Conditions: Focal Dystonia
Keywords: Dystonia Blepharospasm Botulinum Toxin Treatment Clinical Trial Focal Dystonia
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 24
Healthy volunteers: no

Brief summary:
Background:

* Blepharospasm is caused by excessive contraction of the muscles that close the eye. It can be treated with injections of botulinum neurotoxin (BoNT), which works by weakening those muscles.
* Acetyl Hexapeptide-8 (AH-8) is the active ingredient in a number of cosmetic creams used to treat wrinkles, and is marketed under the trade name Argireline(Copyright). Like BoNT, AH-8 works to weaken the muscles, but is available as a skin cream instead of an injection. AH-8 has never been used to treat people with blepharospasm.

Objectives:

\- To determine if AH-8 can be used as part of a treatment regimen for blepharospasm.

Eligibility:

\- Individuals 18 years of age and older who have blepharospasm and have been receiving successful treatment with botulinum toxin injections.

Design:

* Participants will be involved in the study for a maximum of 7 months.
* Patients will have a complete physical and neurological exam, and will be asked questions about their blepharospasm. Patients will then receive BoNT injections in the same areas of the muscle around the eye and at the same doses that have been effective previously.
* After the injections, patients will receive a container of either the active cream (with AH-8) or cream without AH-8, and will be instructed on how to apply it.
* Patients will return 1 month after the first visit for another neurologic exam and questions, and will be asked about any side effects. Another supply of cream will be given.
* Five additional visits will take place on a monthly basis, and patients will be given additional supplies of the cream as needed. Patients will stop participating in the study if they require another BoNT injection for blepharospasm. The study will end after 7 months.

Detailed description:
OBJECTIVE:

To study the efficacy of cutaneous application of Acetyl Hexapeptide-8 (AH8) in the therapy of blepharospasm.

STUDY POPULATION:

22 patients with blepharospasm.

DESIGN:

This will be a double blind, placebo-controlled trial. Patients receiving treatment of blepharospasm with botulinum neurotoxin (BoNT) will be recruited. They will receive either the study substance or a placebo cream containing the emulsion but no active substance, in twice daily applications to the eyelids beginning the day following a BoNT injection treatment. They will continue to apply the cream and we will record the time until their condition worsens back to baseline following benefit from the injections, hypothesizing that the cream application will prolong the time until the need for the next injection by at least 3 months.

OUTCOME MEASURES::

Primary: time until the Jankovic Blepharospasm Rating Scale (JBRS) reverts back to baseline.

Secondary: Change in the JBRS at 6 months; Change in the JBRS at 7 months if not receiving BoNT; Change in the JBRS at 3 months; Change in the Blepharospasm Disability Scale at 6 months

Arms:
arm 1: AH-8 containing topical intervention arm 2: topical intervention WITHOUT AH-8

Interventions: intervention 1: Acetyl-Hexapeptide Topical Treatment intervention 2: placebo
Intervention descriptions: intervention 1: AH-8 containing topical treatment intervention 2: topical treatment NOT containing AH-8

Protocol document: