Treatment of Benign Essential Blepharospasm and Idiopathic Hemifacial Spasm with Vimpat® (Lacosamide)
Published on: 2015-12-21
Background:Benign essential blepharospasm and hemifacial spasm are currently treated with botulinum toxin therapy, eyelid protractormyectomies, and microvascular decompression of the facial nerve or pharmacologic therapies including anticonvulsants.Because of limited treatment success in some patients, another treatment option is needed. Methods:Lacosamide (Vimpat®), a novel anticonvulsant released in 2008 for the treatment of partial-onset seizures, was used to treatnine patients. Four patients had hemifacial spasm and four were diagnosed with benign essential blepharospasm. A ninthpatient had both benign essential blepharospasm and hemifacial spasm. Lacosamide selectively enhances the slow inactivation of voltage-gated sodium channels resulting in stabilization of hyperexcitable neuronal membranes and inhibition of repetitiveneuronal firing. Results:Lacosamide provided rapid and significant relief of hemifacial spasm and benign essential blepharospasm at doses ranging from50 mg bid to 200 mg bid. The symptomatic relief has been sustained in all patients over a period of years. Conclusions:Lacosamide provided effective symptomatic relief in nine patients with either hemifacial spasm or benign essential blepharospasm. Our experience suggests that lacosamide is a potentially valuable adjunct in the management of these conditions. Nevertheless,the long-term efficacy of lacosamide in hemifacial spasm has yet to be determined.