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Youn-shen Bee - One of the best experts on this subject based on the ideXlab platform.

Joseph Jankovic - One of the best experts on this subject based on the ideXlab platform.

  • treatment of Blepharospasm with apraclonidine
    Journal of the Neurological Sciences, 2017
    Co-Authors: Dhanya Vijayakumar, Subhashie Wijemanne, Joseph Jankovic
    Abstract:

    Abstract Objective To describe improvement in Blepharospasm with apraclonidine. Background Blepharospasm is a focal dystonia involving chiefly the orbicularis oculi and periocular muscles resulting in involuntary sustained eyelid closure. Botulinum toxin injection is the mainstay of treatment with meaningful improvement in over 85% of patients, but the effects often wear off within 3–4 months. Apraclonidine is an alpha-2 adrenergic receptor agonist, which causes contraction of superior tarsal (Muller) muscle which may improve Blepharospasm-related eyelid closure. We propose that apraclonidine may be a useful short-term treatment in patients with Blepharospasm, particularly during wearing off from botulinum toxin injection. Methods Patients who had pre-mature wearing off of botulinum injection effect were evaluated before and after the administration of 2 drops of apraclonidine 0.5%–1% solution to each eye. Subjective patient impressions and examiner's impression of symptoms pre and post-apraclonidine administration were recorded. A blinded rater evaluated the videos and provided an independent assessment of the severity of symptoms pre- and post-administration, using a 0–4 scale. Results Our study included 7 patients (4 male) with a mean age of 61 years and mean duration of Blepharospasm of 3.6 years. There was a subjective, albeit transient (about 2–4 h) improvement in Blepharospasm reported by all patients and by the examiner. The mean severity scores, based on blinded video ratings, showed a reduction from of 3.4 pre-administration to 2.3 post-administration of apraclonidine ( p Conclusions Apraclonidine is a potentially useful medication for short term management of Blepharospasm symptoms while awaiting botulinum toxin injection.

  • incobotulinumtoxina xeomin injected for Blepharospasm or cervical dystonia according to patient needs is well tolerated
    Journal of the Neurological Sciences, 2014
    Co-Authors: Virgilio Gerald H Evidente, Joseph Jankovic, Daniel D Truong, Cynthia L Comella, Susanne Grafe, Angelika Hanschmann
    Abstract:

    Typically, botulinum toxin injections for Blepharospasm or cervical dystonia (CD) are administered at approximately 3-month intervals, reflecting concerns that shorter intervals might increase the risk of adverse events (AEs) and development of neutralizing antibodies. These post-hoc analyses investigated flexible incobotulinumtoxinA (Xeomin®) injection intervals (6-20 weeks) in patients with Blepharospasm or CD. Patients received up to 6 injections at intervals ≥ 6 weeks, as determined by physician assessment upon patient request. The Blepharospasm study permitted flexible doses (≤ 50 U/eye). The CD study employed fixed dosing using incobotulinumtoxinA 120 U, 240 U, or placebo for the first treatment followed by subsequent randomization to 120 U or 240 U for the extension period. Standard safety assessments were performed. Intervals <12 weeks were employed in 207 of 461 (44.9%) treatment cycles for Blepharospasm and in 369 of 821 (44.9%) treatment cycles for CD. The most frequent AEs were eyelid ptosis and dry eyes in patients treated for Blepharospasm, and dysphagia and neck pain in patients with CD. AE frequency and severity were similar for intervals <12 weeks and ≥ 12 weeks in both studies. In conclusion, repeated incobotulinumtoxinA injections employing flexible intervals (6-20 weeks) per patients' needs were well tolerated. No additional safety concerns were observed with <12-week intervals compared with ≥ 12-week intervals.

  • botulinum toxin in the treatment of Blepharospasm and hemifacial spasm
    Journal of Neural Transmission, 2008
    Co-Authors: Christopher Kenney, Joseph Jankovic
    Abstract:

    Blepharospasm and hemifacial spasm are the two most common craniofacial movement disorders. Blepharospasm is a syndrome characterized by excessive or continuous eye closure related to overactivity of the orbicularis oculi and adjacent muscles bilaterally. Hemifacial spasm is a peripherally-induced movement disorder typically caused by vascular compression of cranial nerve VII (CN VII) leading to involuntary unilateral contractions of muscles used in facial expression. Treatment options for both conditions include medications, botulinum toxin, and various surgical interventions. This article summarizes the existing medical literature which indicates that botulinum toxin is the treatment of choice for Blepharospasm and hemifacial spasm.

Yng Sun - One of the best experts on this subject based on the ideXlab platform.

Mark S Ledoux - One of the best experts on this subject based on the ideXlab platform.

  • Blepharospasm plus cervical dystonia with predominant anterocollis a distinctive subphenotype of segmental craniocervical dystonia
    Tremor and other hyperkinetic movements (New York N.Y.), 2011
    Co-Authors: Olga Waln, Mark S Ledoux
    Abstract:

    Background:  Dystonia of the eyelids often spreads to affect other muscles in the craniocervical region.  Certain Blepharospasm-plus subphenotypes may be clinically unique. Methods: Seven subjects with the subphenotype of late-onset Blepharospasm with apraxia of eyelid opening and anterocollis were identified from a database of over 1800 patients with primary dystonia.  Results: Blepharospasm was the first affected site in 6/7 subjects followed by spread of the disease to the cervical muscles.   Although 4 patients also had other forms of dystonia (laryngeal, lower face), none showed spread outside the craniocervical region.  Family history of dystonia was present in 4/7.  No mutations were identified in THAP1 or TOR1A .  Overall, Blepharospasm was difficult to treat, typically requiring both myectomy and substantial doses of botulinum toxin into the pretarsal orbicularis oculi muscles.  In one subject, anterocollis markedly improved after deep brain stimulation.   Discussion:  Delineation and characterization of craniocervical dystonia subphenotypes may serve to guide genetic and therapeutic studies, in addition to clinical interventions.  The Blepharospasm with apraxia of eyelid opening and anterocollis subphenotype can be therapeutically challenging.

  • meige syndrome what s in a name
    Parkinsonism & Related Disorders, 2009
    Co-Authors: Mark S Ledoux
    Abstract:

    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.

  • serotonergic modulation of eye blinks in cat and monkey
    Neuroscience Letters, 1998
    Co-Authors: Mark S Ledoux, Joan F Lorden, Jason M Smith, Lawrence E Mays
    Abstract:

    Serotonergic modulation of spontaneous and reflexive blinking was studied in four cats and one monkey. In cats, facial nucleus injections of the type-2 serotonin receptor (5-HT2) antagonist ketanserin tended to increase the latency of the first (R1) and second (R2) components of the blink reflex to supraorbital nerve stimulation. Injections of serotonin tended to increase and of ketanserin, to decrease the duration and amplitude of R2. Serotonin also produced unilateral Blepharospasm and hemifacial spasm. In the monkey, the 5-HT2 agonist 2,5-dimethoxy-4-iodoamphetamine increased spontaneous blink frequency while ketanserin decreased both peak blink velocity and spontaneous blink frequency. These findings in cat and monkey indicate that serotonergic innervation of the facial nucleus has a behaviorally important role in modulation of spontaneous and reflexive blinks and suggest that dysfunction of serotonergic systems could be important to the pathophysiology of some cases of Blepharospasm.

Pei-jhen Tsai - One of the best experts on this subject based on the ideXlab platform.