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Lai CS, Ramachandran S, Lee CC, Lai YW, Chang YP, Huang SH. Evaluation of Blepharoptosis in Patients With Refractory Blepharospasm by VISA-Video Recordings, Idiosyncratic Expressions, Sensory Tricks, and Ancillary Procedures. Ann Plast Surg 2023; 90:S172-S176. [PMID: 37192418 DOI: 10.1097/sap.0000000000003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND How to evaluate blepharoptosis concomitantly presented with refractory and uncontrollable blepharospasm? To date, there is a paucity of publications on the ideal evaluation methods. An innovative method-video recordings, idiosyncratic facial expressions, sensory tricks, and ancillary procedures (VISA)-is developed for preoperative evaluation, and the surgical outcomes are demonstrated. METHODS A retrospective study using VISA for blepharoptosis evaluation was conducted on 51 patients with refractory blepharospasm. Based on the evaluation, patients underwent blepharoptosis correction simultaneously besides the selective myectomy and myotomy in situ of the eyelid protractors for blepharospasm. Preoperative and postoperative palpebral fissure height, margin reflex distance 1, ptosis severity, and levator function were assessed to identify the effectiveness of VISA. All the procedures were performed by the senior author C.-S.L. RESULTS There were 42 patients diagnosed with essential blepharospasm and 9 patients with Meige syndrome. Forty-one patients (82/102 eyelids [80.4%]) had concomitant blepharoptosis and blepharospasm. Ptosis severity was mild in 21 eyelids (25.6%), moderate in 12 eyelids (14.6%), and severe in 49 eyelids (59.8%). Preoperative/postoperative (6 months) values of palpebral fissure height, margin reflex distance 1, and levator function were 4.70 ± 2.45 mm/8.35 ± 1.33 mm (P < 0.05), -0.30 ± 3.19 mm/3.73 ± 1.05 mm (P < 0.05), and 13.07 ± 2.56 mm/13.68 ± 2.34 mm (P < 0.05), respectively. Undercorrection and revision rate reported 9.8% and 3.7%, individually. CONCLUSIONS VISA approach overcomes the difficulty of blepharoptosis assessment in patients with refractory blepharospasm. It provides useful preoperative information required for adequate blepharoptosis correction in blepharospasm surgery and yielded desirable outcomes.
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Affiliation(s)
| | | | - Chia-Chen Lee
- From the Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital
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Hao X, Huang X, Yin X, Wang HY, Lu R, Liang Z, Song C. Elucidation of the mechanism underlying impaired sensorimotor gating in patients with primary blepharospasm using prepulse inhibition. Front Neurol 2023; 14:1105483. [PMID: 36816573 PMCID: PMC9929365 DOI: 10.3389/fneur.2023.1105483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Objective We aimed to analyze prepulse inhibition (PPI) impairment of the blink reflex in patients with primary blepharospasm (BSP). Methods We recruited 30 BSP patients and 20 gender- and age-matched healthy controls (HCs). Weak electrical stimulation was applied to the right index finger at interstimulus intervals (ISIs) of 120, 200, and 300 ms before the supraorbital nerve stimulation to investigate PPI size [PPI size = (1 - R2 area at prepulse trials/R2 area at baseline trials) × 100%]. Results The prepulse stimulus significantly inhibited the R 2 component at the three ISIs in both groups, but less inhibition was shown in the BSP group (p < 0.05). In HCs, the prepulse stimulus induced prolonged R 2 and R 2c latencies at the three ISIs and increased the R 1 amplitude at ISIs of 120 ms; these changes were absent in BSP patients. In the BSP group, patients with sensory tricks showed better PPI than patients without sensory tricks. Disease duration and motor symptom severity showed no significant correlation with PPI size. Conclusion In BSP patients, PPI was impaired while R 1 facilitation was absent. PPI size did not correlate with the motor symptom severity and disease duration. Patients with sensory tricks showed better PPI than those without sensory tricks.
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Affiliation(s)
- Xinqing Hao
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaofeng Huang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoxue Yin
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hai-Yang Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China,Department of Neurology, Jining No. 1 People's Hospital, Jining, China
| | - Ren Lu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhanhua Liang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China,*Correspondence: Zhanhua Liang ✉
| | - Chunli Song
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China,Chunli Song ✉
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Defazio G, Jinnah HA, Berardelli A, Perlmutter JS, Berkmen GK, Berman BD, Jankovic J, Bäumer T, Comella C, Cotton AC, Ercoli T, Ferrazzano G, Fox S, Kim HJ, Moukheiber ES, Richardson SP, Weissbach A, Wrigth LJ, Hallett M. Diagnostic criteria for blepharospasm: A multicenter international study. Parkinsonism Relat Disord 2021; 91:109-114. [PMID: 34583301 DOI: 10.1016/j.parkreldis.2021.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND There are no widely accepted criteria to aid the physician in diagnosing BSP. OBJECTIVE To validate recently proposed diagnostic criteria for blepharospasm in a larger and geographically diverse population and to develop a screening system for blepharospasm. METHODS Video-recordings from 211 blepharospasm patients and 166 healthy/disease controls were examined by 8 raters. Agreement for presence of orbicularis oculi spasms, sensory trick, and increased blinking was measured by k statistics. Inability to voluntarily suppress the spasms was asked by the examiner but not captured in the video. Patients/controls were also requested to fill a self-administered questionnaire addressing relevant blepharospasm clinical aspects. The diagnosis at each site was the gold standard for sensitivity/specificity. RESULTS All the study items yielded satisfactory inter/intra-observer agreement. Combination of items rather than each item alone reached satisfactory sensitivity/specificity. The combined algorithm started with recognition of spasms followed by sensory trick. In the absence of a sensory trick, including "increased blinking" or "inability to voluntarily suppress the spasms" or both items yielded 88-92% sensitivity and 79-83% specificity. No single question of the questionnaire yielded high sensitivity/specificity. Serial application of the questionnaire to our blepharospasm and control subjects and subsequent clinical examination of subjects screening positive by the validated diagnostic algorithms yielded 78-81% sensitivity and 83-91% specificity. CONCLUSION These results support the use of proposed diagnostic criteria in multi-ethnic, multi-center cohorts. We also propose a case-finding procedure to screen blepharospasm in a given population with less effort than would be required by examination of all subjects.
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Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Hyder A Jinnah
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Alfredo Berardelli
- Sapienza University of Rome, Rome, and IRCSS NEUROMED, Pozzilli (Is), Italy
| | | | - Gamze Kilic Berkmen
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany
| | | | - Adam C Cotton
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gina Ferrazzano
- Sapienza University of Rome, Rome, and IRCSS NEUROMED, Pozzilli (Is), Italy
| | - Susan Fox
- Toronto Western Hospital, University of Toronto, Canada
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Centre, Seoul National University Hospital, Seoul, South Korea
| | | | | | - Anne Weissbach
- Institute of Systems Motor Science, University of Luebeck, Luebeck, Germany; Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | | | - Mark Hallett
- Human Motor Control Section, NINDS, NIH, Bethesda, MD, USA
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Murta FR, Waxman J, Skilton A, Wickwar S, Bonstein K, Cable R, Clipston J, Bates A, Mattocks R, Shelley J, McCullough P, Surry M, Matthews J, Worsfold S, Lorenzano D, Jayaprakasam A, Hamed Azzam S, Shafi F, Kwong Q, Koutroumanaos N, Manta A, Negretti G, Haridas A, Ezra DG. The first UK national blepharospasm patient and public involvement day; identifying priorities. Orbit 2019; 39:233-240. [PMID: 31466502 DOI: 10.1080/01676830.2019.1657469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE We describe the planning and outcomes of the first 'Blepharospasm Day' in the UK. Blepharospasm is a distressing condition for patients and carers. Our 'patient and public involvement' event aimed to: cultivate a more informed patient group via active dialogue, help clinicians more effectively prioritise research and to facilitate peer-to-peer support for affected patients and public. DESIGN A national one-day event was organised by the oculoplastics department at Moorfields Eye Hospital. The event was divided into informative lectures delivered by professionals and a patient panel, during which patients shared their experiences and expectations. METHODS Data were collected from a variety of sources including: an interactive voting "LiveWall" poster, a pre-event questionnaire; "living with Blepharospasm", transcripts from patient panel discussions; and a feedback questionnaire. RESULTS The event was well-received with 100% of respondents rating it good or excellent. Four research themes were identified: "aetiology", "alternative treatments", "faster, more accurate diagnosis", and "symptom control". Delegates' self-reported knowledge of blepharospasm increased significantly after the event. Limitations of the BdSI severity-assessment tool were noted with 22% of respondents failing to utilise it appropriately. CONCLUSION Through our innovative "Blepharospasm Day", patient's priorities for research were identified, delegates understanding of blepharospasm increased and an independent blepharospasm patients-representatives' group was established; a first in the UK. Furthermore, short-fallings identified in the BdSI tool highlight the need for better severity-assessment tools. We demonstrate the benefits of the 'patient and public involvement' approach in the management of complex conditions such as blepharospasm. ABBREVIATIONS PPI: Patient and public involvement; SLV-PSP: sight loss and vision sector - priority setting partnership; BRC: Biomedical Research Centre; NIHR: National Institute for Health Research; BsDI: Blepharospasm Disability Index.
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Affiliation(s)
| | - Jacob Waxman
- Ophthalmology Department, Wolfson Medical Centre , Holon, Israel
| | - Andi Skilton
- The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
| | - Sadie Wickwar
- Centre for Health Services Research, School of Health Sciences, City University London , London, UK
| | - Karen Bonstein
- The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
| | - Richard Cable
- The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
| | - Jane Clipston
- The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
| | - Alan Bates
- Blepharospasm Steering Group , London, UK
| | | | | | | | - Marc Surry
- Blepharospasm Steering Group , London, UK
| | | | | | | | | | | | - Fariha Shafi
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Qiang Kwong
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | | | | | - Guy Negretti
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Anjana Haridas
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Daniel G Ezra
- Moorfields Eye Hospital NHS Foundation Trust , London, UK.,The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
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Bezerra TC, Novaretti N, Cunha ALN, Pereira MAP, Oliveira DSD, Brito MCM, Pimentel ÂV, Tumas V. Epidemiological and clinical aspects of a sample of Brazilian patients with primary dystonia and the impact of the new classification on their clinical evaluation. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:821-826. [PMID: 30698205 DOI: 10.1590/0004-282x20180138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/24/2018] [Indexed: 11/22/2022]
Abstract
Dystonia is a relatively common movement disorder but some of its epidemiological and clinical aspects have not been well characterized in Brazilian patients. Also, a new clinical classification for the disorder has been proposed and its impact on clinical practice is unclear. We aimed to describe the clinical and demographic characteristics of a Brazilian series of patients with primary dystonia, to estimate its local prevalence, and to explore the impact of using a new classification for dystonia. We identified 289 patients with primary dystonia over a 12-month period, of whom235 underwent a detailed evaluation. Patients with primary dystoniamade up one-sixth of all patients evaluated at the service where the study was conducted, with an estimated local prevalence of 19.8/100,000 inhabitants. The clinical and demographic characteristics of the patients were similar to those described elsewhere, with blepharospasm as the most common focal dystonia and most patients using sensory tricks that they judged useful on a day-to-day basis. The application of the new classification was easy and simple, and the systematic approach allowed for a better clinical characterization of our patients. We recognized two dystonic syndromes that were not described in the original article that proposed the classification, and suspected that the arbitrary distinction between generalized and multifocal dystonia seems not to be useful for patients with primary dystonia. In conclusion, the prevalence and clinical characteristics of our patients were not distinct from other studies and the new classification was shown to be practical and useful to characterize patients with dystonia.
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Affiliation(s)
- Torben Cavalcante Bezerra
- Universidade Federal do Amazonas, Faculdade de Medicina, Departamento de Cirurgia, Manaus AM, Brasil
| | - Nathália Novaretti
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociência e Ciências do Comportamento, São Paulo SP, Brasil
| | - Ana Luiza Nunes Cunha
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociência e Ciências do Comportamento, São Paulo SP, Brasil
| | - Márcio Alexandre Pena Pereira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociência e Ciências do Comportamento, São Paulo SP, Brasil
| | - Daniel Sabino de Oliveira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociência e Ciências do Comportamento, São Paulo SP, Brasil
| | - Manuelina Capelari Marcuz Brito
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociência e Ciências do Comportamento, São Paulo SP, Brasil
| | - Ângela Vieira Pimentel
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociência e Ciências do Comportamento, São Paulo SP, Brasil
| | - Vitor Tumas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociência e Ciências do Comportamento, São Paulo SP, Brasil
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A trial of a mechanical device for the treatment of blepharospasm. Eye (Lond) 2019; 33:1803-1808. [PMID: 31267089 DOI: 10.1038/s41433-019-0495-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Idiopathic blepharospasm (IB) is a rare but well-characterised adult onset focal dystonia that may cause severe visual disability. The most effective treatment is with periodic injections of botulinum toxin (BTX) into the pre-tarsal and/or pre-septal orbicularis oculi muscles bilaterally. However, even with treatment, practical visual function often remains compromised. A subset of IB sufferers find that eye opening improves with a focal unilateral digital pressure usually on a specific point on the temple. This is known as a 'sensory trick'. We have developed a spectacle mounted device ('Pressop') to apply continuous individually localised focal pressure on the temple to mimic the effect of finger pressure. The aim of the study was to determine if the 'sensory trick' could be replicated by Pressop and if the interval between BTX treatments could thereby be extended. SUBJECTS/METHODS Study participants had three clinic visits-an initial screening assessment, a visit 2 weeks before the next injection was due when the device was fitted, and one 2 weeks later to assess the response to Pressop. A CDQ 24 and device-specific feedback questionnaire were completed and comparison photographs were taken. Repeat BTX injections were administered at the third visit. RESULTS Of 58 patients with typical IB recruited to the trial, 39 reported an effective focal finger pressure sensory trick. 56 completed the trial, more than 50% of whom reported some benefit using Pressop; 18% had substantial improvement, sustained for up to 5 years. Improvement could occur in those without an effective sensory trick, therefore there was no significant correlation between using a sensory trick and benefiting from 'Pressop'. There was a trend towards the responders having greater improvement in CDQ24 total score than non-responders but this was not statistically significant. CONCLUSIONS We recommend a trial of this simple safe device as a means of augmenting visual function in all IB patients.
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Lorenzano D, Tansley S, Ezra DG. Sensory Trick Frames: A New Device for Blepharospasm Patients. J Mov Disord 2019; 12:22-26. [PMID: 30642155 PMCID: PMC6369377 DOI: 10.14802/jmd.18010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/17/2018] [Indexed: 12/01/2022] Open
Abstract
Objective To determine whether the use of unique customized spectacles provided with modified side arms may be helpful in reducing benign essential blepharospasm (BEB) in patients describing periocular sensory tricks (ST). Methods A prospective descriptive study of patients with BEB with positive periocular or temporal region ST phenomenon response under the care of the Botox Clinic at Moorfields Eye Hospital, London, UK. Nine consecutive patients with BEB describing ST were recruited, and the disease frequency and severity were assessed with the Jankovic Rating Scale (JRS) and the Blepharospasm Disability Index (BSDI) before and after the use of the sensory trick frames (STF). Results A reduction in the score was noted in both severity (p = 0.0115) and frequency patterns (p = 0.0117) in the JRS in patients using the STF. A significant reduction of the BSDI score was also observed (p = 0.0314). Conclusion All the patients selected and fitted with the STF had a reduction in spasms and related symptoms. This new device may be helpful in some selected BEB patients who previously responded positively to periocular pressure alleviating maneuvers.
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Affiliation(s)
| | - Steven Tansley
- Spectacle Dispensing Department, Moorfields Eye Hospital, London, UK
| | - Daniel G Ezra
- Adnexal Service, Moorfields Eye Hospital, London, UK.,NIHR Biomedical Research Center for Ophthalmology, London, UK
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8
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Pandey S, Bhattad S. Sensory tricks. ANNALS OF MOVEMENT DISORDERS 2019. [DOI: 10.4103/aomd.aomd_20_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Camargos S, Cardoso F. Understanding dystonia: diagnostic issues and how to overcome them. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:921-936. [DOI: 10.1590/0004-282x20160140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/07/2016] [Indexed: 08/30/2023]
Abstract
ABSTRACT The diagnosis and treatment of dystonia are challenging. This is likely due to gaps in the complete understanding of its pathophysiology, lack of animal models for translational studies, absence of a consistent pathological substrate and highly variable phenotypes and genotypes. The aim of this review article is to provide an overview of the clinical, neurophysiological and genetic features of dystonia that can help in the identification of this movement disorder, as well as in the differential diagnosis of the main forms of genetic dystonia. The variation of penetrance, age of onset, and topographic distribution of the disease in carriers of the same genetic mutation indicates that other factors – either genetic or environmental – might be involved in the development of symptoms. The growing knowledge of cell dysfunction in mutants may give insights into more effective therapeutic targets.
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Waxman J, Hersh D, Murta F, Ezra DG. Language modulation of benign essential blepharospasm. Mov Disord 2016; 31:764-5. [PMID: 26990543 DOI: 10.1002/mds.26531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | | | - Daniel George Ezra
- University College London, London, UK.,Moorfields Eye Hospital, London, UK
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Broussolle E, Laurencin C, Bernard E, Thobois S, Danaila T, Krack P. Early Illustrations of Geste Antagoniste in Cervical and Generalized Dystonia. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:332. [PMID: 26417535 PMCID: PMC4582593 DOI: 10.7916/d8kd1x74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/01/2015] [Indexed: 12/03/2022]
Abstract
Background Geste antagoniste, or sensory trick, is a voluntary maneuver that temporarily reduces the severity of dystonic postures or movements. We present a historical review of early reports and illustrations of geste antagoniste. Results In 1894, Brissaud described this phenomenon in Paris in patients with torticollis. He noted that a violent muscular contraction could be reversed by a minor voluntary action. He considered the improvement obtained by what he called “simple mannerisms, childish behaviour or fake pathological movements” was proof of the psychogenic origin of what he named mental torticollis. This concept was supported by photographical illustrations of the patients. The term geste antagoniste was used by Brissaud’s pupils, Meige and Feindel, in their 1902 monograph on movement disorders. Other reports and illustrations of this sign were published in Europe between 1894 and 1906. Although not mentioned explicitly, geste antagoniste was also illustrated in a case report of generalized dystonia in Oppenheim’s 1911 seminal description of dystonia musculorum deformans in Berlin. Discussion Brissaud-Meige’s misinterpretation of the geste antagoniste unfortunately anchored the psychogenic origin of dystonia for decades. In New York, Herz brought dystonia back into the realm of organic neurology in 1944. Thereafter, it was given prominence by other authors, notably Fahn and Marsden in the 1970–1980s. Nowadays, neurologists routinely investigate for geste antagoniste when a dystonic syndrome is suspected, because it provides a further argument in favor of dystonia. The term alleviating maneuver was proposed in 2014 to replace sensory trick or geste antagoniste. This major sign is now part of the motor phenomenology of the 2013 Movement Disorder Society’s classification of dystonia.
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Affiliation(s)
- Emmanuel Broussolle
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France ; CNRS UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Chloé Laurencin
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France
| | - Emilien Bernard
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France ; CNRS UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Teodor Danaila
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France ; Université Claude Bernard Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France ; CNRS UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Paul Krack
- Département de Psychiatrie et de Neurologie, Unité des Mouvements Anormaux, Centre Hospitalier Universitaire de Grenoble, Grenoble, France ; INSERM Unité 836, Grenoble Institut des Neurosciences, Grenoble, France ; Université Joseph Fourier, Grenoble, France
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Huang XF, Wang KY, Liang ZH, Du RR, Zhou LN. Clinical Analysis of Patients with Primary Blepharospasm: A Report of 100 Cases in China. Eur Neurol 2015; 73:337-41. [PMID: 25997849 DOI: 10.1159/000381707] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/15/2015] [Indexed: 11/19/2022]
Abstract
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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Affiliation(s)
- Xiao-Feng Huang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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13
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Hellman A, Torres-Russotto D. Botulinum toxin in the management of blepharospasm: current evidence and recent developments. Ther Adv Neurol Disord 2015; 8:82-91. [PMID: 25922620 DOI: 10.1177/1756285614557475] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Blepharospasm is a focal (although usually bilateral) dystonia of the orbicularis oculi muscles, producing excessive eye closure. This produces significant disability through functional blindness. Botulinum neurotoxins (BoNT) have become the treatment of choice for blepharospasm; the impressive response rate and the tolerable safety profile have been proven through multiple clinical studies. There are currently four BoNT approved in the United States for different indications - we review the data on blepharospasm for each of these drugs. Currently, incobotulinumtoxinA and onabotulinumtoxinA have the most evidence of benefit for patients with blepharospasm. Current evidence, recent development and future directions are discussed.
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Affiliation(s)
- Amy Hellman
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, 988435 Nebraska Medical Center, Omaha, NE 68198, USA
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Fayers T, Shaw SR, Hau SC, Ezra DG. Changes in corneal aesthesiometry and the sub-basal nerve plexus in benign essential blepharospasm. Br J Ophthalmol 2015; 99:1509-13. [PMID: 25904123 DOI: 10.1136/bjophthalmol-2014-306426] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/04/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aetiology of blepharospasm remains unclear. There is evidence that the afferent pathway is important, but this area remains under-researched. AIM To explore the hypothesis that the afferent arm of the blink reflex is abnormal in blepharospasm by assessing a range of measures of corneal sensory function. METHODS In this prospective case-control study, 21 patients with blepharospasm and 21 age-matched and gender-matched controls completed the Ocular Surface Disease Index questionnaire and underwent the following assessments: tear osmolarity, Shirmer test, tear-film break up time, corneal and conjunctival vital staining, meibomian gland dysfunction, corneal aesthesiometry and confocal microscopy. RESULTS Corneal sensitivity was significantly lower in patients with blepharospasm than in controls (right eyes p=0.009; left eyes p=0.009, paired t test). The median number of main nerve trunks was lower for patients with blepharospasm than for controls, and this was statistically significant at the 5% level (p=0.04, paired t test). Mean nerve density, median number of nerve branches and median total number of nerves were lower for blepharospasm cases than controls, but this did not reach statistical significance. Tortuosity was greater for blepharospasm cases than controls, but this was not statistically significant. CONCLUSIONS Blepharospasm is associated with reduced corneal aesthesiometry and a tendency towards a reduced number of nerves in the sub-basal plexus, implying an impairment in corticosensory processing, possibly a defect of the sensorimotor gating mechanism resulting in a loss of inhibition of the blink reflex.
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Affiliation(s)
| | | | | | - Daniel G Ezra
- Moorfields Eye Hospital, London, UK UCL Institute of Ophthalmology, London, UK NIHR Biomedical Research Centre for Ophthalmology, London, UK
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Şen A, Soysal A, Arpaci B. Clinical Characteristics and Response to Long-Term Botulinum Toxin Type A Therapy in Patients with Cervical Dystonia at a Neurology Clinic. Noro Psikiyatr Ars 2014; 51:383-388. [PMID: 28360658 DOI: 10.5152/npa.2014.7026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 09/15/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To determine the demographic and clinical characteristics and response to botulinum toxin type A (BoNT-A) therapy in patients with cervical dystonia (CD). METHOD A retrospective analysis of the detailed medical records of the patients with CD, followed up at our Botulinum Toxin Outpatient Clinic from 1998 to 2012, was performed. The treatment data were compared between the patients with primary CD and those with secondary CD; between patients receiving BoNT-A treatment for more than 5 years and less than five years, and between first applications and last applications. RESULTS Fifty-seven patients (56.15% women) with CD were included in this study. The mean age was 41.01±13.42 years, the mean age at symptom onset was 32.93±15.45 years, and the mean dystonia duration was 8.10±8.5 years. The interval between onset of symptom and first BoNT-A treatment was 5.94±9.06 years, the duration of BoNT-A treatment was 36.13±29.17 months, and the number of applications was 8.48±6.23 in 45 patients with CD who were under treatment with BoNT-A for more than 1 year and had received at least three injections before. There was no difference between the patients with primary and secondary CD in terms of treatment results. The injection interval of the patients receiving BoNT-A treatment for more than 5 years and less than 5 years was 18.37±5.10 and 14.43±2.36 weeks, respectively (p=.001). There were no differences in the other treatment values. The mean doses were 559.00±147.60 vs. 681.66±188.09 units (p=.0001), the durations of improvement were 11.82±2.71 vs. 13.00±4.00 weeks (p=.014), the response scores were 2.71±.3 vs. 3.02±.5 (p=.002), the response ratings were 64.66%±16.18 vs. 71.22%±17.29 (p=.001), and the numbers of muscles applied were 3.15±1.16 vs. 3.51±0.99 (p=.012) in the first and last applications, respectively. CONCLUSION There were no differences between the response of the patients with primary and secondary CD. Our results showed a statistically significant increase in the mean dose of BoNT-A, the response rating, the number of muscles applied, the duration of improvement, and the injection interval over time.
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Affiliation(s)
- Aysu Şen
- Bakırköy Prof Dr Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Clinic of Neurology, İstanbul, Turkey
| | - Aysun Soysal
- Bakırköy Prof Dr Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Clinic of Neurology, İstanbul, Turkey
| | - Baki Arpaci
- Bakırköy Prof Dr Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Clinic of Neurology, İstanbul, Turkey
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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17
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Patel N, Hanfelt J, Marsh L, Jankovic J. Alleviating manoeuvres (sensory tricks) in cervical dystonia. J Neurol Neurosurg Psychiatry 2014; 85:882-4. [PMID: 24828895 PMCID: PMC4871143 DOI: 10.1136/jnnp-2013-307316] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is limited information on the phenomenology, clinical characteristics and pathophysiology of alleviating manoeuvres (AM), also called 'sensory tricks' in cervical dystonia (CD). METHODS Individual data, collected from 10 sites participating in the Dystonia Coalition (http://clinicaltrials.gov/show/NCT01373424), included description of localisation and phenomenology of AM collected by systematic review of standardised video examinations. Analyses correlated demographic, neurologic, and psychiatric features of CD patients with or without effective AM. RESULTS Of 154 people studied, 138 (89.6%) used AM, of which 60 (43.4%) reported partial improvement, 55 (39.8%) marked improvement, and 4 (0.03%) no effect on dystonic posture. Light touch, usually to the lower face or neck, was used by >90%. The presence or location of AM did not correlate with the severity of the dystonia. CONCLUSIONS In this large and comprehensive study of CD, we found no clinical predictors of effective AM. Further studies of sensorimotor integration in dystonia are needed to better understand the pathophysiology of AM.
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Affiliation(s)
- Neepa Patel
- Department of Neurology and Neurotherapeutics, Center for Movement Disorders, University of Texas Southwestern, Dallas, Texas, USA
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Laura Marsh
- Departments of Psychiatry and Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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