Blepharospasm and periorbital edema after imatinib mesylate: improvement with botulinum toxin

Hélio A. G. TEIVE; Francisco M. B. GERMINIANI; Renato P. MUNHOZ; Carlos Henrique F. CAMARGO

doi:10.1590/0004-282X20190109

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(01): 58-59
DOI: 10.1590/0004-282X20190109

IMAGES IN NEUROLOGY

Blepharospasm and periorbital edema after imatinib mesylate: improvement with botulinum toxin

Blefaroespasmo e edema periorbitário após mesilato de imatinibe: melhora com toxina botulínica

Authors

Hélio A. G. TEIVE

¹Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Clínica Médica, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brasil;

²Universidade Federal do Paraná, Hospital de Clínicas, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba PR, Brasil;
Francisco M. B. GERMINIANI

¹Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Clínica Médica, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brasil;
Renato P. MUNHOZ

³University of Toronto, Toronto Western Hospital, Gloria and Morton Shulman Movement Disorders Centre, Toronto,ON, Canada.
Carlos Henrique F. CAMARGO

²Universidade Federal do Paraná, Hospital de Clínicas, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba PR, Brasil;

Abstract

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A 71-year-old man on treatment for chronic myeloid leukemia with imatinib mesylate presented with bilateral severe periorbital edema, including his eyelids, later progressing to blepharospasm ([Figure A]), and was referred to our Botulinum Toxin Outpatient Clinic two years ago. Hematological routine examinations, head and sinuses CT, brain MRI and CSF studies were normal. No treatment for dystonia had been done previously, including botulinum toxin. Botox^® (70U of onabotulinutoxinA, Allergan Inc., Irvine, CA, USA) was used for treatment of blepharospasm, with partial improvement ([Figure B]).

Figure Patient with severe periorbital edema associated with blepharospasm, secondary to treatment with imatinib mesylate. Imaging before (A) and after (B) botulinum toxin use. (With the patient’s permission).

Periorbital edema is a fairly common side effect of imatinib mesylate[1]; however, the association with blepharospasm, and the treatment with botulinum toxin, has not been published[2]. When the normal protective blink reflex becomes excessive, the ocular surface may be traumatized. The forceful and excessive eyelid blinking is not only debilitating but also results in further microtrauma to the ocular surface, further exacerbating the disease process. Patients with these conditions can present with chronic pain, photophobia, foreign body sensation, and secondary blepharospasm. Therefore, blepharospasm may be a symptom of ocular surface disease, and the use of botulinum toxin may be beneficial[3].

References

References
1 Esmaeli B, Prieto VG, Butler CE, Kim SK, Ahmadi MA, Kantarjian HM, et al. Severe periorbital edema secondary to STI1571 (Gleevec). Cancer. 2002 Aug;95(4):881-7. https://doi.org/10.1002/cncr.10729
2 Simpson DM, Hallet M, Ashman EJ, Comella CL, Green MW, Gronseth G, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016 May; 86(19): 1818-26. https://doi.org/10.1212/WNL.20190109201901092560
3 Yen MT. Secondary blepharospasm associated with ocular surface disease. Int Ophthalmol Clin. 2018 Winter; 58(1):71-5. https://doi.org/10.1097/IIO.20190109201901090205

Figures

Figure Patient with severe periorbital edema associated with blepharospasm, secondary to treatment with imatinib mesylate. Imaging before (A) and after (B) botulinum toxin use. (With the patient’s permission).