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Liu B, Mao Z, Yan X, Yang H, Xu J, Feng Z, Zhang Y, Yu X. Structural network topologies are associated with deep brain stimulation outcomes in Meige syndrome. Neurotherapeutics 2024; 21:e00367. [PMID: 38679556 DOI: 10.1016/j.neurot.2024.e00367] [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: 11/04/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024] Open
Abstract
Deep brain stimulation (DBS) is an effective therapy for Meige syndrome (MS). However, the DBS efficacy varies across MS patients and the factors contributing to the variable responses remain enigmatic. We aim to explain the difference in DBS efficacy from a network perspective. We collected preoperative T1-weighted MRI images of 76 MS patients who received DBS in our center. According to the symptomatic improvement rates, all MS patients were divided into two groups: the high improvement group (HIG) and the low improvement group (LIG). We constructed group-level structural covariance networks in each group and compared the graph-based topological properties and interregional connections between groups. Subsequent functional annotation and correlation analyses were also conducted. The results indicated that HIG showed a higher clustering coefficient, longer characteristic path length, lower small-world index, and lower global efficiency compared with LIG. Different nodal betweennesses and degrees between groups were mainly identified in the precuneus, sensorimotor cortex, and subcortical nuclei, among which the gray matter volume of the left precentral gyrus and left thalamus were positively correlated with the symptomatic improvement rates. Moreover, HIG had enhanced interregional connections within the somatomotor network and between the somatomotor network and default-mode network relative to LIG. We concluded that the high and low DBS responders have notable differences in large-scale network architectures. Our study sheds light on the structural network underpinnings of varying DBS responses in MS patients.
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Affiliation(s)
- Bin Liu
- Medical School of Chinese PLA, Beijing, 100853, China; Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xinyuan Yan
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Hang Yang
- Chinese Institute for Brain Research, Beijing, 102206, China
| | - Junpeng Xu
- Medical School of Chinese PLA, Beijing, 100853, China; Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhebin Feng
- Medical School of Chinese PLA, Beijing, 100853, China; Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yanyang Zhang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Xinguang Yu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
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Xu J, Zhang X, Cheng Q, Zhang H, Zhong L, Luo Y, Zhang Y, Ou Z, Yan Z, Peng K, Liu G. Abnormal supplementary motor areas are associated with idiopathic and acquired blepharospasm. Parkinsonism Relat Disord 2024; 121:106029. [PMID: 38394948 DOI: 10.1016/j.parkreldis.2024.106029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Blepharospasm is a common form of focal dystonia characterized by excessive and involuntary spasms of the orbicularis oculi. In addition to idiopathic blepharospasm, lesions in various brain regions can also cause acquired blepharospasm. Whether these two types of blepharospasm share a common brain network remains largely unknown. Herein, we performed lesion coactivation network mapping, based on meta-analytic connectivity modeling, to test whether lesions causing blepharospasm could be mapped to a common coactivation brain network. We then tested the abnormality of the network in patients with idiopathic blepharospasm (n = 42) compared with healthy controls (n = 44). We identified 21 cases of lesion-induced blepharospasms through a systematic literature search. Although these lesions were heterogeneous, they were part of a co-activated brain network that mainly included the bilateral supplementary motor areas. Coactivation of these regions defines a single brain network that encompasses or is adjacent to most heterogeneous lesions causing blepharospasm. Moreover, the bilateral supplementary motor area is primarily associated with action execution, visual motion, and imagination, and participates in finger tapping and saccades. They also reported decreased functional connectivity with the left posterior cingulate cortex in patients with idiopathic blepharospasm. These results demonstrate a common convergent abnormality of the supplementary motor area across idiopathic and acquired blepharospasms, providing additional evidence that the supplementary motor area is an important brain region that is pathologically impaired in patients with blepharospasm.
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Affiliation(s)
- Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Xiaodong Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China; Shenzhen Children's Hospital, Shenzhen, 518000, China
| | - Qinxiu Cheng
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Haoran Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, 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
| | - 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
| | - 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
| | - 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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Zhu L, Meng H, Zhang W, Xie W, Sun H, Hou S. The pathogenesis of blepharospasm. Front Neurol 2024; 14:1336348. [PMID: 38274886 PMCID: PMC10808626 DOI: 10.3389/fneur.2023.1336348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Blepharospasm is a focal dystonia characterized by involuntary tetanic contractions of the orbicularis oculi muscle, which can lead to functional blindness and loss of independent living ability in severe cases. It usually occurs in adults, with a higher incidence rate in women than in men. The etiology and pathogenesis of this disease have not been elucidated to date, but it is traditionally believed to be related to the basal ganglia. Studies have also shown that this is related to the decreased activity of inhibitory neurons in the cerebral cortex caused by environmental factors and genetic predisposition. Increasingly, studies have focused on the imbalance in the regulation of neurotransmitters, including dopamine, serotonin, and acetylcholine, in blepharospasm. The onset of the disease is insidious, and the misdiagnosis rate is high based on history and clinical manifestations. This article reviews the etiology, epidemiological features, and pathogenesis of blepharospasm, to improve understanding of the disease by neurologists and ophthalmologists.
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Affiliation(s)
- Lixia Zhu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hongmei Meng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wuqiong Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wenjing Xie
- Department of Neurology, The Second Hospital of Jilin University, Changchun, China
| | - Huaiyu Sun
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Shuai Hou
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Huang XF, Hao XQ, Yin XX, Ren L, Wang D, Jin F, Tan LN, Liang ZH, Song CL. Functional connectivity alterations in the frontoparietal network and sensorimotor network are associated with behavioral heterogeneity in blepharospasm. Front Neurol 2023; 14:1273935. [PMID: 38020657 PMCID: PMC10668333 DOI: 10.3389/fneur.2023.1273935] [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: 08/07/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Primary blepharospasm (BSP) is a clinically heterogeneous disease that manifests not only as spasmodic closure of the eyelids but also sometimes with apraxia of eyelid opening (AEO). This cross-sectional study aimed to investigate differences in the neural mechanisms of isolated BSP and BSP-associated AEO subtypes, which may reveal the pathophysiology underlying different phenotypes. Methods A total of 29 patients manifested as isolated BSP, 17 patients manifested as BSP associated with AEO, and 28 healthy controls underwent resting-state functional near-infrared spectroscopy (fNIRS). We assessed functional connectivity (FC) between regions of interest (ROIs) in the fronto-parietal control network (PFCN) and sensorimotor network (SMN). We also examined the relationship between altered FC and behavioral data. Results In the FPCN, ROI- analyses showed decreased FC between the left premotor cortex and supramarginal gyrus in the BSP with AEO group compared to the isolated BSP group. In the SMN, both subgroups showed hypoconnectivity of the left premotor cortex with the right primary motor cortex, primary sensory cortex, and somatosensory association cortex. This hypoconnectivity was positively correlated with the total number of botulinum toxin A treatments, which suggests that long-term botulinum toxin A treatment may modulate motor sequence planning and coordination. Conclusion These findings showed different connectivity alterations in neural networks associated with motor and cognitive control among different behavioral phenotypes of BSP. The identification of specific alterations in various networks that correspond to clinical heterogeneity may inform the identification of potential biomarkers for early diagnosis and personalized neuromodulation targets for treating different BSP subphenotypes.
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Affiliation(s)
| | | | | | | | | | | | | | - Zhan-Hua Liang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chun-Li Song
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Liu Y, Yang L, Yan H, Feng C, Jiang W, Li W, Lei Y, Pang L, Liang M, Guo W, Luo S. Increased functional connectivity coupling with supplementary motor area in blepharospasm at rest. Brain Res 2023; 1817:148469. [PMID: 37355150 DOI: 10.1016/j.brainres.2023.148469] [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: 02/26/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To explore the abnormalities of brain function in blepharospasm (BSP) and to illustrate its neural mechanisms by assuming supplementary motor area (SMA) as the entry point. METHODS Twenty-five patients with BSP and 23 controls underwent resting-state functional MRI, seed-based functional connectivity (FC), correlation analysis, receiver operating characteristic curve (ROC) analysis, and support vector machine (SVM) were applied to process the data. RESULTS Patients showed that the left medial prefrontal cortex (MPFC), left lingual gyrus, right cerebellar crus I, and right lingual gyrus/cerebellar crus I had enhanced FC with the left SMA, whereas the right inferior temporal gyrus (ITG) had enhanced FC with the right SMA relative to controls. The FC between the left MPFC and left SMA was positively correlated with symptomatic severity. The ROC analysis verified that the abnormal FCs demonstrated in this study can separate patients and controls at high sensitivity and specificity. SVM analysis exhibited that combined FCs of the left SMA were optimal for distinguishing patients and control group at the accuracy of 89.58%, with sensitivity of 92.00% and specificity of 86.96%. CONCLUSIONS Several brain networks partake in the neurobiology of BSP. SMA plays a vital role in several brain networks and might be the key pathogenic factor in BSP. SIGNIFICANCE Providing novel evidence for the engagement of the MPFC in the motor symptoms of BSP, enhancing credibility of the thesis that SMA regulates the neurobiology of BSP, and providing ideas of screening susceptible population of BSP using neuroimaging.
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Affiliation(s)
- Yang Liu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu 224001, China
| | - Lu Yang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Haohao Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Changqiang Feng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Wenyan Jiang
- Department of Intensive Care Unit, Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Wenmei Li
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Yiwu Lei
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Lulu Pang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Meilan Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Shuguang Luo
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
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Defazio G, Gigante AF, Erro R, Belvisi D, Esposito M, Trinchillo A, De Joanna G, Ceravolo R, Mazzucchi S, Unti E, Barone P, Scannapieco S, Cotelli MS, Turla M, Bianchi M, Bertolasi L, Pisani A, Valentino F, Altavista MC, Moschella V, Girlanda P, Terranova C, Bono F, Spano G, Fabbrini G, Ferrazzano G, Albanese A, Castagna A, Cassano D, Coletti Moja M, Pellicciari R, Bentivoglio AR, Eleopra R, Cossu G, Ercoli T, Mascia MM, Di Biasio F, Misceo S, Magistrelli L, Romano M, Scaglione CLM, Tinazzi M, Maderna L, Zibetti M, Berardelli A. Phenotypic Variability in Acquired and Idiopathic Dystonia. Mov Disord Clin Pract 2023; 10:1107-1113. [PMID: 37476305 PMCID: PMC10354612 DOI: 10.1002/mdc3.13801] [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: 11/21/2022] [Revised: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 07/22/2023] Open
Abstract
Background To date, a few studies have systematically investigated differences in the clinical spectrum between acquired and idiopathic dystonias. Objectives To compare demographic data and clinical features in patients with adult-onset acquired and idiopathic dystonias. Methods Patients were identified from among those included in the Italian Dystonia Registry, a multicenter Italian dataset of patients with adult-onset dystonia. Study population included 116 patients with adult-onset acquired dystonia and 651 patients with isolated adult-onset idiopathic dystonia. Results Comparison of acquired and idiopathic dystonia revealed differences in the body distribution of dystonia, with oromandibular dystonia, limb and trunk dystonia being more frequent in patients with acquired dystonia. The acquired dystonia group was also characterized by lower age at dystonia onset, greater tendency to spread, lower frequency of head tremor, sensory trick and eye symptoms, and similar frequency of neck pain associated with CD and family history of dystonia/tremor. Conclusions The clinical phenomenology of dystonia may differ between acquired and idiopathic dystonia, particularly with regard to the body localization of dystonia and the tendency to spread. This dissimilarity raises the possibility of pathophysiological differences between etiologic categories.
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Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | | | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana"University of SalernoFiscianoItaly
| | - Daniele Belvisi
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | | | - Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology“Federico II” UniversityNaplesItaly
| | | | - Roberto Ceravolo
- Parkinson and Movement Disorders CentreNeurology Unit Azienda Ospedaliero‐Universitaria PisanaPisaItaly
- Clinical and Experimental Medicine University of PisaPisaItaly
| | - Sonia Mazzucchi
- Parkinson and Movement Disorders CentreNeurology Unit Azienda Ospedaliero‐Universitaria PisanaPisaItaly
- Clinical and Experimental Medicine University of PisaPisaItaly
| | - Elisa Unti
- Parkinson and Movement Disorders CentreNeurology Unit Azienda Ospedaliero‐Universitaria PisanaPisaItaly
- Clinical and Experimental Medicine University of PisaPisaItaly
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana"University of SalernoFiscianoItaly
| | - Sara Scannapieco
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana"University of SalernoFiscianoItaly
| | | | | | | | | | - Antonio Pisani
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | | | | | | | - Paolo Girlanda
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Carmen Terranova
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Francesco Bono
- Center for Botulinum Toxin TherapyNeurology Unit, A.O.U. Mater dominiCatanzaroItaly
| | - Giorgio Spano
- Center for Botulinum Toxin TherapyNeurology Unit, A.O.U. Mater dominiCatanzaroItaly
| | - Giovanni Fabbrini
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Gina Ferrazzano
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Alberto Albanese
- Department of NeurologyIRCCS Humanitas Research HospitalMilanItaly
| | | | | | | | - Roberta Pellicciari
- Department of Basic Medical Sciences, Neurosciences and Sense OrgansUniversity of Bari “Aldo Moro”BariItaly
| | - Anna Rita Bentivoglio
- Agostino Gemelli IRCCS University Hospital FoundationRomeItaly
- Institute of NeurologyUniversità Cattolica del Sacro CuoreRomeItaly
| | - Roberto Eleopra
- Neurology Unit 1, Fondazione IRCSSIstituto Neurologico “Carlo Besta”MilanItaly
| | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of NeuroscienceAO BrotzuCagliariItaly
| | - Tommaso Ercoli
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | | | | | | | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational MedicineUniversity of Piemonte OrientaleNovaraItaly
| | | | | | - Michele Tinazzi
- Neurology Unit, Department of Neuroscience, Biomedicine and MovementUniversity of VeronaVeronaItaly
| | - Luca Maderna
- Department of Neuroscience, U.O. of NeurophysiologyIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Maurizio Zibetti
- Department of Neuroscience “Rita Levi Montalcini”University of TorinoTorinoItaly
- Neurology 2 UnitA.O.U. Città Della Salute e Della Scienza di TorinoTorinoItaly
| | - Alfredo Berardelli
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
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Tawfik HA, Dutton JJ. Debunking the Puzzle of Eyelid Apraxia: The Muscle of Riolan Hypothesis. Ophthalmic Plast Reconstr Surg 2023; 39:211-220. [PMID: 36136731 DOI: 10.1097/iop.0000000000002291] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Apraxia of eyelid opening (AEO) has been defined by the presence of an intermittent nonparalytic bilateral loss of the volitional ability to open the eyes or to maintain the eyelids in a sustained elevated position. It is not known whether the condition represents an apraxia, a dystonia, or a freezing phenomenon, and several different nomenclatorial terms have been suggested for this condition including the so-called AEO (scAEO), blepahrocolysis, focal eyelid dystonia, and so on. The primary goal of this review is to attempt to clarify the pathogenetic mechanisms underlying scAEO as a clinical phenomenon. This review also addresses the issue of whether scAEO is part of the spectrum of blepharospasm (BSP) which includes BSP, dystonic blinks and other dystonic eyelid conditions, or whether it is a separate phenomenologically heterogeneous disease with clinical features that merely overlap with BSP. METHODS A literature review was conducted in PubMed, MEDLINE, PubMed Central (PMC), NCBI Bookshelf, and Embase for several related keywords including the terms "apraxia of eyelid opening," "pretarsal blepharospasm," "blepharocolysis," "eyelid freezing," "eyelid akinesia," "levator inhibition," "blepharospasm-plus," as well as "blepharospasm." The clinical findings in patients with scAEO who fulfilled the classic diagnostic criteria of the disease that were originally set by Lepore and Duvoisin were included, while patients with isolated blepharospasm or dystonic blinks (DB) were excluded. In addition, electromyographic (EMG) studies in patients with scAEO were reviewed in detail with special emphasis on studies that performed synchronous EMG recordings both from the levator muscle (LPS) and the pretarsal orbicularis oculi muscle (OO). RESULTS The apraxia designation is clearly a misnomer. Although scAEO behaves clinically as a hypotonic freezing phenomenon, it also shares several cardinal features with focal dystonias. The authors broadly categorized the EMG data into 3 different patterns. The first pattern (n = 26/94 [27.6%]) was predominantly associated with involuntary discharges in the OO muscle and has been termed pretarsal blepharospasm (ptBSP). The commonest pattern was pattern no. 2 (n = 53/94 [56.38%]), which was characterized by involuntary discharges in the OO muscle, together with a disturbed reciprocal innervation of the antagonist levator muscle and is dubbed disturbed reciprocal innervation (DRI). This EMG pattern is difficult to discern from the first pattern. Pattern no. 3 (n = 15/94 [15.9%]) is characterized by an isolated levator palpebrae inhibition (ILPI). This levator silence was observed alone without EMG evidence of contractions in the pretarsal orbicularis or a disturbed reciprocal relation of both muscles. CONCLUSION EMG evidence shows that the great majority (84%) of patients show a dystonic pattern, whereas ILPI (16%) does not fit the dystonic spectrum. The authors propose that a spasmodic contraction of the muscle of Riolan may be the etiological basis for levator inhibition in patients with ILPI. If this is true, all the 3 EMG patterns observed in scAEO patients (ptBSP, DRI, and ILPI) would represent an atypical form of BSP. The authors suggest coining the terms Riolan muscle BSP ( rmBSP ) for ILPI, and the term atypical focal eyelid dystonia ( AFED ) instead of the term scAEO, as both terms holistically encompass both the clinical and EMG data and concur with the authors' theorem.
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Affiliation(s)
- Hatem A Tawfik
- Department of Ophthalmology, Ain Shams University, Cairo, Egypt
| | - Jonathan J Dutton
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
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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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Mantel T, Jochim A, Meindl T, Deppe J, Zimmer C, Li Y, Haslinger B. Thalamic structural connectivity profiles in blepharospam/Meige's syndrome. Neuroimage Clin 2022; 34:103013. [PMID: 35483134 PMCID: PMC9125780 DOI: 10.1016/j.nicl.2022.103013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Blepharospasm is a debilitating focal dystonia characterized by involuntary eyelid spasms that can be accompanied by oromandibular muscle involvement (Meige's syndrome). Frequently observed abnormality in functional neuroimaging hints at an important position of the thalamus, that relays involved cortico-basal ganglia-cortical and cortico-cerebello-cortical circuits, within the abnormal network in blepharospasm. OBJECTIVE To characterize abnormal cortico-thalamic structural/streamline connectivity (SC) patterns in the disease, as well as their potential co-occurrence with abnormal subcortico-thalamo-cortical projections using diffusion tractography. METHODS Diffusion imaging was obtained in 17 patients with blepharospasm (5 with mild lower facial involvement) and 17 healthy controls. Probabilistic tractography was used for quantification of SC between six cortical regions and thalamus, and voxel-level thalamic SC mapping as well as evaluation of the thalamic SC distributions' topography by center-of-gravity analysis was performed. Post-hoc, correlations of SC with clinical parameters were evaluated. Further, white matter integrity was investigated within representative segments of the dentato-thalamo-cortical and pallido-thalamo-cortical tract. RESULTS Connectivity mapping showed significant reduction of right (pre)motor- and left occipital-thalamic SC, as well as a topographic shift of the left occipital-thalamic SC distribution in patients. Significant positive correlation of occipital-thalamic SC with disease severity was found. Post-hoc analysis revealed significantly reduced mean fractional anisotropy in patients within the dentato-thalamo-cortical trajectory connecting to right (pre)motor and left occipital cortex. CONCLUSION Abnormal occipital/motor SC provides evidence for dysfunction of the thalamus-relayed visual and motor network as a key aspect in the disease. Concurrent impairment of microstructural integrity within the dentato-thalamic trajectories targeting those cortices hints at cerebellar contribution.
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Affiliation(s)
- Tobias Mantel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Angela Jochim
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Tobias Meindl
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Jonas Deppe
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Yong Li
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany.
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Yang J, Zhang L, Hou Y, Wei Q, Ou R, Lin J, Song W, Cao B, Shang H. Excessive daytime sleepiness in idiopathic blepharospasm. Parkinsonism Relat Disord 2021; 89:134-138. [PMID: 34298213 DOI: 10.1016/j.parkreldis.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the frequency of excessive daytime sleepiness (EDS), and its impact on quality of life and its associated clinical factors in idiopathic blepharospasm. METHODS This cross-sectional study was carried out in 425 idiopathic blepharospasm patients and a group of 424 age-matched and sex-matched healthy subjects. EDS was assessed with the Epworth Sleepiness Scale (ESS) in all subjects. Other clinical characteristics of patients with idiopathic blepharospasm including motor symptoms, sleep quality, depression, anxiety, cognition, and quality of life were also assessed. RESULTS EDS was significantly more frequent in patients with idiopathic blepharospasm than in controls (22.1% vs 12.3%; p < 0.05). Blepharospasm patients with EDS scored significantly higher in Jankovic Rating scale, Hamilton Rating Scale for Depression (HDRS), Hamilton Rating Scale for Anxiety (HARS), and significantly lower in Montreal Cognitive Assessment (MoCA) and 36-Item Short Form Health Survey (SF-36) than those without EDS (p < 0.05). The binary logistic regression model indicated that male, younger age of onset of blepharospasm, higher motor scores, higher HDRS scores, and lower MoCA scores were associated with the presence of EDS in patients with blepharospasm (p < 0.05). CONCLUSIONS Recognition and management of EDS in idiopathic blepharospasm patients is necessary as the occurrence of EDS was associated with higher motor burden, more serious mood and cognitive disturbances, and poorer quality of life. Our results suggest that blepharospasm may exhibit abnormal sleep-wake patterns and further support the clinical heterogeneity of the disease.
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Affiliation(s)
- Jing Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingyu Zhang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanbing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junyu Lin
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Song
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Gamain J, Herr T, Fleischmann R, Stenner A, Vollmer M, Willert C, Veit B, Lehnert B, Mueller JU, Steigerwald F, Tost F, Kronenbuerger M. Smell and taste in idiopathic blepharospasm. J Neural Transm (Vienna) 2021; 128:1215-1224. [PMID: 34184129 PMCID: PMC8237775 DOI: 10.1007/s00702-021-02366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
The pathophysiology of blepharospasm is incompletely understood. Current concepts suggest that blepharospasm is a network disorder, involving basal ganglia, thalamus, cortex, and, possibly, the cerebellum. Tracing, imaging, and clinical studies revealed that these structures are also concerned with olfaction and taste. Because of this anatomical overlap, dysfunction of the chemical senses in blepharospasm is expected. Injections of botulinum toxin into the eyelid muscles are the first-line treatment of blepharospasm. Yet, the effects of botulinum toxin on the chemical senses have not been systematically assessed. To contribute to a better understanding of blepharospasm, olfactory and gustatory abilities were assessed in 17 subjects with blepharospasm and 17 age-/sex-matched healthy controls. Sniffin Sticks were used to assess odor threshold, odor discrimination, and odor identification. Results of these three Sniffin Sticks subtests were added to the composite olfactory score. The Taste Strips were applied to assess taste. In an adjacent study, we assessed the sense of smell and taste in eight subjects with blepharospasm before and 4 weeks after botulinum toxin treatment. Subjects with blepharospasm had significantly lower (= worse) scores for odor threshold and for the composite olfactory score than healthy controls, while odor discrimination, odor identification, and the composite taste score were not different between groups. The adjacent study revealed that botulinum toxin did not impact the chemical senses. In this study, subjects with blepharospasm had a lower (= worse) odor threshold than healthy controls. As olfaction is important in daily life, findings justify further research of olfaction in blepharospasm.
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Affiliation(s)
- Julie Gamain
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Thorsten Herr
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | | | - Andrea Stenner
- Department of Neurology, Paracelsus Clinic Zwickau, Zwickau, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University of Greifswald, Greifswald, Germany
| | | | - Birgitt Veit
- Neurology Group Practice, Neubrandenburg, Germany
| | - Bernhard Lehnert
- Department of Otorhinolaryngology, University of Greifswald, Greifswald, Germany
| | - Jan-Uwe Mueller
- Department of Neurosurgery, University of Greifswald, Greifswald, Germany
| | - Frank Steigerwald
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Frank Tost
- Department of Ophthalmology, University of Greifswald, Greifswald, Germany
| | - Martin Kronenbuerger
- Department of Neurology, University of Greifswald, Greifswald, Germany. .,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA. .,Department of Neurology, Medical School OWL, University of Bielefeld, Bielefeld, Germany.
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Girard B, Davoudi O, Tatry M, Tassart M. [Secondary blepharospasm, analysis and pathophysiology of blepharospasm. French translation of the article]. J Fr Ophtalmol 2021; 44:151-162. [PMID: 33431190 DOI: 10.1016/j.jfo.2020.06.011] [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: 05/14/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To localize the brain structures involved in blepharospasm. MATERIALS AND METHODS This is a retrospective consecutive series of brain MRI's of patients with secondary blepharospasm whose immediate past medical history included cerebrovascular accident or head trauma. RESULTS Six patients, including 4 with CVA with ischemic or hemorrhagic lesions of the thalamus and caudate nuclei and 2 with head trauma with contusive sequellae to the tectal plate and frontal cortical and cerebellar atrophy. CONCLUSION According to the literature, brain lesions associated with blepharospasm involve mainly the thalamus, head of the caudate nucleus, corpus striatum, globus pallidus, internal capsule, cerebral cortex and cerebellum. This study demonstrates that blepharospasm is associated with a lesion of a complex neural network - cortex-thalamus-globus pallidus-cortex - and does not correspond to a single, unique lesion. This network is connected with ascending and descending sensory-motor pathways and motor nuclei.
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Affiliation(s)
- B Girard
- Service d'ophtalmologie de l'hôpital Tenon, Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - O Davoudi
- Service d'ophtalmologie de l'hôpital Tenon, AP-HP, Paris, France; Service d'ophtalmologie de l'Hôpital Tenon, APHP, université de Clermont-Ferrand, Clermont-Ferrand, France
| | - M Tatry
- Service d'ophtalmologie de l'hôpital Tenon, Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M Tassart
- Service de radiologie de l'hôpital Tenon, GHU Sorbonne université, AP-HP, Paris, France
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Secondary blepharospasm, analysis and pathophysiology of blepharospasm. J Fr Ophtalmol 2020; 44:e1-e12. [PMID: 33349487 DOI: 10.1016/j.jfo.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/13/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To localize the brain structures involved in blepharospasm. MATERIALS AND METHODS This is a retrospective consecutive series of brain MRI's of patients with secondary blepharospasm whose immediate past medical history included cerebrovascular accident or head trauma. RESULTS Six patients, including 4 with CVA with ischemic or hemorrhagic lesions of the thalamus and caudate nuclei and 2 with head trauma with contusive sequellae to the tectal plate and frontal cortical and cerebellar atrophy. CONCLUSION According to the literature, brain lesions associated with blepharospasm involve mainly the thalamus, head of the caudate nucleus, corpus striatum, globus pallidus, internal capsule, cerebral cortex and cerebellum. This study demonstrates that blepharospasm is associated with a lesion of a complex neural network - cortex-thalamus-globus pallidus-cortex - and does not correspond to a single, unique lesion. This network is connected with ascending and descending sensory-motor pathways and motor nuclei.
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