Cannabidiol as an Adjunct to Botulinum Toxin in Blepharospasm – A Randomized Pilot Study

pubmed logo

“Purpose: The purpose of this study was to evaluate the safety and efficacy of low dose cannabidiol (CBD; Epidiolex) as adjunctive therapy for idiopathic adult-onset blepharospasm (BPS), as well as develop a novel objective assessment methodology to gauge response.

Methods: Prospective, randomized, double-masked, placebo-controlled crossover design of 6 months duration of 12 patients with BPS undergoing routine maximal botulinum toxin (BTX) therapy and experiencing breakthrough symptoms. Participants received their standard BTX every 3 months and were randomized to group A = CBD daily in cycle 1, followed by placebo in cycle 2 or group B = placebo followed by CBD. Videos recorded at days 0, 45, and 90 of each cycle were analyzed to quantify eyelid kinematics. The Jankovic Rating Scale (JRS) was used to provide a clinical rating.

Results: All 12 patients completed the study without adverse events. CBD decreased median eyelid closure amplitude by 19.1% (-1.66 mm, confidence interval [CI] = -3.19 to -0.14 mm, P = 0.03), decreased median eyelid closure duration by 15.8% (-18.35 ms, CI = -29.37 to -7.32 ms, P = 0.001), and increased the maximum eyelid closure velocity by 34.8% (-13.26 mm/ms, CI = -20.93 to -5.58 mm/ms, P = 0.001). The JRS showed a 0.5 reduction in severity and frequency, which was not statistically significant.

Conclusions: Low dose CBD was safely tolerated and improved several BPS kinematic parameters. The clinical scale suggested a direction of effect but may have been underpowered. Further studies are needed to better quantify the clinical relevance.”

Medical cannabis oil for benign essential blepharospasm: a prospective, randomized controlled pilot study

“Objective: To examine the efficacy and safety of medical cannabis in benign essential blepharospasm (BEB).

Methods: This is a prospective, double-blind, placebo-controlled study. All consecutive adult BEB patients who had been treated with BTX-A injections without success between 3/2019 and 2/2020 were recruited. The study patients were randomly allocated into a treatment and a control (placebo) group in a 1:1 ratio. The treatment group used cannabis drops and the control group used cannabis oil drops during the first 6 weeks of the study, and both groups were treated with the medical cannabis drops during the second 6 weeks. The cannabis dose was gradually increased for each patient depending upon effect and tolerability.

Results: Three patients were included in each group (treatment and control groups). The mean duration of spasm attack during the first 6 weeks was 4.29 min in the treatment group and 73.9 min in the placebo group (P < 0.01). During the last 6 weeks, the treatment group used an average of 6.27 drops and the placebo group used an average of 5.36 drops (P = 0.478). There were 61 spasm events in the treatment group and 94 spasm events in the placebo group (P = 0.05). The mean duration of spasm attack was 1.77 and 8.96 min, respectively (P < 0.01). The side effects were mild, and they included general fatigue, dry mouth, and insomnia.

Conclusions: Medical cannabis can be an effective and safe treatment for BEB as a second line after BTX-A injections when used for 3 months. No significant ocular or systemic side effects was associated with the treatment.”

Association between cannabis and the eyelids: A comprehensive review.

Publication cover image“Cannabis is the most consumed illicit drug worldwide. As more countries consider bills that would legalize adult use of cannabis, health care providers, including eye care professionals (ophthalmologists, optometrists), will need to recognize ocular effects of cannabis consumption in patients.

There are only 20 studies on the eyelid effects of cannabis usage as a medical treatment or a recreational drug.

These include: ptosis induction, an “eyelid tremor” appearance and blepharospasm attenuation.

Six articles describe how adequately dosed cannabis regimens could be promising medical treatments for blepharospasm induced by psychogenic factors.

The exact mechanism of cannabinoids connecting cannabis to the eyelids is unclear.

Further studies should be conducted to better understand the cannabinoid system in relation to the eyelid and eventually develop new, effective and safe therapeutic targets derived from cannabis.”

What is the evidence for cannabis use in otolaryngology?: A narrative review.

American Journal of Otolaryngology

“A small number of studies exist that suggest cannabis may be a useful therapy for Otolaryngological patients suffering from blepharospasm, the effects of radiation, and the psychological sequelae of receiving a cancer diagnosis.

Further research is required to determine the potential therapeutic roles and adverse effects of cannabis on conditions related to Otolaryngology.”

“Otolaryngology is a medical specialty which is focused on the ears, nose, and throat.”

Medical Cannabis, a Beneficial High in Treatment of Blepharospasm? An Early Observation.

Publication Cover

“The objective of this study was to observe the effect of medical cannabis in benign essential blepharospasm (BEB) as an adjunct to botulinum toxin.

Three out of four patients (75%) reported symptomatic improvement.

Medical cannabis has made great strides as a treatment modality for symptom relief for many disease processes, including muscle spasms related to multiple sclerosis. Medical cannabis is an accepted therapy for muscle spastic disorders.

We believe that this observational case series provides a backdrop to exploring prospective, double-masked studies to determine the therapeutic effect of cannabis for patients suffering from BEB”

“Blepharospasm is any abnormal contraction or twitch of the eyelid”

“Cannabinoid agonists in the treatment of blepharospasm – A case report study.  This case study demonstrates that the therapy with a cannabinoid agonist may provide a novel tool in the treatment of blepharospasm and maybe of other multifactorial related movement disorders.”