Brief Answer:
Consultation

Detailed Answer:
Hi XXXX, thanks for asking from HCM.


I can understand your concern. You are suffering from Blepharospasm, balance difficulty, depression and anxiety disorder. I will detect treatment of each condition one by one.

: Blepharospasm - As such there is no 100% effective treatment which can cure it completely. It is controlled only. You need to understand it. You have to overcome it. You can follow few steps

; Use of tinted glasses - The first line of treatment for all patients should address the sensory limb of the blepharospasm vicious cycle circuit. Such measures include wearing tinted sunglasses with ultraviolet blocking to decrease the poorly understood cause of painful light sensitivity

; Hygiene of eyes - Lid hygiene to decrease irritation and blepharitis should be encouraged. Frequent applications of artificial tears and punctal occlusion to alleviate dry eyes often improve symptoms.

; You can contact Benign Essential Blepharospasm Research Foundation, a foundation working for management of benign essential blepharospasm (BEB), Meige syndrome, and related disorders. This organisation is located in XXXXXXX XXXXXXX and promotes awareness of these conditions.

;Pharmacotherapy
Since the central control center for blepharospasm is unknown, drug therapy directed against this as of yet unidentified center tends to follow a "shotgun approach."

Most patients respond incompletely or not at all to pharmacotherapy. At best, pharmacotherapy provides only partial, transient relief. Tricyclic antidepressants like Amitriptyline/Nortrityline do not directly help blepharospasm but are useful if there is depression exacerbating the symptoms. In your case, depression might be the cause behind it and thus taking TCAD might decrease it. Also drugs with the highest percentages of favourable patient responses include lorazepam (67% of patients), clonazepam (42%), and Arcane (41%). These medications also provide relief in anxiety and thus your whole symptoms might be covered by all this.

; Botulinum toxin
Botulinum A toxin is regarded as the most effective treatment of choice for the rapid but temporary treatment of orbicularis spasm. More than 95% of patients with blepharospasm report significant improvement with use of the toxin.
It causes paralysis of muscle and thus relief in spasms.
The paralytic effect is dose related, with a peak of effect at 5-7 days after injection. Patients typically note the onset of relief 2.5 days after injection, with a mean duration of relief from symptoms of 3 months.
Most patients require repeated treatment every 3 months, but this ranges from 1-5 months

Now coming to your psychological symptoms of depression and anxiety, they can be treated by

: Counselling and behavioural therapy
: Start Yoga and meditation. It will calm your nerves and stabilise your imbalance also.
: Try to be with someone with whom you can share your problems/happiness/moods. Loneliness is a very common cause of all the above mentioned symptoms.
: You can take TCA (Wmitriptyline/Nortrityline) or SSRI (Fluoxetine/Duloxetine) as mentioned above, after proper prescription. It will relieve your depression.
: You can take Alprazolam/Diazepam (Valium) for relief of anxiety.
: For headache, you need proper sleep (8 hours). Your sleep has decreased due to depression. This is further increasing your symptoms. So you need to control it by getting proper sleep. You should avoid tea/coffee/late night computer use to get proper sleep.

Now coming to balance difficulty. It can be because of many causes other than depression. Consult neurologist and get neurological examination done. The doctor will evaluate your cerebellar function, vestibular function to rule out organic cause.

MRI brain may be advised to know about any degenerative changes/tumor/ventricular dilatation etc. If any positive finding, treatment will depend upon the cause. If no positive findings, you will get relief after treatment of depression.

It is good that you are trying hard to move out from disturbing relation. It will give you advantage in long run.

Hope it will help you. If still any doubt, do let me know. I would be happy to help you.

Thanks. Take care.

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