Du Hai-ying, Yu Xing-yuan

1 Ophthalmology Department, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310006, China

2 Ophthalmology Department, Dongfang Hospital Affiliated to Beijing University of Traditional Chinese Medicine, Beijing 100078, China

Clinical Observation on Aligned Needling in Treating Idiopathic Blepharospasm

Du Hai-ying1, Yu Xing-yuan2

1 Ophthalmology Department, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310006, China

2 Ophthalmology Department, Dongfang Hospital Affiliated to Beijing University of Traditional Chinese Medicine, Beijing 100078, China

Objective: To observe the clinical effect of aligned needling method in treating idiopathic blepharospasm.

Methods: Seventy-eight patients with idiopathic blepharospasm were randomized into two groups. Forty-six cases in the treatment group were treated with aligned needling method applied to orbicularis oculi muscles; 32 cases in the control group were treated with anticonvulsants. Therapeutic effects were compared after 3 treatment courses.

Results: The total effective rate was 93.5% in the treatment group versus 75.0% in the control group, and the difference was statistically significant (P＜0.05).

Conclusion: Aligned needling method applied to orbicularis oculi muscle has better therapeutic effect than anticonvulsants in treating blepharospasm.

Acupuncture Therapy; Needling Methods; Blepharospasm

Idiopathic blepharospasm refers to an ophthalmological disease characterized by intermittent or persistent involuntary closure of bilateral or unilateral eyelids, and the subsequent functional blindness in some severe cases may lead to loss of living ability[1]. The causes of the disease remain unclear, though some researches claim that blepharospasm should result from abnormal function of brain basal ganglia and consequent excessive electrical activity of the 7th cerebral nerves (facial nerves) and local dystonia. Middle-aged and elderly people usually run a high risk of the disease. With the aging of our society, the incidence of blepharospasm is increasing year by year. We have treated 46 cases of idiopathic blepharospasm by applying aligned needling to orbicularis oculi muscles, and compared it to the treatment of another 32 cases with conventional medication. The report is now given as follows.

1 Clinical Materials

Seventy-eight patients with idiopathic blepharospasm (88 eyes) were enrolled, all from the outpatients and inpatients of our hospital. Of the subjects, 27 cases were male and 51 cases were female; aged between 26 and 68 years old, with an average age of 43 years old; disease duration ranged from 3 d to 5 years; 10 cases had both eyes affected, and 68 with single eye affected. They were randomized into a treatment group and a control group. Of the 46 cases in the treatment group, there were 16 males and 30 females, with age averaged at 42; of the 32 cases in the control group, there were 11 males and21 females, with age averaged at 41. There were no significant differences between the two groups in comparing gender and age data (P＞0.05), hence they were comparable.

The clinical flow chart is shown in Fig.1.

Fig.1 Processing flow chart in the two groups

2 Treatment Methods

2.1 Treatment group

Acupoints: Ashi points, Hegu (LI 4), Fengchi (GB 20), Baihui (GV 20), Cuanzhu (BL 2), Sizhukong (TE 23), and Taiyang (EX-HN 5).

Operation: Ashi points were selected from the spastic orbicularis oculi muscles and treated with filiform needles of 25 mm in length by aligned needling. Needles were inserted subcutaneously with a distance of 0.3 cm between each two needles. According to the affected area size of the orbicularis oculi muscles, 2-3 rows of needles may be used, with 5 needles in each row. Because of the rich vessels around eyelids, needling should be performed swiftly to avoid vessel arches of the upper and lower lids and the happening of ecchymoma. Hegu (LI 4) and Fengchi (GB 20) were needled by filiform needles with reducing technique after qi arrival, and for the rest acupoints, even reinforcing-reducing manipulations were adopted. The treatment was given once a day, but twice a day for severe cases, and the needles were retained for 30 min each time.

2.2 Control group

Patients in the control group were given oral administration of Benzhexol Hydrochloride tablets at 2 mg, Baclofen tablets at 5 mg, tid. Clonazepam was added when it’s necessary at 1-2 mg, once per night.

For both groups, 10-day treatments were considered as a treatment course, and 3 courses were given in total. An over 3-month follow-up study was conducted among all subjects.

2.3 Observation index

The subjects were graded according to the spasm severity of the eyelids.

Grade 0: No spasm.

Grade 1: Increased blinking due to external stimuli.

Grade 2: Mild spasm. Slight shivering of eyelids, without functional disorder.

Grade 3: Moderate spasm. Obvious convulsion of eyelids, with mild functional disorder.

Grade 4: Severe spasm. Severe spasm of eyelids and obvious functional disorder, affecting work and life.

3 Observation on Therapeutic Effects

3.1 Criteria of therapeutic effects

Cured: Spasm severity decreases to grade 0.

Marked relief: Spasm severity decreases by 2-3 grades.

Partial relief: Spasm severity decreases by 1 grade.

Failure: Spasm severity remains unchanged or even becomes exaggerated.

3.2 Treatment result

The total effective rate was 93.5% in the treatment group versus 75.0% in the control group, and the difference between the two groups was statistically significant (P＜0.05), suggesting that the treatment effect of the treatment group should be better than that of the control group (table 1).

Table 1. Comparison of clinical effect (case)

3.3 Case study

A female patient, 46 years old.

Chief complaint and present medical history: Spasm of eyelids has been 5 years, beginning with occasional onset, like 1-2 times a month and lasting for 1-2 d each time. It has been gradually exaggerated over the 5 years. The patient once repeatedly received Botulinum Toxin-A injection to orbicularis oculi muscles in a Western medicine hospital, but only achieved a remission of 2-3 months each time after injection. When she came to visit, both upper eyelids showed spastic drooping, and the palpebral fissure was 3 mm at the primary position of eye.

Diagnosis: Severe blepharospasm.

Treatment procedure: Aligned needling method was applied to orbicularis oculi muscles, and meanwhile, ordinary filiform needling was applied to Fengchi (GB 20), Baihui (GV 20), Cuanzhu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5), and Hegu (LI 4). The treatment was given twice a day, and needles were retained for 30 min each time. After a 1-month treatment, the patient had obvious relief from symptoms, and the upper-eyelid edges were folding with corneal edges. She was cured after 3 treatment courses, and no relapse happened during the 2-year follow-up study.

4 Discussion

The onset of idiopathic blepharospasm involves with head trauma, being in touch with toxic substances, genetic factors, and mental pressure[2-3]. It often happens in the elderly, characterized by intermittent involuntary closure (remission after several seconds or minutes) or persistent involuntary closure of bilateral or unilateral eyelids. Currently, Botulinum Toxin-A injection, myectomy, and ganglion blocking are often adopted in treating this disease in Western medicine. Generally, dystonia responds well to medication, of which, anticholinergic drug is used the most widely and is effective. Benzhexol Hydrochloride is an antiparkinsonian drug, Clonazepam is an anticonvulsant, and Baclofen is a muscle relaxant. They all can relieve eyelid spasm, but with certain side effects. Botulinum Toxin-A can block the release of acetylcholine and reduce neuromuscular transmission, and subsequently relieve spasm. However, its high price restricts its application in clinic.

Traditional Chinese medicine (TCM) has given a description to blepharospasm in a quite early time, believing that it should be caused by internal wind produced by long-term blood deficiency of liver-spleen, deficiency of heart-spleen, insufficiency of qi and blood, and malnutrition of tendons and muscles. Females have a predilection to develop insufficient qi and blood, due to menstruation and delivery. Deficiency of heartspleen is often seen in intellectual workers because they think too much and consume and hurt qi and blood. Therefore, this disease often happens in middle-aged women and intellectual workers. The treatment principle should be to relax tendons and muscles and activate collaterals, and to tonify blood and expel wind[4].

Aligned needling is a special needling method in treatment of various musculature diseases in modern time. It’s a treatment method usually performed along the paths of the muscle regions of the twelve meridians with needles of different types and by selecting where the muscle region is running on face, limbs and trunk[5-7]. This needling method is better than the ordinary one in comparing the action of promoting activity of local meridian qi. When aligned needling is applied to orbicularis oculi muscles, the blood circulation around eyelids and the recovery of the function of affected nerves and muscles are promoted. Aligned needling is an effective approach in treating blepharospasm.

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Translator: Hong Jue

R246.82

A

Date: December 20, 2012

Author: Du Hai-ying, attending physician. E-mail: info@hztcm.net