A case of blepharospasm relieved by playing an oboe and singing

Investigators reported the case of a 61-year-old woman, a musician who played the oboe, who presented with the complaint of eye squinting, ie, benign essential blepharospasm, that was described as progressive and involuntary and had been present over a period of 4 years.

Authors Ryan Weng Zhou, MD, Cathy Meng Fei Li, MD, and John Alexander Fraser, MD, are affiliated with the Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Li is also affiliated with the Department of Neurology, Harvard Medical School, Mass General Brigham, Boston; and Fraser is affiliated with the Department of Ophthalmology, Western University. They described this case in JAMA Neurology.¹

The patient was initially diagnosed with dry eye, but the symptoms did not respond to instillation of artificial tears. She did not have a history of use of dopamine receptor antagonists. A noteworthy observation was that “her symptoms reliably abated when she played the oboe or when she sang, only to return immediately after stopping.”

The investigators reported the presence of bilateral blepharospasm that was “characterized by brow furrowing and palpebral fissure narrowing, but without excessive blinking or complete eye closure.”

The blepharospasm did not improve when the patient was asked to imitate just the movements associated with playing the oboe with the reed in her mouth or imitate playing the oboe while blowing through a straw, they explained. Her ocular examination was otherwise normal.

The physicians explained the patients with benign essential blepharospasm can in some cases use a trick that alleviates the blepharospasm; “these are typically simple tactile phenomena such as pressing on the eyelids or gently touching the temple, although more complex tricks have also been described, including physical actions such as gardening or abstract mental processes such as thinking positively.”^2,3

In the case under discussion, the investigators commented that the patient used a musical trick in that the sound produced by the oboe and the singing voice “reliably alleviated the blepharospasm, while nonmusical mimics did not. Additionally, because speaking nonmusically failed to relieve the spasms but singing musically reliably did, it appears that the production of music itself, and not the mechanics or physical sensation of playing the oboe, was the key factor in alleviating her blepharospasm.”

The investigators proposed that “dysfunction within the motor control network, especially within the communication pathways between the sensorimotor cortex and basal ganglia, results in reduced cortical inhibition of dystonic movements via maladaptive brain plasticity.”⁴

In the current case, the trick that the patient discovered may attenuate the dysregulation in the cortical areas supporting her dystonia.

The patient responded well to botulinum toxin injections to control her symptoms over 7 years, the investigators reported.

References

1. Zhou RW, Li CMF, Fraser JA. Musical trick alleviating benign essential blepharospasm. JAMA Neurol. 2026; published online May 18. doi: 10.1001/jamaneurol.2026.1298

2. RamosVF, Karp BI, Hallett M. Tricks in dystonia: ordering the complexity. J Neurol Neurosurg Psychiatry. 2014;85:987-93. doi:10.1136/jnnp-2013-306971

3. Lee AG, Miller NR. Alleviating maneuvers for benign essential blepharospasm and hemifacial spasm. JAMA Ophthalmol. 2016;134:1253-4. doi:10.1001/jamaophthalmol.2016.2983

4. Breakefield XO, Blood AJ, Li Y, Hallett M, Hanson PI, Standaert DG. The pathophysiological basis of dystonias. Nat Rev Neurosci. 2008;9:222-34. doi:10.1038/nrn2337