Jankovic J (2015) The therapeutic potential of cannabinoids for movement disorders. Mov Disord 30:313–327
Gauter B, Rukwied R, Konrad C (2004) Cannabinoid agonists in the treatment of blepharospasm-a case report study. Neuroendocrinol Lett 25:45–48
Ronan PJ, Wongngamnit N, Beresford TP (2016) Molecular mechanisms of cannabis Signaling in the brain. Prog Mol Biol Transl Sci 137:123–147
Devinsky O, Cilio MR, Cross H et al (2014) Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia 55:791–802
Radke PM, Mokhtarzadeh A, Lee MS, Harrison AR (2017) Medical cannabis, a beneficial high in treatment of blepharospasm? An early observation. Neuro-Ophthalmology 41:253–258
Kichloo A, Albosta M, Aljadah M et al (2021) Marijuana: a systems-based primer of adverse effects associated with use and an overview of its therapeutic utility. SAGE Open Med 9:20503121211000908
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The study funded by Tikun Olam, Israel.
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The study was approved by the local institutional review board (IRB) of the Sheba Medical Center.
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Zloto, O., Weisman, A., Avisar, I. et al. Medical cannabis oil for benign essential blepharospasm: a prospective, randomized controlled pilot study. Graefes Arch Clin Exp Ophthalmol 260, 1707–1712 (2022). https://doi.org/10.1007/s00417-021-05533-1
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DOI: https://doi.org/10.1007/s00417-021-05533-1