Skip to main content Accessibility help
×
Home
Hostname: page-component-544b6db54f-d2wc8 Total loading time: 0.435 Render date: 2021-10-21T13:06:04.614Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Book contents

Chapter 8 - Treatment of blepharospasm

Published online by Cambridge University Press:  05 February 2014

Carlo Colosimo
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
Dorina Tiple
Affiliation:
Dipartimento di Biologia Cellulare Neuroscienze, Istituto Superiore di Sanita, Roma, Italy
Alfredo Berardelli
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
Daniel Truong
Affiliation:
The Parkinson’s and Movement Disorders Institute, Fountain Valley, California
Dirk Dressler
Affiliation:
Department of Neurology, Hannover University Medical School
Mark Hallett
Affiliation:
George Washington University School of Medicine and Health Sciences, Washington, DC
Christopher Zachary
Affiliation:
Department of Dermatology, University of California, Irvine
Get access

Summary

Introduction

Primary blepharospasm is a common adult-onset focal dystonia, characterized by involuntary contractions of the periocular muscles that result in forceful eye closure and impaired opening and closing of the eyes (Marsden, 1976; Berardelli et al., 1985; Defazio et al., 2007). The severity of blepharospasm can vary from repeated frequent blinking, causing only minor discomfort, to persistent forceful closure of the eyelids leading to functional blindness (Fig. 8.1). Blepharospasm can be caused by tonic or phasic contractions of the orbicularis oculi muscles and may also be associated with levator palpebrae muscle inhibition (apraxia of eyelid opening) or involuntary movements in the lower face and masticatory muscles (Meige’s syndrome). In most cases, blepharospasm is considered primary and is only occasionally secondary to structural brain lesions or drug therapy (Jankovic, 2006).

Pathophysiology

Neurophysiological recordings of the blink reflex have given important insights into the pathophysiology of blepharospasm. In patients with blepharospasm, the recovery cycle of the R2 component of the blink reflex is enhanced, presumably owing to a lack of brainstem interneuronal inhibition (Berardelli et al., 1985, 1998). Blepharospasm is also associated with an abnormal responsiveness of the blink reflex to sensory stimuli. Studies using magnetic brain stimulation also suggest a loss of inhibition and increased plasticity in the central nervous system of patients with blepharospasm (Defazio et al., 2007; Quartarone et al., 2008).

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albanese, A, Bentivoglio, AR, Colosimo, C et al. (1996). Pretarsal injections of botulinum toxin improve blepharospasm in previously unresponsive patients. J Neurol Neurosurg Psychiatry, 61, 693–4.CrossRefGoogle Scholar
Berardelli, A, Rothwell, JC, Day, BL, Marsden, CD (1985). Pathophysiology of blepharospasm and oromandibular dystonia. Brain, 108, 593–608.CrossRefGoogle ScholarPubMed
Berardelli, A, Rothwell, JC, Hallett, M et al. (1998). The pathophysiology of primary dystonia. Brain, 121, 1195–1212.CrossRefGoogle ScholarPubMed
Cakmur, R, Ozturk, R, Uzunel, F, Donmez, B, Idiman, F (2002). Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm. J Neurol, 249, 64–8.CrossRefGoogle ScholarPubMed
Colosimo, C, Chianese, M, Contarino, F, Giovannelli, M, Bentivoglio, AR (2003). Botulinum toxin type B in blepharospasm. J Neurol Neurosurg Psychiatry, 74, 687.CrossRefGoogle ScholarPubMed
Colosimo, C, Tiple, D, Berardelli, A (2012). Efficacy and safety of long-term botulinum toxin treatment in craniocervical dystonia: a systematic review. Neurotox Res, 22, 265–73.CrossRefGoogle ScholarPubMed
Costa, J, Espírito-Santo, C, Borges, A et al. (2005). Botulinum toxin type A therapy for blepharospasm. Cochrane Database Syst Rev, (1), CD004900.Google Scholar
Defazio, G, Berardelli, A, Hallett, M (2007). Do primary adult-onset focal dystonias share aetiological factors?Brain, 130, 1183–93.CrossRefGoogle ScholarPubMed
Jankovic, J (2006). Treatment of dystonia. Lancet Neurol, 5, 864–72.CrossRefGoogle ScholarPubMed
Jankovic, J, Orman, J (1987). Botulinum A toxin for cranial-cervical dystonia: A double-blind, placebo-controlled study. Neurology, 37, 616–23.CrossRefGoogle ScholarPubMed
Marsden, CD (1976). Blepharospasm–oromandibular dystonia syndrome (Brueghel’s syndrome). A variant of adult-onset torsion dystonia?J Neurol Neurosurg Psychiatry, 39, 1204–9.CrossRefGoogle ScholarPubMed
Quartarone, A, Morgante, F, Sant’angelo, A et al. (2008). Abnormal plasticity of sensorimotor circuits extends beyond the affected body part in focal dystonia. J Neurol Neurosurg Psychiatry, 79, 985–90.CrossRefGoogle ScholarPubMed
Truong, D, Comella, C. et al. (2008). Efficacy and safety of purified botulinum toxin type A (Dysport) for the treatment of benign essential blepharospasm: a randomized, placebo-controlled, phase II trial. Parkinsonism Relat Disord, 14, 407–14.CrossRefGoogle ScholarPubMed
Ward, AB, Molenaers, G, Colosimo, C, Berardelli, A (2006). Clinical value of botulinum toxin in neurological indications. European J Neurol, 13(Suppl 4), 20–6.CrossRefGoogle ScholarPubMed

Send book to Kindle

To send this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats
×

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats
×