Rare case of Botox-treated paraneoplastic blepharospasm

The authors report in the April issue of Ophthalmology the only known case of paraneoplastic blepharospasm as a result of anti-Hu antibodies, as well as the only case that was treated with botulinum toxin A. This case illustrates that botulinum toxin can be offered as a possible treatment to improve visual function.

Although paraneoplastic blepharospasm is rare, it is an important diagnosis to be aware of because paraneoplastic disorders often herald an occult tumor and prompt diagnosis of paraneoplastic blepharospasm has important systemic implications.

The patient in this case was a 57-year-old man with altered mental status and a 20-pound weight loss from an occult small -cell lung cancer who also presented with severe blepharospasm.

Neuroimaging and cerebrospinal fluid studies found no evidence of intracranial metastases. However, his paraneoplastic panel was positive for anti-Hu antibodies. He was diagnosed with paraneoplastic encephalitis and blepharospasm.

Intravenous Solu-Medrol (Pharmacia & Upjohn Co., Bridgewater, N.J.) improved his mental status but did not change his ocular symptoms. However, subsequent botulinum toxin A injections allowed spontaneous eyelid opening.

The authors note that caution should be exercised in using botulinum toxin to treat blepharospasm if a patient has diplopia as a result of a paraneoplastic ocular motility deficit. However, in cases without incomitant ophthalmoplegia, this therapy can improve visual quality of life.