Clinical Analysis of Blepharospasm and Apraxia of Eyelid Opening in Patients with Parkinsonism

Abstract

Background and PurposeBlepharospasm (BSP) and apraxia of eyelid opening (AEO) have been reported as dystonia related with parkinsonism. However, systematic analysis of clinical characteristics of BSP and AEO in parkinsonism has been seldom reported. To investigate the clinical characteristics of BSP and AEO in parkinsonism and to find out the clinical significance to differentiate parkinsonism.MethodsWe enrolled 35 patients who had BSP with or without AEO out of 1113 patients with parkinsonism (913 IPD, idiopathic Parkinson's disease; 190 MSA, multiple system atrophy, 134 MSA-p, 56 MSA-c and 10 PSP, progressive supranuclear palsy). We subdivided MSA into MSA-p (predominantly parkinsonism) and MSA-c (predominantly cerebellar) according to the diagnostic criteria proposed by Quinn. We analyzed the clinical features of BSP and parkinsonism including onset age, onset interval to BSP, characteristics of BSP, presence of AEO, coexisted dystonias on the other body parts, severity of parkinsonism and relationship with levodopa treatment.ResultsBSP with or without AEO were more frequently observed in atypical parkinsonism (PSP, 70%; MSA-p, 11.2%; MSA-c, 8.9%) than in IPD (0.9%). Reflex BSP was observed only in atypical parkinsonism (4 MSA-p, 1 MSA-c and 2 PSP). BSP preceding parkinsonism (Pre-BSP) was observed mainly in atypical parkinsonism (2 MSA-p, 1 MSA-c, 1 PSP and 1 IPD). The presence of AEO was more frequent in atypical parkinsonism than in IPD, but isolated AEO was not detected. BSP related to levodopa ('off' symptom or 'peak-dose' effect) were observed only in IPD.ConclusionsReflex BSP, Pre-BSP and the presence of AEO may be a unique feature of atypical parkinsonism. BSP related to levodopa might be representative of IPD. No differences were found in the clinical features of BSP between MSA-p and MSA-c.

Prevalence of Blepharospasm and Apraxia of Eyelid Opening in Patients with Parkinsonism, Cervical Dystonia and Essential Tremor

“…In our study, the frequency of BSP was increased in patients with atypical parkinsonism, for example in PSP (10.52%) versus in IPD (3.26%). In contrast to the findings of Yoon et al [2], our findings did not indicate the presence of BSP among MSA patients, possibly due to the small number of MSA and also CBD patients in our study. We also prospectively followed 10 patients with BSP and of those, only 2 developed IPD.…”

“…There have been many reports that indicate that BSP is much more prevalent in IPD, atypical parkinsonism [2] and other movement disorders including CD [1,8]. Different studies have examined this relationship but the results have not unequivocally indicated an association between BSP and parkinsonism or CD.…”

“…BSP is often associated with apraxia of eyelid opening (AEO) [2]. AEO has on occasion been reported in association with atypical parkinsonism, especially progressive supranuclear palsy (PSP) [2]. Furthermore, Yoon et al [2] report that BSP and AEO are coexisting dystonia in atypical parkinsonism (commonly seen in PSP patients) and indicate that further research is necessary to confirm and clarify this correlation.…”

“…BSP is often associated with apraxia of eyelid opening (AEO) [2]. AEO has on occasion been reported in association with atypical parkinsonism, especially progressive supranuclear palsy (PSP) [2].…”

“…Blepharospasm (BSP) is a focal dystonia characterized by intermittent, involuntary eyelid closure, increased blinking rate, ocular discomfort and dry eyes [1,2]. BSP is often associated with apraxia of eyelid opening (AEO) [2].…”