Oral medication treatment patterns in blepharospasm and Meige syndrome: a multi-institutional TriNetX study

Background Blepharospasm (BSP) and Meige Syndrome (MeS) are focal dystonias frequently associated with disability and reduced quality of life. While botulinum neurotoxin is the standard of care treatment for these conditions, they only partially and transiently relieve symptoms and can be painful. A variety of off-label oral medications may be tried to mitigate motor symptoms in BSP and MeS, but current treatment patterns have not been assessed. We explored real-world oral medication prescription patterns in individuals with BSP and MeS and identified predictors that influence prescriptions. Methods We used TriNetX, a database of deidentified medical data from healthcare organizations around the world, to conduct a retrospective cohort study of oral medication prescription patterns of BSP and MeS. Patient demographics, diagnoses, and medication history were extracted. Medications of interest were grouped into nine classes and analyzed for prescription prevalence, documented prescription interval (first to last record), and prescription of multiple classes of medication. Prescription data and patterns for all medications were analyzed, and multivariate logistic regression models were used to assess the odds of oral medical treatments based on demographic factors. Results A total of 20,485 cases of BSP and 6,854 cases of MeS were identified across a 20-year index period. We found 46.7% of patients were treated with at least one class of medication, and that benzodiazepines were the most prescribed class followed by muscle relaxers and gabapentinoids. Lower odds of receiving any oral medication prescriptions were associated with being male, Asian, and in the Southern U.S. while higher odds were associated with being Black. Of those prescribed medications, 35.0% of patients were only prescribed a medication from one class while another 38.3% were prescribed medications from three or more classes. Conclusion In a large database cohort, almost half of BSP and MeS patients were prescribed an oral medication that can lessen dystonia severity and the prescription patterns varied across sex, race, and region. In those patients prescribed an oral medication, more than a third are being prescribed medications from three or more different classes suggesting current oral medication treatment options for BSP and MeS may be inadequate.