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Cao L, Palmisano C, Chen X, Isaias IU, Händel BF. Spontaneous blink-related beta power increase and theta phase reset in subthalamic nucleus of Parkinson patients during walking. Clin Neurophysiol 2024; 161:17-26. [PMID: 38432185 DOI: 10.1016/j.clinph.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/20/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Both blinking and walking are altered in Parkinson's disease and both motor outputs have been shown to be linked in healthy subjects. Additionally, studies suggest an involvement of basal ganglia activity and striatal dopamine in blink generation. We investigated the role of the basal ganglia circuitry on spontaneous blinking and if this role is dependent on movement state and striatal dopamine. METHODS We analysed subthalamic nucleus (STN) activity in seven chronically implanted patients for deep brain stimulation (DBS) with respect to blinks and movement state (resting state and unperturbed walking). Neurophysiological recordings were combined with individual molecular brain imaging assessing the dopamine reuptake transporter (DAT) density for the left and right striatum separately. RESULTS We found a significantly higher blink rate during walking compared to resting. The blink rate during walking positively correlated with the DAT density of the left caudate nucleus. During walking only, spontaneous blinking was followed by an increase in the right STN beta power and a bilateral subthalamic phase reset in the low frequencies. The right STN blink-related beta power modulation correlated negatively with the DAT density of the contralateral putamen. The left STN blink-related beta power correlated with the DAT density of the putamen in the less dopamine-depleted hemisphere. Both correlations were specific to the walking condition and to beta power following a blink. CONCLUSION Our findings show that spontaneous blinking is related to striatal dopamine and has a frequency specific deployment in the STN. This correlation depends on the current movement state such as walking. SIGNIFICANCE This work indicates that subcortical activity following a motor event as well as the relationship between dopamine and motor events can be dependent on the motor state. Accordingly, disease related changes in brain activity should be assessed during natural movement.
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Affiliation(s)
- Liyu Cao
- Department of Psychology and Behavioural Sciences, Zhejiang University, Hangzhou, China; Department of Psychology (III), Julius-Maximilian-University of Würzburg, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Xinyu Chen
- Department of Psychology (III), Julius-Maximilian-University of Würzburg, Würzburg, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini CTO, Milano, Italy
| | - Barbara F Händel
- Department of Psychology (III), Julius-Maximilian-University of Würzburg, Würzburg, Germany; Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany.
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Xu J, Luo Y, Zhang J, Zhong L, Liu H, Weng A, Yang Z, Zhang Y, Ou Z, Yan Z, Cheng Q, Fan X, Zhang X, Zhang W, Hu Q, Liang D, Peng K, Liu G. Progressive thalamic nuclear atrophy in blepharospasm and blepharospasm-oromandibular dystonia. Brain Commun 2024; 6:fcae117. [PMID: 38638150 PMCID: PMC11025674 DOI: 10.1093/braincomms/fcae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/21/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
The thalamus is considered a key region in the neuromechanisms of blepharospasm. However, previous studies considered it as a single, homogeneous structure, disregarding potentially useful information about distinct thalamic nuclei. Herein, we aimed to examine (i) whether grey matter volume differs across thalamic subregions/nuclei in patients with blepharospasm and blepharospasm-oromandibular dystonia; (ii) causal relationships among abnormal thalamic nuclei; and (iii) whether these abnormal features can be used as neuroimaging biomarkers to distinguish patients with blepharospasm from blepharospasm-oromandibular dystonia and those with dystonia from healthy controls. Structural MRI data were collected from 56 patients with blepharospasm, 20 with blepharospasm-oromandibular dystonia and 58 healthy controls. Differences in thalamic nuclei volumes between groups and their relationships to clinical information were analysed in patients with dystonia. Granger causality analysis was employed to explore the causal effects among abnormal thalamic nuclei. Support vector machines were used to test whether these abnormal features could distinguish patients with different forms of dystonia and those with dystonia from healthy controls. Compared with healthy controls, patients with blepharospasm exhibited reduced grey matter volume in the lateral geniculate and pulvinar inferior nuclei, whereas those with blepharospasm-oromandibular dystonia showed decreased grey matter volume in the ventral anterior and ventral lateral anterior nuclei. Atrophy in the pulvinar inferior nucleus in blepharospasm patients and in the ventral lateral anterior nucleus in blepharospasm-oromandibular dystonia patients was negatively correlated with clinical severity and disease duration, respectively. The proposed machine learning scheme yielded a high accuracy in distinguishing blepharospasm patients from healthy controls (accuracy: 0.89), blepharospasm-oromandibular dystonia patients from healthy controls (accuracy: 0.82) and blepharospasm from blepharospasm-oromandibular dystonia patients (accuracy: 0.94). Most importantly, Granger causality analysis revealed that a progressive driving pathway from pulvinar inferior nuclear atrophy extends to lateral geniculate nuclear atrophy and then to ventral lateral anterior nuclear atrophy with increasing clinical severity in patients with blepharospasm. These findings suggest that the pulvinar inferior nucleus in the thalamus is the focal origin of blepharospasm, extending to pulvinar inferior nuclear atrophy and subsequently extending to the ventral lateral anterior nucleus causing involuntary lower facial and masticatory movements known as blepharospasm-oromandibular dystonia. Moreover, our results also provide potential targets for neuromodulation especially deep brain stimulation in patients with blepharospasm and blepharospasm-oromandibular dystonia.
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Affiliation(s)
- Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yuhan Luo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Jiana Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Linchang Zhong
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Huiming Liu
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ai Weng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zhengkun Yang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Yue Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zilin Ou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zhicong Yan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Qinxiu Cheng
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xinxin Fan
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xiaodong Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Weixi Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Dong Liang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Kangqiang Peng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Gang Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
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Mechelli A, Quattrone A, Nisticò R, Crasà M, La Torre D, Vescio B, Quattrone A. Blink reflex recovery cycle distinguishes patients with idiopathic normal pressure hydrocephalus from elderly subjects. J Neurol 2021; 269:1007-1012. [PMID: 34213613 DOI: 10.1007/s00415-021-10687-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The R2 component of blink reflex recovery cycle (R2BRrc) is a simple neurophysiological tool to detect the brainstem hyperexcitability commonly occurring in several neurological diseases such as Parkinson's disease and atypical parkinsonisms. In our study, we investigated for the first time the usefulness of R2BRrc to assess brainstem excitability in patients with idiopathic Normal Pressure Hydrocephalus (iNPH) in comparison with healthy subjects. METHODS Eighteen iNPH patients and 25 age-matched control subjects were enrolled. R2BRrc was bilaterally evaluated at interstimulus intervals (ISIs) of 100, 150, 200, 300, 400, 500 and 750 ms in all participants. We investigated the diagnostic performance of R2BRrc in differentiating iNPH patients from control subjects using ROC analysis. Midbrain area and Magnetic Resonance Hydrocephalic Index (MRHI), an MRI biomarker for the diagnosis of iNPH, were measured on T1-weighted MR images, and correlations between R2BRrc values and MRI measurements were investigated. RESULTS Fourteen (78%) of 18 iNPH patients showed an enhanced R2BRrc at ISIs 100-150-200 ms, while no control subjects had abnormal R2BRrc. The mean amplitude of bilateral R2BRrc at the shortest ISIs (100-150-200 ms) showed high accuracy in differentiating iNPH patients from controls (AUC = 0.89). R2BRrc values significantly correlated with midbrain area and MRHI values. CONCLUSIONS This study represents the first evidence of brainstem hyperexcitability in iNPH patients. Given its low cost and wide availability, R2BRrc could be a useful tool for selecting elderly subjects with mild gait and urinary dysfunction who should undergo an extensive diagnostic workup for the diagnosis of NPH.
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Affiliation(s)
- Alessandro Mechelli
- Department of Medical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Andrea Quattrone
- Department of Medical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Rita Nisticò
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Marianna Crasà
- Neuroscience Research Centre, University Magna Graecia, Catanzaro, Italy
| | - Domenico La Torre
- Department of Medical Sciences, Institute of Neurosurgery, University Magna Graecia, Catanzaro, Italy
| | | | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy. .,Neuroscience Research Centre, University Magna Graecia, Catanzaro, Italy. .,Neuroscience Centre and Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Magna Graecia University, 88100, Catanzaro, Italy.
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Blitzer AL, Phelps PO. Facial spasms. Dis Mon 2020; 66:101041. [PMID: 32622683 DOI: 10.1016/j.disamonth.2020.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Andrea L Blitzer
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
| | - Paul O Phelps
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States; Division of Ophthalmology, NorthShore University HealthSystem, Evanston, IL, United States.
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Dong H, Luo Y, Fan S, Yin B, Weng C, Peng B. Screening Gene Mutations in Chinese Patients With Benign Essential Blepharospasm. Front Neurol 2020; 10:1387. [PMID: 32038460 PMCID: PMC6989602 DOI: 10.3389/fneur.2019.01387] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: This study aimed to screen gene mutations in Chinese patients with benign essential blepharospasm (BEB) to understand its etiology. Methods: Twenty BEB patients diagnosed by clinical manifestations between April 2015 and October 2015 were enrolled. All the cases were investigated by questionnaires about general conditions, social behavioral factors, environmental factors, psychological factors, genetic factors, and previous diseases. In each patient, a total of 151 genes related to movement disorders were analyzed by second-generation sequencing. Results: Two patients had a family history of BEB, and they had SYNE1 and Cdkn1A-interacting zinc finger protein 1 (CIZ1) mutation, respectively. We found the SYNE1 mutation in seven patients, the CIZ1 mutation in two patients, the CACNA1A mutation in two patients, the LRRK2 mutation in two patients, and the FUS mutation in two patients. The C10orf2, TPP1, SLC1A3, PNKD, EIF4G1, SETX, PRRT2, SPTBN2, and TTBK2 mutations were found in only one patient, respectively, while not any mutation in the 151 genes were found in two patients. Some patients had mutations in two genes. Conclusion: Genetic factors, especially SYNE1 and CIZ1 mutations, contribute to the etiology of BEB.
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Affiliation(s)
- Hongjuan Dong
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ying Luo
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shanghua Fan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bo Yin
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chao Weng
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bin Peng
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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Fang XB, Xie MS, Song ZB, Zhong ZG, Wang Y, Ou ZL, Dang C, Li L, Zhang WX. Long-term treatment of blepharospasm with botulinum toxin A: a service-based study over a 16-year follow-up in southern China. Neurol Sci 2019; 41:645-652. [PMID: 31745757 DOI: 10.1007/s10072-019-04123-8] [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] [Received: 07/25/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To elucidate the effect of long-term treatment with botulinum toxin A (BTX-A) for blepharospasm. Prevalence data and clinical features in southern China and influencing factors for selecting BTX-A treatment were explored. METHODS We collected data retrospectively from 338 consecutive patients diagnosed with blepharospasm over 16 years to assess prevalence data and clinical features. Thereafter, all patients were classified into BTX-A (n = 135) or non-BTX-A (n = 203) treatment groups according to the patients' requests in order to explore the factors influencing whether BTX-A treatment was chosen. Furthermore, dynamic follow-up data were analyzed to evaluate the long-term efficacy in the BTX-A group. RESULTS The prevalence was 23.3 per million, with an onset age of 50.3 ± 12.3 years and a female:male ratio of 2.4:1; the most common symptom was excessive blinking (91.2%). The symptom severity and psychological assessment scores were significantly decreased by treatment with BTX-A (p < 0.01), and there was no significant difference in response duration with the prolongation of BTX-A injections. Adverse events occurred 52 times (5.0%) among 1038 injections. The symptom severity and psychological assessment scores and the occurrence of eye-opening difficulty were higher, and medical expenses and the symptom tolerability rate were lower in the BTX-A group than in the non-BTX-A group (p < 0.05). CONCLUSION The onset age was earlier than that in Western countries. However, starting BTX-A treatment early is justified, even though a higher dosage was needed to maintain reliable long-term efficacy. Additionally, symptom severity and medical expenses are the primary factors affecting whether patients select BTX-A treatment.
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Affiliation(s)
- Xiao-Bo Fang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Meng-Shu Xie
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Zu-Biao Song
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Zhi-Gang Zhong
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Ying Wang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Zi-Lin Ou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Chao Dang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Ling Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Wei-Xi Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, China.
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Ferrazzano G, Conte A, Belvisi D, Fabbrini A, Baione V, Berardelli A, Fabbrini G. Writing, reading, and speaking in blepharospasm. J Neurol 2019; 266:1136-1140. [PMID: 30783748 DOI: 10.1007/s00415-019-09243-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/25/2019] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Abstract
The aim of the study was to evaluate the effects of writing, reading, and speaking on orbiculari oculi (OO) muscle spasms and on the blink rate in patients with blepharospasm (BSP). Patients with hemifacial spasm (HFS) and healthy subjects (HS) acted as control subjects. Thirty patients with BSP, 20 patients with primary HFS and 20 age-matched healthy subjects were videotaped according to a standardized procedure: at rest with eyes open; while writing a standard sentence on paper; while writing a standard sentence on a blackboard keeping the head straight; during a conversation based on a simple topic (speaking task); and while reading a standard text aloud. Two independent movement disorders specialists reviewed the videotapes and measured the number of OO spasms and blinks in each segment. Writing and reading reduced the number of OO spasms in BSP patients, whereas speaking did not. On the other hand, writing, reading, and speaking did not modify spasms in HFS patients. These tasks modulated the blink rate in all the three groups of subjects (BSP, HFS, and HS). Our hypothesis is that the modulation of OO spasm in BSP during writing and reading depends on influences coming from occipital areas onto the brainstem circuits. Whether cognitive training with reading and writing may be used to improve OO muscle spasms is an issue that warrants further investigation.
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Affiliation(s)
| | - Antonella Conte
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università 30, 00185, Rome, Italy
| | | | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università 30, 00185, Rome, Italy
| | - Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università 30, 00185, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università 30, 00185, Rome, Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy. .,Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università 30, 00185, Rome, Italy.
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Wakakura M, Yamagami A, Iwasa M. Blepharospasm in Japan: A Clinical Observational Study From a Large Referral Hospital in Tokyo. Neuroophthalmology 2018; 42:275-283. [PMID: 30258472 DOI: 10.1080/01658107.2017.1409770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/13/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022] Open
Abstract
Focal dystonia is regarded as a characteristic feature of blepharospasm. However, patients do not always present with motor symptoms. To clarify the clinical features of blepharospasm in Japan, we conducted a retrospective observational study involving a large population of patients from a single institution. Common symptoms included difficulty opening the eyes, photophobia, and ocular pain/irritation. Initial symptoms often occurred following the long-term use of psychotropics such as etizoram, benzodiazepines, and zolpidem (32% of patients). Our findings demonstrated that the clinical presentation of blepharospasm is heterogenous, and that understanding regarding sensory-dominant forms of the disease may be poor among practitioners in Japan.
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Affiliation(s)
- M Wakakura
- Division of Neuro-ophthalmology, Inouye Eye Hospital, Tokyo, Japan
| | - A Yamagami
- Division of Neuro-ophthalmology, Inouye Eye Hospital, Tokyo, Japan
| | - M Iwasa
- Division of Neuro-ophthalmology, Inouye Eye Hospital, Tokyo, Japan
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Abstract
OPINION STATEMENT The treatment of both hemifacial spasm (HFS) and blepharospasm (BEB) requires making the appropriate clinical diagnosis. Advance imaging and electrophysiologic studies are useful; however, one's clinical suspicion is paramount. The purpose of this review is to summarize current and emerging therapies for both entities. Botulinum toxin (BTX) remains the first-line therapy to treat both conditions. If chemodenervation has failed, surgery may be considered. Due to the risks associated with surgery, the benefits of this option must be carefully weighed. Better surgical outcomes are possible when procedures are performed at tertiary centers with experienced surgeons and advanced imaging techniques. Microvascular decompression is an efficacious method to treat HFS, and myectomy is an option for medication-refractory BEB; the risks of the latter may outweigh any meaningful clinical benefits. Oral agents only provide short-term relief and can cause several unwanted effects; they are reserved for patients who cannot receive BTX and/or surgery. Transcranial magnetic stimulation has gained some traction in the treatment of BEB and may provide safer non-invasive options for refractory patients in the future.
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Affiliation(s)
- Kemar E Green
- Departments of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
| | - David Rastall
- Michigan State University, College of Osteopathic Medicine, East Lansing, MI, USA
| | - Eric Eggenberger
- Departments of Ophthalmology and Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
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