Relationship between eye symptoms and blepharospasm: A multicenter case–control study

Martino, Davide; Defazio, Giovanni; Alessio, Giovanni; Abbruzzese, Giovanni; Girlanda, Paolo; Tinazzi, Michèle; Fabbrini, Giovanni; Marinelli, Lucio; Majorana, G.; Buccafusca, Maria; Vacca, Laura; Livrea, Paolo; Berardelli, Alfredo

doi:10.1002/mds.20635

Cited by 89 publications

(58 citation statements)

References 26 publications

(44 reference statements)

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“…Moreover, Wen-Juh Hwang reported that only 11% of the patients spontaneously complained of photophobia, but upon questioning, 97% of the patients had photophobia [3]. Eye symptoms associated with PBS result from eye diseases and may be involved in the pathogenesis of PBS [12]. The first-degree relatives of blepharospasm patients more frequently had eye symptoms such as dry eyes and gravel and burning sensations [13].…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Patients with Primary Blepharospasm: A Report of 100 Cases in China

et al. 2015

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Purpose: This study explored the clinical characteristics, diagnosis and treatments of primary blepharospasm. Methods: In this retrospective analysis, 100 patients with blepharospasm were enrolled. Data were collected from medical records and face-to-face interviews with patients and their families. Results: The age of onset was 56.4 ± 2.7 (range, 32-76 years). The duration between onset and accurate diagnosis was 38.7 ± 36.0 months (range, 2-120 months). Dry eyes occurred in 54% of the patients. The initial diagnostic accuracy was 10%. Dry eye syndrome, conjunctivitis/keratitis and myasthenia gravis caused the most confusion in the differential diagnosis. Regular botulinum toxin type A injections improved both eyelid spasms and subjective ocular symptoms in all patients. Conclusions: Regular botulinum toxin type A injections improved both eyelid spasms and subjective ocular symptoms in blepharospasm patients. The differentiation of primary blepharospasm differentiation from dry eye syndrome, conjunctivitis/keratitis and myasthenia gravis must be improved.

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Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Patients with Primary Blepharospasm: A Report of 100 Cases in China

et al. 2015

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“…18 Blink reflex recovery cycle. The blink reflex recovery cycle was studied, according to the experimental procedure reported in previous studies, by delivering electrical shocks to the supraorbital nerve through silver chloride disc surface electrodes.…”

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confidence: 99%

Is increased blinking a form of blepharospasm?

et al. 2013

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Objective: The aim of this study was to investigate whether increased blink rate (BR) is part of the clinical spectrum of primary blepharospasm (BSP). Methods:We enrolled 40 patients (16 patients with an increased BR but without typical orbicularis oculi [OO] spasms, and 24 patients with typical involuntary OO spasms) and 18 healthy subjects. The BR, blink reflex recovery cycle, and somatosensory temporal discrimination threshold (STDT) were tested in patients and controls.Results: Patients who had typical OO spasms had an altered R2 recovery cycle whereas those who had an increased BR alone had a normal blink reflex recovery cycle. STDT values were higher in patients than in healthy subjects and no difference was found in the STDT abnormalities in the 2 groups of patients.Conclusions: Our study shows that, despite the similar STDT abnormalities, the different changes in the R2 recovery cycle in patients with BSP and those with increased BR alone suggest that these disorders arise from different pathologic mechanisms. Neurology Patients who present with excessive involuntary eyelid closure raise a diagnostic challenge. Whereas some patients have sustained orbicularis oculi (OO) spasms and are therefore diagnosed as having blepharospasm (BSP), a common focal dystonia, 1-4 others have increased blinking alone. In these patients, increased blinking may reflect ophthalmologic disorders involving the ocular surface, tear film, or eyelids but can manifest also in apparently healthy subjects without any secondary causes.5 Although increased blinking at rest and during conversation may occur in patients with BSP, 6 and some suggest that increased blinking is sometimes a prodromal sign of primary BSP, 2 no evidence yet shows whether patients with increased blinking alone have a dystonia subtype, essentially a forme fruste of BSP.Our aim in this case-control study was to investigate whether increased blinking is a subtype of primary BSP. To do so, we tested the blink rate (BR) and the neurophysiologic variables known to be altered in primary BSP, the blink reflex recovery cycle-reflecting brainstem excitability [7][8][9][10] -and somatosensory temporal discrimination threshold (STDT), [11][12][13] in patients presenting with excessive involuntary eyelid closure who had sustained OO spasms (primary BSP), those with increased blinking alone, and healthy age-matched control subjects.METHODS Study participants. Among consecutive patients with excessive involuntary eyelid closure who were seen in our movement disorders outpatient clinic, we identified 16 subjects with increased blinking without sustained OO spasms. These subjects could not voluntarily control the excessive blinking and reported no premonitory sensation before eyelid movements. Nor did any evidence suggest a psychogenic movement disorder such as persisting unilateral or asymmetric symptoms, paroxysmal symptoms, and other inconsistencies such as pain, associated somatizations, blinking diminished by distraction, unusual sensory tricks, or unexpected res...

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“…The neurologist then 1 Integrative Medicine Centre, Fairhope, AL. 2 recommended a neuro-ophthalmologist for another opinion. The neuro-ophthalmologist's diagnosis was ''benign essential blepharospasm'' 4,5 and Klonopin was prescribed.…”

Section: Case Historymentioning

confidence: 99%

“…It is a relatively rare disease occurring in only about 1 in every 20,000 adults in the United States. 2 The first record of blepharospasm and lower facial spasm was documented in the 16th century in a painting titled De Gaper. At that time, and for several ensuing centuries, patients with such spasms were regarded as being mentally unstable and often were institutionalized in insane asylums.…”

Section: Introductionmentioning

confidence: 99%