Benign essential blepharospasm (BEB) is a functionally disabling focal dystonia. Botulinum
neurotoxin (BoNT) therapy is suboptimal in many BEB patients. Repetitious transcranial
magnetic stimulation (rTMS) therapy is a promising noninvasive therapy and has shown positive
benefits in BEB. rTMS therapy can be easily combined with BoNT injections to enhance the
effects of BoNT in BEB.
A two week course of rTMS therapy to achieve sustained benefits will be employed. With
standard BoNT treatment, the peak-dose benefits are seen at about 4-6 weeks after the
administration of injections. rTMS will be introduced during this peak-dose period (about 6
weeks after BoNT or T1).The effects of combined therapy at about 10 weeks after BoNT
injections (T2) and at about 12 weeks after BoNT injections (T3) will be examined along with
the physiological effects at these time points.
- subjects diagnosed with blepharospasm or cranio-cervical dystonia who receive BoNT
therapy at the Center for Movement Disorders will be approached. The investigators
will enroll only those subjects who report experiencing positive benefits with BoNT
but lasting about 10 weeks or less.
- active seizure disorder
- significant cognitive impairment
- exposure to neuroleptics
- presence of a metallic body such as pacemaker, implants, prosthesis, artificial limb
or joint, shunt, metal rods and hearing aid.