PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
J Neurol Neurosurg Psychiatry. 1988 June; 51(6): 767–772.
PMCID: PMC1033145

Blepharospasm: a review of 264 patients.

Abstract

The natural history and response to different treatments have been evaluated in 264 patients with blepharospasm. The mean age of onset was 55.8 years and there was a female preponderance of 1.8 to 1. Dystonia elsewhere was found in 78% of patients, usually in the cranial-cervical region, and appeared to follow a somatotopic progression. A family history of blepharospasm or dystonia elsewhere was found in 9.5% of cases, which suggests a genetic predisposition. Ocular lesions preceded the onset of blepharospasm in 12.1% of cases. The response to drugs was inconsistent, although initial improvement was experienced by one fifth of patients treated with anticholinergics. Twenty-nine bilateral facial nerve avulsion operations were performed with benefit in 27 cases; but recurrences appeared in 22, on average one year after surgery. Botulinum toxin injections were performed in 151 patients. Significant improvement was achieved in 118 cases. Mean duration of benefit was 9.2 weeks. Transient ptosis and diplopia were the commonest side effects.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (930K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Paulson GW. Meige's syndrome. Dyskinesia of the eyelids and facial muscles. Geriatrics. 1972 Aug;27(8):69–73. [PubMed]
  • Marsden CD. Blepharospasm-oromandibular dystonia syndrome (Brueghel's syndrome). A variant of adult-onset torsion dystonia? J Neurol Neurosurg Psychiatry. 1976 Dec;39(12):1204–1209. [PMC free article] [PubMed]
  • Tolosa ES. Clinical features of Meige's disease (idiopathic orofacial dystonia): a report of 17 cases. Arch Neurol. 1981 Mar;38(3):147–151. [PubMed]
  • Jankovic J, Ford J. Blepharospasm and orofacial-cervical dystonia: clinical and pharmacological findings in 100 patients. Ann Neurol. 1983 Apr;13(4):402–411. [PubMed]
  • Jankovic J, Orman J. Blepharospasm: demographic and clinical survey of 250 patients. Ann Ophthalmol. 1984 Apr;16(4):371–376. [PubMed]
  • Nutt JG, Hammerstad JP. Blepharospasm and oromandibular dystonia (Meige's syndrome) in sisters. Ann Neurol. 1981 Feb;9(2):189–191. [PubMed]
  • Marsden CD. The problem of adult-onset idiopathic torsion dystonia and other isolated dyskinesias in adult life (including blepharospasm, oromandibular dystonia, dystonic writer's cramp, and torticollis, or axial dystonia). Adv Neurol. 1976;14:259–276. [PubMed]
  • Corin MS, Elizan TS, Bender MB. Oculomotor function in patients with Parkinson's disease. J Neurol Sci. 1972 Mar;15(3):251–265. [PubMed]
  • Klawans HL, Jr, Erlich MA. Observations on the mechanism of parkinsonian blepharospasm and its treatment with L-dopa. Eur Neurol. 1970;3(6):365–372. [PubMed]
  • Jackson JA, Jankovic J, Ford J. Progressive supranuclear palsy: clinical features and response to treatment in 16 patients. Ann Neurol. 1983 Mar;13(3):273–278. [PubMed]
  • Weiner WJ, Nausieda PA, Glantz RH. Meige syndrome (blepharospasm-oromandibular dystonia) after long-term neuroleptic therapy. Neurology. 1981 Dec;31(12):1555–1556. [PubMed]
  • Burke RE, Fahn S, Jankovic J, Marsden CD, Lang AE, Gollomp S, Ilson J. Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology. 1982 Dec;32(12):1335–1346. [PubMed]
  • Weiner WJ, Nausieda PA. Meige's syndrome during long-term dopaminergic therapy in Parkinson's disease. Arch Neurol. 1982 Jul;39(7):451–452. [PubMed]
  • Powers JM. Decongestant-induced blepharospasm and orofacial dystonia. JAMA. 1982 Jun 18;247(23):3244–3245. [PubMed]
  • Keane JR, Young JA. Blepharospasm with bilateral basal ganglia infarction. Arch Neurol. 1985 Dec;42(12):1206–1208. [PubMed]
  • Jankovic J. Blepharospasm with basal ganglia lesions. Arch Neurol. 1986 Sep;43(9):866–868. [PubMed]
  • Powers JM. Blepharospasm due to unilateral diencephalon infarction. Neurology. 1985 Feb;35(2):283–284. [PubMed]
  • Jankovic J, Patel SC. Blepharospasm associated with brainstem lesions. Neurology. 1983 Sep;33(9):1237–1240. [PubMed]
  • Day TJ, Lefroy RB, Mastaglia FL. Meige's syndrome and palatal myoclonus associated with brain stem stroke. A common mechanism? J Neurol Neurosurg Psychiatry. 1986 Nov;49(11):1324–1325. [PMC free article] [PubMed]
  • Blepharospasm associated with palatal myoclonus and communicating hydrocephalus. Neurology. 1984 Nov;34(11):1522–1524. [PubMed]
  • Leenders KL, Frackowiak RS, Quinn N, Brooks D, Sumner D, Marsden CD. Ipsilateral blepharospasm and contralateral hemidystonia and parkinsonism in a patient with a unilateral rostral brainstem-thalamic lesion: structural and functional abnormalities studied with CT, MRI, and PET scanning. Mov Disord. 1986;1(1):51–58. [PubMed]
  • García-Albea E, Franch O, Muñoz D, Ricoy JR. Brueghel's syndrome, report of a case with postmortem studies. J Neurol Neurosurg Psychiatry. 1981 May;44(5):437–440. [PMC free article] [PubMed]
  • Altrocchi PH, Forno LS. Spontaneous oral-facial dyskinesia: neuropathology of a case. Neurology. 1983 Jun;33(6):802–805. [PubMed]
  • Jankovic J, Havins WE, Wilkins RB. Blinking and blepharospasm. Mechanism, diagnosis, and management. JAMA. 1982 Dec 17;248(23):3160–3164. [PubMed]
  • Berardelli A, Rothwell JC, Day BL, Marsden CD. Pathophysiology of blepharospasm and oromandibular dystonia. Brain. 1985 Sep;108(Pt 3):593–608. [PubMed]
  • Sheehy MP, Marsden CD. Trauma and pain in spasmodic torticollis. Lancet. 1980 Apr 5;1(8171):777–778. [PubMed]
  • Sheehy MP, Marsden CD. Writers' cramp-a focal dystonia. Brain. 1982 Sep;105(Pt 3):461–480. [PubMed]
  • Schott GD. The relationship of peripheral trauma and pain to dystonia. J Neurol Neurosurg Psychiatry. 1985 Jul;48(7):698–701. [PMC free article] [PubMed]
  • Miller E. Dimethyl aminoethanol in the treatment of blepharospasm. N Engl J Med. 1973 Sep 27;289(13):697–697. [PubMed]
  • Chakravorty NK. Treatment of blepharospasm with levodopa. Postgrad Med J. 1974 Aug;50(586):521–523. [PMC free article] [PubMed]
  • Merikangas JR, Reynolds CF., 3rd Blepharospasm: successful treatment with clonazepam. Ann Neurol. 1979 Apr;5(4):401–402. [PubMed]
  • Skarf B, Sharpe JA. Choline for blepharospasm. N Engl J Med. 1981 Oct 15;305(16):957–958. [PubMed]
  • Jankovic J. Treatment of hyperkinetic movement disorders with tetrabenazine: a double-blind crossover study. Ann Neurol. 1982 Jan;11(1):41–47. [PubMed]
  • Micheli F, Fernández Pardal MM, Leiguarda RC. Beneficial effects of lisuride in Meige disease. Neurology. 1982 Apr;32(4):432–434. [PubMed]
  • Duvoisin RC. Meige syndrome: relief on high-dose anticholinergic therapy. Clin Neuropharmacol. 1983 Mar;6(1):63–66. [PubMed]
  • Tolosa ES, Lai C. Meige disease: striatal dopaminergic preponderance. Neurology. 1979 Aug;29(8):1126–1130. [PubMed]
  • Casey DE. Pharmacology of blepharospasm-oromandibular dystonia syndrome. Neurology. 1980 Jul;30(7 Pt 1):690–695. [PubMed]
  • Marsden CD, Lang AE, Sheehy MP. Pharmacology of cranial dystonia. Neurology. 1983 Aug;33(8):1100–1102. [PubMed]
  • Tanner CM, Glantz RH, Klawans HL. Meige disease: acute and chronic cholinergic effects. Neurology. 1982 Jul;32(7):783–785. [PubMed]
  • Fahn S. High dosage anticholinergic therapy in dystonia. Neurology. 1983 Oct;33(10):1255–1261. [PubMed]
  • Nutt JG, Hammerstad JP, deGarmo P, Carter J. Cranial dystonia: double-blind crossover study of anticholinergics. Neurology. 1984 Feb;34(2):215–217. [PubMed]
  • Lang AE. High dose anticholinergic therapy in adult dystonia. Can J Neurol Sci. 1986 Feb;13(1):42–46. [PubMed]
  • McCord CD, Jr, Coles WH, Shore JW, Spector R, Putnam JR. Treatment of essential blepharospasm. I. Comparison of facial nerve avulsion and eyebrow-eyelid muscle stripping procedure. Arch Ophthalmol. 1984 Feb;102(2):266–268. [PubMed]
  • Gillum WN, Anderson RL. Blepharospasm surgery. An anatomical approach. Arch Ophthalmol. 1981 Jun;99(6):1056–1062. [PubMed]
  • McCord CD, Jr, Shore J, Putnam JR. Treatment of essential blepharospasm. II. A modification of exposure for the muscle stripping technique. Arch Ophthalmol. 1984 Feb;102(2):269–273. [PubMed]
  • Frueh BR, Felt DP, Wojno TH, Musch DC. Treatment of blepharospasm with botulinum toxin. A preliminary report. Arch Ophthalmol. 1984 Oct;102(10):1464–1468. [PubMed]
  • Scott AB, Kennedy RA, Stubbs HA. Botulinum A toxin injection as a treatment for blepharospasm. Arch Ophthalmol. 1985 Mar;103(3):347–350. [PubMed]
  • Tsoy EA, Buckley EG, Dutton JJ. Treatment of blepharospasm with botulinum toxin. Am J Ophthalmol. 1985 Feb 15;99(2):176–179. [PubMed]
  • Elston JS, Russell RW. Effect of treatment with botulinum toxin on neurogenic blepharospasm. Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1857–1859. [PMC free article] [PubMed]
  • Mauriello JA., Jr Blepharospasm, Meige syndrome, and hemifacial spasm: treatment with botulinum toxin. Neurology. 1985 Oct;35(10):1499–1500. [PubMed]
  • Dutton JJ, Buckley EG. Botulinum toxin in the management of blepharospasm. Arch Neurol. 1986 Apr;43(4):380–382. [PubMed]
  • Kao I, Drachman DB, Price DL. Botulinum toxin: mechanism of presynaptic blockade. Science. 1976 Sep 24;193(4259):1256–1258. [PubMed]
  • Dolly JO, Black J, Williams RS, Melling J. Acceptors for botulinum neurotoxin reside on motor nerve terminals and mediate its internalization. Nature. 1984 Feb 2;307(5950):457–460. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group