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Zhao W, Huang B, Du XD, Lin HD, Wu J, Zhao X, Zhou QH, Yao M. [Efficacy of CT-guided partial radiofrequency ablation of bilateral responsible cranial nerves in the treatment of Meige syndrome]. Zhonghua Yi Xue Za Zhi 2023; 103:2100-2105. [PMID: 37455128 DOI: 10.3760/cma.j.cn112137-20230227-00285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Objective: To evaluate the efficacy of CT-guided partial radiofrequency ablation of bilateral responsible cranial nerves in the treatment of Meige syndrome. Methods: The Clinical data of 56 patients with Meige syndrome in the Department of Pain Medicine, Affiliated Hospital of Jiaxing University from June 2019 to January 2023 were retrospectively analyzed [19 males and 37 females, aged 42-76 (58.6±8.3) years], including 51 cases of blepharospasm, 3 cases of oromandibular dystonia and 2 cases of blepharospasm concomitant with oromandibular dystonia. CT-guided partial radiofrequency ablation of bilateral responsible cranial nerves was performed on different types of Meige syndrome. And the efficacy and complications of the technique were observed. Results: Fifty-one patients with blepharospasm Meige syndrome underwent CT-guided radiofrequency of facial nerve through bilateral stylomastoid foramen punctures, the symptoms of blepharospasm disappeared completely, leaving bilateral mild and moderate facial paralysis symptoms. Three patients with oral-mandibular dystonia underwent CT-guided radiofrequency therapy by bilateral foramen ovale puncture of mandibular branches of trigeminal nerve, masticatory muscle spasm disappeared, the patients had no difficulty opening the mouth, and the skin numbness in bilateral mandibular nerve innervation area was left. Two cases of Meige syndrome with blepharospasm concomitant with oromandibular dystonia were treated by radiofrequency of facial nerve and mandibular branch of trigeminal nerve, and all symptoms disappeared. The patients were followed up for 1-44 months after the operation, and the symptoms of mild and moderate facial paralysis disappeared at (3.2±0.8) months after the operation, but the numbness did not disappear. Three patients with blepharospasm recurred at the 14, 18 and 22 months after the operation, respectively, while the rest cases did not recur. Conclusions: According to different types of Meige syndrome, CT-guided partial radiofrequency ablation of responsible cranial nerves can effectively treat the corresponding type of Meige syndrome. The complications are only mild and moderate facial paralysis which can be recovered, and/or skin numbness in the mandibular region.
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Affiliation(s)
- W Zhao
- Graduate school of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310006, China Department of Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - B Huang
- Graduate school of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310006, China Department of Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - X D Du
- Department of Pain Medicine, the Redcross Hospital of Hangzhou, Hangzhou 310006, China
| | - H D Lin
- Department of Pain Medicine, the first Hospital of Ninbo city, Ningbo 315000, China
| | - J Wu
- Department of Pain Medicine, the First Municipal Hospital of Jinjiang city, Jinjiang 214500, China
| | - X Zhao
- Department of Pain Medicine, Shulan Hangzhou Hospital, Hangzhou 310006, China
| | - Q H Zhou
- Department of Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - M Yao
- Department of Pain Medicine, the Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
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Ray S, Padmanabha H, Mahale R, Mailankody P, Arunachal G. DNAJC6 mutation causing cranial-onset dystonia with tremor dominant levodopa non-responsive parkinsonism: A novel phenotype. Parkinsonism Relat Disord 2021; 89:1-3. [PMID: 34175496 DOI: 10.1016/j.parkreldis.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
DNAJC6 mutation causes two types of phenotypes: slowly progressive parkinsonism with levodopa response and rapidly progressive parkinsonism with additional manifestations like intellectual disability, epilepsy etc. We report a new phenotype wherein an adolescent girl developed blepharospasm followed by jaw opening, lingual and cervical dystonia followed by tremors of limbs (rest and action) with rigidity, bradykinesia. The dystonia-parkinsonism phenotype has not been described. She had novel homozygous missense mutation in DNAJC6 gene.
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Affiliation(s)
| | | | - Rohan Mahale
- Department of Neurology, NIMHANS, Bengaluru, India.
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Sun Y, Tsai PJ, Chu CL, Huang WC, Bee YS. Epidemiology of benign essential blepharospasm: A nationwide population-based retrospective study in Taiwan. PLoS One 2018; 13:e0209558. [PMID: 30586395 PMCID: PMC6306223 DOI: 10.1371/journal.pone.0209558] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/09/2018] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE This study provides a nationwide, population-based data on the incidence of benign essential blepharospasm in Asian adults. BACKGROUND To describe the incidence, patient demographics, and risk factors associated with benign essential blepharospasm. DESIGN Population-based retrospective study. PARTICIPANTS AND SAMPLES A total of 1325 patients with benign essential blepharospasm were identified. METHODS Patients with diagnosis of blepharopsasm between January 2000 and December 2013 were sampled using the Longitudinal Health Insurance Database 2000. Secondary blepharospasm that may be related to neurological, trauma, and ocular surface disease were excluded. MAIN OUTCOME MEASURED Multivariate conditional logistic regression was used to estimate the odds ratios for potential risk factors of benign essential blepharospasm. RESULTS The mean annual incidence was 0.10‰ (0.07‰ for males, and 0.12‰ for females). The peak incidence was in the 50 to 59-year-old age group (0.19‰). People living in urban regions have more risk of developing blepharospasm comparing to people living in less urban regions (p <0.01). White-collar workers also have higher chance of having blepharospasm (p<0.001). Significant difference between control group and case group in hyperlipidemia (p <0.001), sleep disorders (p <0.001), mental disorders (depression, anxiety, obsessive compulsive disorder) (p <0.001), dry eye-related diseases (dry eye, Sjögren's syndrome) (p <0.001), Parkinson's disease (p <0.004), and rosacea (p <0.021) were also identified. CONCLUSIONS AND RELEVANCE Higher level of urbanization, white-collar work, sleep disorders, mental health diseases, dry eye-related diseases, Parkinsonism, and rosacea are possible risk factors for benign essential blepharospasm.
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Affiliation(s)
- Yng Sun
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University of Hospital, Kaohsiung, Taiwan
| | - Pei-Jhen Tsai
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - Wei-Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Youn-Shen Bee
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
- National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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Abstract
A 58-year-old man consulted our hospital due to a 2-year history of dysarthria and a 1-month history of blepharospasm. In addition to the ataxic dysarthria and blepharospasm, a neurological examination demonstrated slight ataxia of the trunk and lower limbs. Brain MRI demonstrated atrophy of the upper portion of the cerebellar vermis. Gene analysis established a diagnosis of spinocerebellar ataxia type 31 (SCA31). Single photon emission computed tomography (SPECT) with the three-dimensional stereotaxic ROI template (3DSRT) software program demonstrated hyperperfusion in the lenticular nucleus and thalamus. Although the association between SCA31 and blepharospasm in our patient remains unclear, we considered that this combination might be more than coincidental.
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Affiliation(s)
- Sakiko Itaya
- Department of Neurology, JA Toride Medical Center, Japan
| | - Zen Kobayashi
- Department of Neurology, JA Toride Medical Center, Japan
| | - Kokoro Ozaki
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Nozomu Sato
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Yoshiyuki Numasawa
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Kinya Ishikawa
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Japan
| | - Shuzo Shintani
- Department of Neurology, JA Toride Medical Center, Japan
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Mali YP, Simon JW, Chaudhri I, Zobal-Ratner J, Barry GP. Episodic Excessive Blinking in Children. J Pediatr Ophthalmol Strabismus 2016; 53:22-4. [PMID: 26835998 DOI: 10.3928/01913913-20150929-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/24/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Many children present with excessive blinking. Categorization, associated conditions, and prognosis are controversial. METHODS All children with excessive blinking were reviewed, excluding those with known uveitis, glaucoma, or obvious eyelid abnormalities. Parents were telephoned for follow-up. RESULTS No ocular pathology was identified in 31 of 34 children with excessive blinking (91%). Parents were able to report a specific cause of blinking in 7 (21%). In 24 of 34 (71%), parents reported complete resolution of excessive blinking. No new ophthalmologic diagnoses were uncovered on follow-up. CONCLUSIONS Episodes of excessive blinking rarely indicate neurologic disorders and frequently resolve spontaneously.
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Abstract
Three main problems of facial nerve pathology and surgery are considered in this paper. The intraneural anatomy of the facial nerve with its consequences for surgery, especially surgery for facial hyperkinesia, is studied and an original method of selective funicular neurolysis is proposed as a symptomatic operation. Quantitative and qualitative findings in the normal facial nerve are compared to findings in nerves after palsy. The results show that the introduction of neurometric methods for the quantitative assessment may yield further parameters in the judgement of past pathological processes within the nerve. Finally, prognosis of peripheral facial palsy, seen through electrophysiological testing methods, is discussed.
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Abstract
We herein report three cases of Parkinson's disease associated with difficulty in eyelid opening, referred to as apraxia of eyelid opening (AEO), which improved after aripiprazole treatment. In case 1, aripiprazole was administered as a psychiatric treatment. It proved to be effective in AEO with blepharospasm. In case 2 and case 3, the patients experienced AEO without blepharospasm, and a significant improvement was observed after aripiprazole treatment. In this study, the aripiprazole dosage ranged between 3 and 9 mg/day. This is the first report of aripiprazole as a potentially effective treatment for AEO in Parkinson's disease.
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Affiliation(s)
- Kaori Tokisato
- The Department of Neurology, Kumamoto Kinoh Hospital, Japan
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Methawasin K, Bhidayasiri R, Phanthumchinda K, Kaufman L. Blepharoclonus: anatomical localization and etiological consideration. J Med Assoc Thai 2014; 97:977-981. [PMID: 25536716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Blepharoclonus refers to myoclonic rhythmic eyelid closure. This is an extremely rare abnormal movement of the eyelids. The symptom has an ill-defned anatomical localization and hypothesized etiologies are diverse. We describe a 42 year-old woman with known poorly controlled hypertension (HTN) who presented with a three-week history ofataxia, dysmetria, and uncontrolled eyelid twitching. The bilateral abnormal eyelid movement occurred during either eyelid closure or opening, and was compatible with blepharoclonus. MRI revealed multiple cerebral infarctions at red nucleus, dentate nucleus, and inferior olives. These foci are within Guillain-Mollaret's triangle. The ataxia and dysmetria gradually improved within three weeks. While the blepharoclonus improved, it persisted after one year offollow-up. Our conclusion was one of HTN leading to a lacunar infarct that manifested partially as blepharoclonus. Due to the neuroimaging findings and clinical course, we propose that blepharoclonus may be a variant ofpalatal myoclonus and may be considered as another lacunar syndrome.
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Kormos W. On call. I have started to notice a constant twitching under my right eyelid. It appears during the day and often lasts for hours. I was told not to be concerned, but is it possible to fix this problem? Harv Mens Health Watch 2014; 18:2. [PMID: 25108944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Gálvez-Ruiz AL. [Blepharospasm as the presenting symptom of a brain stem glioma]. Rev Neurol 2014; 58:236-237. [PMID: 24570363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Kurlan R. Environmental risk factors and clinical phenotype in familial and sporadic primary blepharospasm. Neurology 2011; 77:2138. [PMID: 22170944 DOI: 10.1212/wnl.0b013e31823ff01a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nociti V, Loria G, Soleti F, Bentivoglio AR, Tartaglione T, Tonali P, Batocchi AP. The left parietal lobe plays a role in the pathogenesis of blepharospasm? Eur J Neurol 2011; 18:e66-7. [PMID: 21244581 DOI: 10.1111/j.1468-1331.2010.03319.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lambrecq V, Sibon I, Loiseau H, Jeannin S, Dousset V, Rotgé JY, Guehl D, Burbaud P. Acute blepharospasm and torticollis associated with an ependymoma of the lateral ventricle. Mov Disord 2010; 25:653-5. [PMID: 20201058 DOI: 10.1002/mds.22984] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Robb-Nicholson C. By the way, doctor. From time to time, my eyelids twitch. What causes this, and is there anything I can do about it? Harv Womens Health Watch 2010; 17:8. [PMID: 20597142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Rouvin B, Kone M, N'diaye M, Seck M, Diatta B. [Spitting cobras: description of 2 cases in Djibouti]. Med Trop (Mars) 2010; 70:95-96. [PMID: 20337127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The purpose of this report is to describe two cases involving ophthalmic exposure to venom from spitting cobras. Based on these cases, readers are reminded that eye injury can be prevented by low-cost treatment consisting of prompt, prolonged saline irrigation. This treatment also reduces pain.
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Chauhan V, Negi RC, Verma B, Thakur S. Unilateral blepharospasm and blepharoptosis with bilateral vertical gaze palsy in thalamic hemorrhage. J Assoc Physicians India 2009; 57:768-770. [PMID: 20329446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We present here case of a 49-year-old female with unilateral left sided blepharospasm and blepharoptosis, bilateral vertical gaze palsy, right hemiparesis and right seventh nerve supranuclear palsy as a manifestation of left thalamic hemorrhage. To our knowledge this is the first reported case of a combination of unilateral blepharospasm and blepharoptosis with bilateral vertical gaze palsy.
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Affiliation(s)
- V Chauhan
- Department of Medicine, Indira Gandhi Medical College, Shimla 171001, Himachal Pradesh
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Abstract
Primary blepharospasm is an adult-onset dystonia typically present at rest and exacerbated by bright light, stress and voluntary movements of eyes and eyelids. Inconsistency or inducibility by activities involving muscles other than orbicularis oculi muscles are considered incongruous with typical primary blepharospasm, heralding the suspicion of psychogenicity. We report the clinical vignette of two patients manifesting an unusual presentation of primary blepharospasm, specifically triggered by voiced speech and associated with an otherwise 'typical' presentation of primary adult-onset dystonia in the lower face, larynx or upper limb. Speech-induced primary blepharospasm seems a rare occurrence, representing 1.3% of our clinic-based series of 149 patients with primary adult-onset primary blepharospasm. In these atypical patients, the feature of speech inducibility suggests that the abnormal surrounding inhibition between cortical subregions representing laryngeal and orbicularis oculi muscles might underlie dystonic overflow to the orbicularis oculi muscles following the voiced speech.
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Affiliation(s)
- Davide Martino
- Department of Neurological and Psychiatric Sciences, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Abstract
BACKGROUND Pallidal deep brain stimulation (DBS) of globus pallidus internus (Gpi) has emerged as an effective treatment for dystonia. The experience is however limited concerning focal dystonias and to date only a few cases of pallidal DBS in the treatment of Meige syndrome have been published. METHODS/RESULTS We here present a patient with Meige syndrome in whom unilateral pallidal DBS failed to improve the axial symptoms, but bilateral stimulation resulted in a major improvement. The Burke-Fahn-Marsden score (BFM) improved by 71.5% and the patient's blepharospasm was abolished. CONCLUSIONS The results suggest bilateral pallidal DBS may be an effective treatment for Meige syndrome.
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Affiliation(s)
- P Blomstedt
- Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden.
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Hara K, Matsuda A, Kitsukawa Y, Tanaka K, Nishizawa M, Tagawa A. Botulinum toxin treatment for blepharospasm associated with myasthenia gravis. Mov Disord 2008; 22:1363-4. [PMID: 17486596 DOI: 10.1002/mds.21558] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Girgis NM, Frantz KA. A case of primary congenital glaucoma: a diagnostic dilemma. ACTA ACUST UNITED AC 2007; 78:167-75. [PMID: 17400138 DOI: 10.1016/j.optm.2006.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 10/11/2006] [Accepted: 10/27/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary congenital glaucoma generally presents with a classic clinical triad of photophobia, blepharospasm, and epiphora caused by the corneal changes that occur secondary to increased intraocular pressure (IOP). The condition typically presents bilaterally and is rarely hereditary. Onset is from age 2 months to 2 to 3 years. CASE REPORT A 2-year, 5-month-old Hispanic boy presented with an enlarged right eye and an intermittent right exotropia, without tearing or photophobia. Examination also found high myopia and an optic nerve cup-to-disc ratio larger in the right than the left eye. Referral to a pediatric ophthalmologist was initiated. On the first examination under anesthesia (EUA), the child was diagnosed with unilateral megalocornea with a normal IOP. He did not have any other typical signs and symptoms of primary congenital glaucoma. An EUA 8 months later led to a diagnosis of primary congenital glaucoma based on the new appearance of Haab's striae, further enlargement of the cornea, and an elevated IOP. At this point, medical management was instituted. CONCLUSION This case shows the importance of recognizing signs of primary congenital glaucoma so that appropriate management can begin as soon as possible to provide the best visual outcome for a child.
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Affiliation(s)
- Nadine M Girgis
- Northwest Optometric Associates, Harwood Heights, Illinois 60706, USA.
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Svetel M, Pekmezović T, Jović J, Ivanović N, Dragasević N, Marić J, Kostić VS. Spread of primary dystonia in relation to initially affected region. J Neurol 2007; 254:879-83. [PMID: 17401742 DOI: 10.1007/s00415-006-0457-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 10/12/2006] [Accepted: 10/23/2006] [Indexed: 11/25/2022]
Abstract
Not only childhood-onset, but also adult-onset primary dystonia may spread to multiple body parts. The relative risk of spread by site of onset of dystonia, important for clinical prognosis and approach, has not been well characterized. The aim of this study was to prospectively follow the spread of dystonia in 132 consecutive patients and to estimate the risk of spread by the site of onset of dystonia. The patients were included in the study if primary focal dystonia was the only sign of neurological disease other than tremor; i.e. in all patients a single body part could be identified as affected at the onset. At the end of the followup (mean duration 7.5 years; range 5.2-13.4 years), 96 patients (73%) remained focal, while 26 (20%) and 10 (7%) progressed to segmental and generalized dystonia, respectively. The highest likelihood for further spread was observed in patients with initial blepharospasm (10 out of 30 patients; 33.3%), followed by dystonia of upper extremities (32.3%), torticollis (19.6%), and laryngeal dystonia (6.7%). In addition to the highest risk for further spread of dystonia, blepharospasm was associated with the fastest rate of spread (the second region affected on average after 1.2 years). Our results demonstrated that the initial site of primary dystonia was relevant for the risk of spread.
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Affiliation(s)
- Marina Svetel
- Institute of Neurology CCS, ul. Dr Subotića 6, 11000 Belgrade, Serbia and Montenegro
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Kim HT, Edwards MJ, Tyson J, Quinn NP, Bitner-Glindzicz M, Bhatia KP. Blepharospasm and limb dystonia caused by Mohr-Tranebjaerg syndrome with a novel splice-site mutation in the deafness/dystonia peptide gene. Mov Disord 2007; 22:1328-31. [PMID: 17534980 DOI: 10.1002/mds.21351] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mohr-Tranebjaerg syndrome (MTS) is an X-linked disorder characterized by childhood-onset progressive deafness, dystonia, spasticity, mental deterioration, and blindness. It is due to mutations in the deafness/dystonia peptide (DDP1) gene. We describe a sporadic 42-year-old man with MTS presenting with postlingual deafness, adult-onset progressive dystonia with marked arm tremor, mild spasticity of the legs, and visual disturbance due to a novel mutation (g to a transition at the invariant gt of the 5' splice donor site of exon 1) in the DDP1 gene. This case, and a review of previously reported cases, highlights a variety of potential diagnostic pitfalls in this condition.
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Affiliation(s)
- Hee T Kim
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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Abstract
Primary dystonia is associated with abnormal brainstem function, as shown by abnormalities of the blink reflex in blepharospasm (BSP) and of the auditory startle reaction in cervical dystonia. We examined the auditory startle reaction--a brainstem reflex elicited by an unexpected loud stimulus--in patients with primary BSP to expand knowledge on brainstem pathophysiology in primary focal dystonia. Thirteen patients with primary BSP were included and 13 age- and sex-matched healthy volunteers served as controls. Auditory startle responses (ASRs) were elicited by binaural high-intensity auditory stimuli, and reflex electromyographic activity was recorded simultaneously with surface electrodes bilaterally from masseter, orbicularis oculi, sternocleidomastoid, and biceps brachii muscles. Patients with BSP showed higher ASR probabilities (masseter, sternocleidomastoid, biceps brachii), shorter ASR onset latencies (masseter, orbicularis oculi, sternocleidomastoid), and larger ASR area-under-the-curve (masseter, sternocleidomastoid) as compared with normal controls. Habituation of ASRs did not differ significantly between patients and controls. These results corroborate previous findings of increased brainstem excitability in primary BSP but point to a different pattern of brainstem dysfunction compared to cervical dystonia, indicating that different pathophysiological mechanisms are involved in the two types of focal dystonia.
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Affiliation(s)
- Jörg Müller
- Department of Neurology, Medical University Innsbruck, Austria
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O'Rourke K, O'Riordan S, Gallagher J, Hutchinson M. Paroxysmal torticollis and blepharospasm following bilateral cerebellar Infarction. J Neurol 2006; 253:1644-5. [PMID: 17219037 DOI: 10.1007/s00415-006-0202-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Accepted: 12/31/2005] [Indexed: 11/25/2022]
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Abstract
Blepharospasm, psychotic symptoms, and obsessive-compulsive symptoms can result from brain infarction. However, a presentation of these 3 symptoms simultaneously is rare. This report describes a 65-year-old woman who had old brain infarction and presented with these 3 symptoms for 2 years. The patient recovered after receiving a regimen of clozapine 125 mg/d for 3 months. No recurrences of symptoms were noted during a 6-month follow-up. This is the first case report demonstrating that clozapine is effective for a patient with blepharospasm, obsessive-compulsive symptoms, and psychotic symptoms presenting simultaneously. This report also reminds physicians of the possible organic causes of unusual presentations in elderly patients.
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Affiliation(s)
- Cheng-Hsien Sun
- Department of Psychiatry, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Morrison DA, Mellington FB, Hamada S, Moore AT. Schwartz-Jampel syndrome: surgical management of the myotonia-induced blepharospasm and acquired ptosis after failure with botulinum toxin A injections. Ophthalmic Plast Reconstr Surg 2006; 22:57-9. [PMID: 16418670 DOI: 10.1097/01.iop.0000195008.15872.a0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 6-year-old boy with Schwartz-Jampel syndrome and severe myotonia-induced blepharospasm and ptosis did not respond to botulinum toxin A injections in the orbicularis muscle. The clinical diagnosis was further supported by electromyography. Surgical management using a combination of techniques in one operation produced a satisfactory result for both function and appearance. Muscle biopsy was also done during surgery.
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Abstract
Amongst all regions of the body, the craniocervical region is the one most frequently affected by dystonia. Whilst blepharospasm--involuntary bilateral eye closure--is produced by spasmodic contractions of the orbicularis oculi muscles, oromandibular dystonia may cause jaw closure with trismus and bruxism, or involuntary jaw opening or deviation, interfering with speaking and chewing. Both forms of dystonia can be effectively treated with botulinum toxin injection. This article summarizes injection techniques in both forms of dystonia and compares doses, potency and efficacy of different commercially available toxins, including Botox, Dysport, Xeomin and Myobloc/NeuroBloc.
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Affiliation(s)
- R Bhidayasiri
- Division of Neurology, Chulalongkorn University Hospital, Bangkok, Thailand
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Abstract
Amongst all regions of the body, the craniocervical region is the one most frequently affected by dystonia. Whilst blepharospasm--involuntary bilateral eye closure--is produced by spasmodic contractions of the orbicularis oculi muscles, oromandibular dystonia may cause jaw closure with trismus and bruxism, or involuntary jaw opening or deviation, interfering with speaking and chewing. Both forms of dystonia can be effectively treated with botulinum toxin injection. This article summarizes injection techniques in both forms of dystonia and compares doses, potency and efficacy of different commercially available toxins, including Botox, Dysport, Xeomin and Myobloc/NeuroBloc.
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Affiliation(s)
- R Bhidayasiri
- Division of Neurology, Chulalongkorn University Hospital, Bangkok, Thailand
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I periodically suffer from really annoying twitches in my lower eyelids. Is this a sign of a neurological disorder? These twitches start for no apparent reason, keep up for weeks, and then disappear. Health News 2005; 11:16. [PMID: 16419179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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34
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Cattaneo L, Chierici E, Pavesi G. Bell's palsy-induced blepharospasm relieved by passive eyelid closure and responsive to apomorphine. Clin Neurophysiol 2005; 116:2348-53. [PMID: 16098807 DOI: 10.1016/j.clinph.2005.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 06/07/2005] [Accepted: 06/20/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We describe the case of a woman with Bell's Palsy-induced blepharospasm (BPIB) of the right eye that appeared simultaneously with a complete left facial nerve palsy. The involuntary spasm was relieved by passive lowering of the upper eyelid on the paretic side. METHODS The recovery curve of the blink reflex was evaluated on the non-paretic side in baseline conditions, after subcutaneous apomorphine and placebo administration and 8 months later, at recovery from the palsy. RESULTS We found increased recovery of the test-R2 responses at short interstimulus intervals at baseline, which was normalised by apomorphine but not by placebo. At recovery the blink reflex R2 recovery curve returned to normal. CONCLUSIONS This report demonstrates for the first time a response of BPIB to a dopamine agonist. SIGNIFICANCE Our findings are in agreement with an animal model of blepharospasm that suggests a combined role of weakness of the orbicularis oculi muscle and a dysfunction of the dopaminergic system in the pathogenesis of this disorder.
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Affiliation(s)
- Luigi Cattaneo
- Dipartimento di Neuroscienze, Sezione di Neurologia, Università degli Studi di Parma, Via Gramsci 14, 43100 Parma, Italy.
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Affiliation(s)
- Bhupendra C K Patel
- Division of Facial Plastic Reconstructive and Cosmetic Surgery, John Moran Eye Center, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
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Leon-Sarmiento FE, Bayona-Prieto J, Gomez J. Neurophysiology of blepharospasm and multiple system atrophy: clues to its pathophysiology. Parkinsonism Relat Disord 2005; 11:199-201; author reply 203-4. [PMID: 15823487 DOI: 10.1016/j.parkreldis.2004.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Revised: 07/22/2004] [Accepted: 07/27/2004] [Indexed: 10/26/2022]
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Martinaud O, Guegan-Massardier E, Iasci L, Miret N, Mihout B, Hannequin D. [Anti-Ri paraneoplastic syndrome associated with ophtalmoplegia, blepharospasm and palilalia]. Rev Neurol (Paris) 2005; 161:81-6. [PMID: 15678006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Anti-Hu and anti-Yo are the most well-known anti-neuronal antibodies. The anti-Ri antibodies, which are less common, are generally found in subjects with opsoclonus-myoclonus, often associated with breast cancer. CASE REPORT A 54-year-old woman presented anti-Ri antibodies associated with a paraneoplastic syndrome and unusual symptoms of ophthalmoplegia, blepharospasm, palilalia and ataxia. Adenocarcinoma of the breast was also found. After chemotherapy, radiotherapy, and several immunoglobulin infusions, the patient did not improve ten months after tumor surgery. CONCLUSION Anti-Ri antibodies associated with paraneoplastic syndrome can be observed in patients who develop a rapidly progressive brainstem tumor. Breast or lung cancer and conduct to search a breast or pulmonary cancer.
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Affiliation(s)
- O Martinaud
- Département de Neurologie, Hôpital Charles Nicolle, CHU de Rouen
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Abstract
We report on a patient who presented a transient eyelid motor disorder characterized by bilateral reflex blepharospasm as the main clinical manifestation of a right-sided striatal infarction. This case emphasizes the role of the nondominant striatum in the pathophysiology of eyelid motor abnormalities.
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Affiliation(s)
- Francisco Grandas
- Service of Neurology, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007 Madrid, Spain.
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41
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Abstract
PURPOSE To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining eyelid synkinesia in aberrant facial nerve regeneration, while concurrently observing for the presence of side effects to differing treatment doses. METHODS A prospective interventional study of five patients with eyelid synkinesia resulting from aberrant regeneration of the facial nerve. Patients were treated with injections of either 120, 80 or 40 units of BTX-A (Dysport) into the orbicularis oculi. Objective and subjective reduction in synkinesia, maintenance of response and presence of side effects were recorded. RESULTS All five patients had improvement of the synkinesia with BTX-A treatment. Lower doses were found to be as effective as higher doses. Mean duration of abolished synkinesia was three months. Two patients developed a ptosis which resolved spontaneously. None of the patients treated with the lowest dose of 40 units developed a ptosis. CONCLUSION Low-dose BTX-A has a lower incidence of ptosis and is effective in the treatment of aberrant facial nerve regeneration.
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Affiliation(s)
- C N Chua
- Oxford Eye Hospital Radcliffe Infirmary, Oxford, UK.
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von Dengler R, Rollnik JD. [Dystonias: what the practitioner needs to know]. MMW Fortschr Med 2004; 146:44-6. [PMID: 15625936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Dystonia is characterized by involuntary muscular contractions resulting in repetitive movements and/or postures, with co-contraction of antagonist muscle groups. the present overview describes the fundamentals of dystonic movement disorders, and provides information on their diagnosis and therapy, including in particular the not infrequent focal dystonias spasmodic torticollis, blepharospasm, and writer's cramp, and the generalized forms. For the practitioner it is of primary importance to be able to recognize these sometimes bizarre movement disorders as dystonias. In many cases, the correct diagnosis makes possible effective treatment that frequently results in an appreciable improvement in the patient's symptoms.
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Affiliation(s)
- R von Dengler
- Neurologische Klinik mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, D-30623 Hannover
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Abstract
A large number of patients with Parkinson's disease (PD) experience nocturnal problems that impair their sleep quality. Among them, motor disorders such as tremor, rigidity, akinesia, akathisia, periodic leg movements, painful dystonia, dyskinesias, restless legs syndrome, and rapid eye movement sleep behavior disorder are common. This article reviews the clinical characteristics of some nocturnal motor problems that often induce sleep disruption in PD patients.
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Affiliation(s)
- F Grandas
- Department of Neurology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain.
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Mulè F, Rauch D, Moore RS, Nield LS, Moore CA, Byerley J, Basinger A, Lau E, White A. Index of suspicion. Pediatr Rev 2004; 25:254-9. [PMID: 15231992 DOI: 10.1542/pir.25-7-254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kamada M, Fukutake T, Hiroyoshi Y, Sato S, Shibayama H, Nishino H. [A case of myasthenia gravis associated with blephaloptosis mimicking blephalospasm]. Rinsho Shinkeigaku 2004; 44:54. [PMID: 15199740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
Primary blepharospasm is an adult-onset focal dystonia characterised by involuntary contractions of the orbicularis oculi muscles. Patients may have various types of movements arising from the different parts of the orbicularis oculi muscle. These include typical blepharospasm associated with Charcot's sign, pretarsal blepharospasm and flickering of the eyelids. Primary blepharospasm may be associated with so-called apraxia of eyelid opening as well as dystonia in the lower face, jaw or cervical muscles. Unless there are clinical clues to a symptomatic cause, adults presenting with blepharospasm do not require extensive aetiological investigation because the condition is rarely due to an identifiable condition. As the aetiology of primary blepharospasm is largely unknown, therapeutic approaches are symptomatic, with type A botulinum toxin being the treatment of choice.
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Affiliation(s)
- Giovanni Defazio
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy.
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47
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Kurbanova NF. [Surgical tactics in eye injuries and their sequelae according to specialized-unit data]. Vestn Oftalmol 2003; 119:45-6. [PMID: 14598497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Khouri AS. Excessive blinking in children. Ophthalmology 2003; 110:878; author reply 878. [PMID: 12750081 DOI: 10.1016/s0161-6420(02)01864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Martino D, Livrea P, Giorelli M, Masi G, Aniello MS, Defazio G. Menopause and menarche in patients with primary blepharospasm: an exploratory case-control study. Eur Neurol 2002; 47:161-4. [PMID: 11914554 DOI: 10.1159/000047975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We studied the relationships between blepharospasm (BSP) and menopause/menarche in female patients with primary BSP (n = 83) and age-matched healthy (n = 83) and disease controls (n = 83). BSP patients and matched controls had comparable age at menopause, and there was no correlation between age at menopause and age at BSP onset. Thus, menopause probably exerts no significant influence on the age-dependent development of BSP. BSP cases tended to have a later menarche than either group of controls. The association was independent of age, disease duration and education level. Because the higher the age at menarche, the higher the age at BSP onset, later menarche was unlikely to be a risk factor for BSP. Rather, the two conditions may share pathophysiologic mechanisms, for example minor abnormality of neurotransmitter systems controlling both the motor system and the maturation of the hypothalamic-pituitary-gonadal axis responsible for the onset of puberty.
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Affiliation(s)
- Davide Martino
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy
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