BLEPHAROSPASM

Blepharospasm (from the Greek blepharo; eyelid and spasm meaning an uncontrolled muscle contraction) is any abnormal contraction or twitch of the eyelid. It is well described in Wikipedia as “a neurological movement disorder involving involuntary and sustained contractions of the muscles around the eyes” Wikipedia goes on to say that “the person’s eyelids feel like they are clamping shut and will not open without great effort”. It is fairly rare, affecting only one in 20,000 people. In some cases an affected person is able temporarily to open his/her eyes by a voluntary mental diversion. For example, he/she might want to go into a store to buy something but is functionally blind. By saying “e.g. Mary had a little lamb---etc.” the eyes open, but close again after the verbal diversion is completed. This, of course, suggests a “psychosomatic” background, but I have tried to deal with that issue in previous posts. Wikipedia indicates that its cause is unknown but obviously it is related to abnormal brain function in sending unwanted messages to the eyelid muscles. I am addressing this because of a most unusual case that I encountered many years ago. She did not fit at all into the descriptions provided by Wikipedia. It seemed to illustrate two things that I have tried to emphasize repeatedly in this blog. First, it is the brain/body combination and secondly the fundamental role of oxidation, the use of intracellular oxygen in energy synthesis, particularly as it affects the brain. The patient was a girl, 12 years of age. She had been referred because her eyelids had been in a permanent state of spasm for some time. As I examined her I tried to open one of her eyes manually. The spasm was so strong that I could only open it as a slit and as I did this a stream of tear fluid shot out several inches in the form of a spray, indicating that the tear glands were being stimulated at the same time. The other thing that I noticed was that her skin was covered with “goose bumps”. At one time in our evolutionary history we were covered with hair and each hair could be raised by the contraction of a tiny muscle attached to the follicle from which the hair grew. It is thought that the ape-like animal would look much fiercer when confronting an enemy with all his hair fluffed up. We no longer have the hairs but the follicles have remained and when the little muscle contracts, it makes a tiny cone-like bump that we call a “goose bump”. We still experience hair rising on the back of the neck when we encounter a form of sudden stress. Running my hand over the child’s skin, it felt rough because of the generalized pilo-erection (pilo: a hair). Most people associate this skin appearance with feeling cold, quite correctly. This is because the action is mediated by the sympathetic branch of the autonomic (automatic) nervous system (ANS). In previous posts I have discussed the ANS and the sympathetic branch is responsible for mobilizing action as in the fight-or-flight reflex that is initiated in a state of imminent danger. In other words this child was experiencing a danger reaction without there being any form of danger. After admission to the hospital it was found that she had a high blood sugar indicating that she had diabetes. Then a strange thing happened; after a single injection of insulin the pilo-erection disappeared. This, of course, indicated that her sympathetic system had become less activated. How to explain this gave me a great deal of thought. I came to the conclusion that the diabetes was due to the fact that the central part of her brain was not monitoring the concentration of circulating blood sugar and failed to send a signal to the pancreas to produce the necessary insulin. This made some sense considering the fact that the blepharospasm was caused by an outpouring of signals from the brain. I came to the conclusion that oxidative metabolism in the brain was the central underlying cause for everything and started to give her thiamine tetrahydrofurfuryl disulfide (TTFD) {Blog posts:3/16/11, A Remarkable Nutritional Supplement. 10/8/11: An Unusual Recovery}. To my surprise and satisfaction, the eyes opened and she became clinically well. She turned out to be an exceptionally intelligent and delightful personality who delighted in writing poetry. She lived in another State and after discharge I lost sight of her. Some years later I heard from another source that she had developed a calcified tumor in the center of the brain but I was not a party to how this was treated or what was the outcome. That supported my original contention that the problem was due to abnormal activity in the lower part of the brain. I need hardly add that there was no evidence of a tumor when she was under my care. There was therefore no possibility of knowing whether the tumor was related to cause or effect. I am describing this case because, as I have already said, it illustrates the dual action of the brain and body in both health and disease. Her blood sugar was raised because the pancreas had not received an appropriate signal from the part of the brain that monitors blood sugar, so her diabetes was a most unusual form. The sympathetic branch of the ANS had evidently been alerted from the lower brain control system. To think of this as connected in any way with psychology is absurd and I have long since regarded traditional ”psychosomatic” disease as a reflection of abnormal chemistry in the brain, commonly induced by poor diet. There was probably a genetic cause for the disease in this unfortunate girl. The response to TTFD did indeed suggest that oxygen was not being consumed efficiently in brain cells. As I have previously indicated, TTFD can be compared to a spark plug that ignites gasoline in a car engine. Also, even if there had been a genetic cause, it must have influenced the chemistry of cellular oxidation .