Benign Essential Blepharospasm (BEB) is a form of focal dystonia that causes involuntary, excessive blinking and eyelid closure. Though not life-threatening, blepharospasm can be severely disabling, often leading to functional blindness, impaired daily functioning, and decreased quality of life. The first-line treatment has traditionally been botulinum toxin injections, but their effects are temporary, often lasting just 8–10 weeks. For patients who experience suboptimal relief or seek non-invasive solutions, Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation therapy that uses magnetic pulses to influence neural activity.
In the treatment of blepharospasm, low-frequency rTMS (typically 0.2 Hz) is applied to target brain regions such as the anterior cingulate cortex (ACC) and the supplementary motor area (SMA), both of which are involved in motor control and have been implicated in the pathophysiology of Benign Essential Blepharospasm.
Several studies have demonstrated that Repetitive Transcranial Magnetic Stimulation( rTMS) can reduce the severity and frequency of blepharospasm symptoms:
- A randomized controlled study published in Neurology found that a single 15-minute session of 0.2 Hz rTMS over the anterior cingulate cortex (ACC) significantly improved blink rate and reduced spasm duration
- A 2018 double-blind trial tested a 2-week course of low-frequency rTMS in patients already receiving botulinum toxin therapy. Those who received real rTMS showed significant improvements in symptom severity, frequency, and quality of life compared to the sham group.
- Improvements were especially notable in activities of daily living and social functioning, as measured by the Jankovic Rating Scale (JRS) and Craniocervical Dystonia Questionnaire (CDQ-24).
Research suggests that in blepharospasm, there is abnormal hyperexcitability in cortical and subcortical areas, especially the anterior cingulate cortex Low-frequency Repetitive Transcranial Magnetic Stimulation( rTMS) reduces this excitability, restoring balance in motor pathways and leading to symptom relief. It may also modulate blink reflex circuitry and support better inhibition within the cortico-basal ganglia-thalamic loops.
The standard rTMS protocol for treating blepharospasm involves low-frequency stimulation at 0.2 Hz, specifically targeting the anterior cingulate cortex (ACC). Each session typically lasts between 15 and 20 minutes and is conducted daily over a period of one to two weeks. In some cases, booster sessions may be recommended later to maintain therapeutic effects. Repetitive Transcranial Magnetic Stimulation (rTMS) is generally well-tolerated, with only mild and temporary side effects reported, such as slight scalp discomfort or fatigue.
The Repetitive Transcranial Magnetic Stimulation (rTMS) for Benign Essential Blepharospasm may be beneficial to:
- Patients with refractory blepharospasm who respond poorly to botulinum toxin
- Individuals seeking non-invasive, drug-free alternatives
- Patients with short duration of botulinum toxin relief
- Those experiencing significant functional impairment
Repetitive Transcranial Magnetic Stimulation (rTMS) represents a novel, safe, and non-invasive approach to managing blepharospasm. When used alone or in combination with botulinum toxin therapy, Repetitive Transcranial Magnetic Stimulation( rTMS) can enhance symptom control, reduce spasm frequency, and improve quality of life.