J Clin Neurol.  2005 Oct;1(2):159-165. 10.3988/jcn.2005.1.2.159.

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

• Yoon WT
• Chung EJ
• Lee SH
• Kim BJ
• Lee WY

• KMID: 1808486
• DOI: http://doi.org/10.3988/jcn.2005.1.2.159

Abstract

BACKGROUND AND PURPOSE
Blepharospasm (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.
METHODS
We 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.
RESULTS
BSP 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.
CONCLUSIONS
Reflex 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.

Keyword

Blepharospasm; Apraxia of eyelid opening; Parkinsonism; Reflex blepharospasm

MeSH Terms

Age of Onset
Apraxias*
Blepharospasm*
Dystonia
Eyelids*
Human Body
Humans
Levodopa
Multiple System Atrophy
Parkinson Disease
Parkinsonian Disorders*
Reflex
Levodopa

Figure

• 

  Figure 1 EMG of the levator palpebrae (LP) and orbicularis oculi (OO) in the normal individual (A), in the MSA-p patient with blepharospasm (B) and in the patient with blepharospasm and apraxia of eyelid opening (C). Comparing with normal finding (A), EMG showed a marked contraction of OO (white arrow) during eye opening (gray line) (B). During eye opening, OO inhibition was incomplete (gray arrow) and LP contraction was not sustained (black arrow) (C).

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