A randomized, placebo-controlled, crossover clinical trial of super blue-green algae in patients with essential blepharospasm or Meige syndrome

The effect of bangerter occlusion foils on blepharospasm and hemifacial spasm in occlusion-positive and occlusion-negative patients

Objective:

To test the hypothesis that occlusion-positive (OP) patients with blepharospasm (BEB) or hemifacial spasm (HFS) will benefit from a Bangerter occlusion foil (BOF), compared to occlusion-negative (ON) patients. OP/ON was based on immediate improvement in spasm with placement of a hand in front of either eye.

Design:

Prospective non-randomised single-centre pilot study.

Participants:

Fifteen-patients (6 BEB, 9 HFS).

Methods:

Patients were identified as OP or ON and wore highest-density BOF tolerable over one spectacle lens for 1 month. Outcomes were assessed at 1 month.

Main Outcome Measures:

Validated quality-of-life questionnaire (CDQ-24), scores of blink-rate and spasm severity assessed by two observers from video-recordings.

Results:

OP group had mean improvement in all scores. There was no change or worsening of scores in the ON group. In both BEB and HFS, more OP patients reported subjective benefit from wearing a foil (2 of 4 BEB, and 2 of 2 HFS) compared to the ON group (0 of 2 BEB, and 1 of 7 HFS).

Conclusion:

OP patients with BEB and HFS are more likely to experience improvement in spasms from wearing a BOF compared to ON patients. The occlusion test should be considered on all patients with BEB or HFS.

Effect of reading on surface electromyogram recordings in patients with blepharospasm

PURPOSE

To compare the surface electromyogram recordings between patients with benign essential blepharospasm and controls while maintaining primary gaze and reading in downgaze.

METHODS

A university-based, prospective case series of 7 benign essential blepharospasm patients and 7 normal patients. Bilateral lower eyelid preseptal orbicularis oculi muscle potentials were recorded via surface electromyogram and video while performing a standardized 60-second task that was divided in 3 equal 20-second subtasks. Specifically, patients were asked to maintain primary gaze for the first 20-second interval, to read quietly for the second interval, and again maintain primary gaze for the third 20-second interval. Fourteen trials capturing bilateral recordings were performed in each group; qualitative and quantitative analysis of the surface electromyogram recordings was performed and compared both between patient groups and between subtasks. Blepharospasm patients were also asked to describe the effect of reading on their spasms. Specifically, they were asked before the study if reading lessened or worsened their spasms and then were asked poststudy if their symptoms lessened or worsened during the reading task.

RESULTS

The mean surface electromyogram potential of the orbicularis muscle was significantly less in normal eyes when compared with blepharospasm eyes for each task. Furthermore, the mean surface electromyogram potential during the reading task was significantly reduced when compared with the primary gaze task in all eyes. Only blepharospasm patients noticed this reduction subjectively.

CONCLUSIONS

Although conventional wisdom regarding blepharospasm suggests that reading is an exacerbating factor, short durations of reading seem to relieve spasms. This may be due to the effect of downgaze on the blink reflex and may offer possible areas of investigation for novel blepharospasm treatments.

Meige syndrome: what's in a name?

Frequently, blepharospasm is associated with involuntary movements of the platysma, lower face and masticatory muscles. Similarly, masticatory dystonia may occur in isolation or in combination with dystonia of other cranial and cervical muscles. The non-possessive and possessive forms of Meige and Brueghel syndromes have been variably and imprecisely ascribed to various anatomical variations of craniocervical dystonia. Herein, the origin of eponymic terms as applied to craniocervical dystonia is reviewed as support for proposed elimination of these eponyms from clinical usage. Although the term "segmental craniocervical dystonia" more accurately captures the combination of blepharospasm and dystonia of other head and neck muscles, delineation of craniocervical subphenotypes is essential for etiological/genetic and treatment studies. To conclude, the clinical features, epidemiology, pathophysiology and therapeutic management of segmental craniocervical dystonia are examined with a particular focus on "blepharospasm-plus" subphenotypes.

Toxin mixture in cyanobacterial blooms--a critical comparison of reality with current procedures employed in human health risk assessment

Cyanobacteria are the oldest life forms on earth known to produce a broad spectrum of secondary metabolites. The functions/advantages of most of these secondary metabolites (peptides and alkaloids) are unknown, however, some of them have adverse effects in humans and wildlife, especially when ingested, inhaled or upon dermal exposure. Surprisingly, some of these cyanobacteria are ingested voluntarily. Indeed, for centuries mankind has used cyanobacteria as a protein source, primarily Spirulina species. However, recently also Aphanizomenon flos-aquae are used for the production of so called blue green algae supplements (BGAS), supposedly efficacious for treatment of various diseases and afflictions. Unfortunately, traces of neurotoxins and protein phosphatases (inhibiting compounds) have been detected in BGAS, making these health supplements a good example for human exposure to a mixture of cyanobacterial toxins in a complex matrix. The discussion of this and other possible exposure scenarios, e.g. drinking water, contact during recreational activity, or consumption of contaminated food, can provide insight into the question of whether or not our current risk assessment schemes for cyanobacterial blooms and the toxins contained therein suffice for protection of human health.

Orofacial pain and sensory disorders in the elderly

Many orofacial pain conditions occur in the elderly. Specifically,this article reviews the prevalence of general and orofacial-related pain in the elderly. The authors also describe and discuss the likely disorders and diseases that produce facial pain and burning pain in the mouth. They do not cover jaw joint pain, oral sores, or ulceration-induced pain, as these conditions are better discussed in the context of arthritis and oral pathologies of the mouth. The authors discuss oral motor disorders, myogenous pain, vascular pain, headaches, trigeminal neuralgia, trigeminal neuropathic dis-ease, postherpetic neuralgia, burning mouth syndrome, and occlusal dysesthesia.