A new variant of blepharospasm.

Elston, John

doi:10.1136/jnnp.55.5.369

Cited by 57 publications

(45 citation statements)

References 14 publications

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“…1). These injection sites correspond to the location of Riolan’s muscle [9]. The severity of ELA functional disability was evaluated during a visit on the day of treatment and during a follow-up visit scheduled 3–4 weeks after treatment.…”

Section: Methodsmentioning

confidence: 99%

Botulinum Toxin Injection into Riolan’s Muscle: Somatosensory ‘Trick’

Inoue

2007

Eur Neurol

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We studied the effect of injecting botulinum toxin A (BTX-A) into the pars ciliaris – also known as Riolan’s muscle – of patients with eyelid apraxia (ELA). Six patients with ELA were treated with injections of BTX-A into the region of Riolan’s muscle at the medial and lateral portions of the upper and lower pretarsal orbicularis oculi. Clinical benefit was seen in all 6 patients, 2 of whom had previously been treated with conventional pretarsal injections of BTX-A and had not improved. BTX-A injections into Riolan’s muscle are effective as treatment for ELA. The proposed mechanism is not that of muscle relaxation but rather modulation of the somatosensory cortex, similar to that of a ‘sensory trick’ in patients with dystonia.

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Section: Methodsmentioning

confidence: 99%

Botulinum Toxin Injection into Riolan’s Muscle: Somatosensory ‘Trick’

Inoue

2007

Eur Neurol

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“…To identify all possible cases of scAEO, the following key words were used: apraxia of eyelid opening [1], eyelid freezing [15], involuntary LPS inhibition [2], blepharokolysis [16], focal eyelid dystonia [9] and pretarsal BS [8]. To obtain additional reports we reviewed the bibliographies of all papers thereby identified.…”

Section: Methodsmentioning

confidence: 99%

“…In reviewing the literature from 1965 to 1996, we found 11 patients with isolated scAEO [3,4,8,9,17,18] in a total of approximately 200 reported cases. Detailed clinical description was lacking in 3 patients [9].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…In reviewing the literature, we found sporadic reports [3,4,8,9,17,18], mostly consisting of anecdotal descriptions, on isolated scAEO, that is scAEO without extrapyramidal disorders or cerebrovascular diseases. Thus, the origin, nature and clinical features of isolated scAEO are uncertain, as well as the response to BT.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, the origin, nature and clinical features of isolated scAEO are uncertain, as well as the response to BT. To further investigate these issues, we present 10 new patients and a review of the cases described in the literature [3,4,8,9, [7,18].…”

Section: Introductionmentioning

confidence: 99%

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Isolated So-Called Apraxia of Eyelid Opening: Report of 10 Cases and a Review of the Literature

Defazio¹,

Livrea²,

Lamberti³

et al. 1998

Eur Neurol

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So-called apraxia of eyelid opening (scAEO) has been described chiefly in the context of extrapyramidal disorders. We described 10 new patients with scAEO developing in the absence of any other CNS sign and reviewed the 11 cases with isolated scAEO reported in the literature. Combining our patients and those from the literature, peak age at onset was in the 6th decade and there was a female preponderance of 2:1. The characteristic inability to initiate lid elevation was frequently associated with failure to sustain lid elevation, thus suggesting that eyelid motor control may be abnormal in isolated scAEO. Antecedent events included ocular signs and symptoms consistent with diseases of eyes or face (4 cases in our series and 2 in the literature), chronic treatment with flunarizine (1 case), and family history of dystonia (1 case). Flunarizine discontinuation led to sustained remission of the eyelid disturbance. Overall, these clues suggest the involvement of the extrapyramidal system in the pathophysiology of isolated scAEO. Familial clustering of isolated scAEO in one of our patients may be in favor of a genetic contribution. In our series, botulinum toxin administration close to the pretarsal part of the orbicularis oculi muscle significantly improved scAEO in 8/10 cases, whereas orbital/preseptal injection had no effect. We conclude that the term ‘apraxia’ may not be the correct descriptive term even when the eyelid disturbance occurs without any other CNS disease.

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