Ocular motility in Parkinson's disease.

Introduction: Parkinson's disease is associated with multiple abnormalities of both the afferent and efferent visual systems. Blepharospasm, paucity of blinking, apraxia of lid opening, visual neglect, reduced vergence, reduced upgaze, and blurred vision are reported findings in these patients. The association of these findings with the disease, and their duration, severity, and treatment have not been systematically investigated.

[Difficulty in eye opening following left hemispheric infarction-- causative lesion and pathophysiology of abnormalities of the eye and eyelids movements].

We reported a patient suffering from difficulty in eye opening following left hemispheric infarction. A 78-year-old left-handed woman with atrial fibrillation had an acute onset of right hemiparesis and difficulty in eye opening. On admission, mild disorientation, vertical gaze palsy, right homonymous hemianopia, anosognosia of right hemiparesis, agnosia of right side of the body and forced grasping reflex of the left hand were seen.

Lid opening apraxia is associated with medial frontal hypometabolism.

We used [18F]fluorodeoxyglucose with positron emission tomography to explore the functional basis of lid opening apraxia (LOA). We studied four patients with LOA without associated pyramidal or extrapyramidal motor dysfunction (mean age 65.5 +/- 4.

"Apraxia of lid opening," a focal eyelid dystonia: clinical study of 32 patients.

We have seen 32 patients with "apraxia of lid opening" (ALO) in the following clinical settings: as an isolated condition (3 patients), idiopathic blepharospasm (BSP, 20 patients, including 4 familial cases), progressive supranuclear palsy (PSP, 7 patients), and dystonic parkinsonian syndrome (2 patients). Twenty-nine patients treated with botulinum toxin into the orbicularis oculi muscle were rated before and after treatment and 83% of the patients improved on a clinical scale. Best results were obtained with injections directed toward the junction of the preseptal and pretarsal parts of the palpebral orbicularis oculi.

[Asynchronous Bell's phenomenon in progressive supranuclear palsy].

A 60-year-old man suffering from progressive supranuclear palsy showed asynchronous Bell's phenomenon and apraxia of eye-lid opening. He showed synchronous upward rotation of the eyeball at closing eyes. Although apraxia of eye-lid opening was observed in both sides, eye opening of the right side took longer duration than that of the opposite side.

Neuro-ophthalmic findings in progressive supranuclear palsy.

We studied 104 patients with progressive supranuclear palsy (PSP), 38 of whom were examined by both a neurologist and a neuro-ophthalmologist. Neuro-ophthalmic findings that may help differentiate PSP from Parkinson's disease include vertical supranuclear ophthalmoparesis and fixation instability. Eyelid abnormalities, particularly lid retraction, blepharospasm, and "apraxia" of eyelid opening and closure, were important distinguishing signs.

Apraxia of lid opening in blepharospasm.

Apraxia of lid opening is a nonparalytic motor abnormality characterized by difficulty in initiating the act of lid elevation. It has been reported with extrapyramidal disorders, including Parkinson's disease, Huntington's chorea, progressive supranuclear palsy, and Shy-Drager syndrome. We found seven cases (7%) of functionally disabling apraxia of lid opening in 100 consecutive blepharospasm patients studied.

Apraxia of eyelid opening secondary to right hemisphere infarction.

A variety of eyelid movement abnormalities have been attributed to lesions of the central nervous system. Apraxia of lid movements, and especially of lid opening, has received the least attention. We present 2 cases of lid opening apraxia and propose that this abnormality may be due to right hemisphere dysfunction.

Eyelid movement abnormalities in progressive supranuclear palsy.

We systematically videotaped eyelid movements in a community-based series of 38 patients with progressive supranuclear palsy (PSP). Ten patients (26%) had blepharospasm, "apraxia" of lid opening and/or "apraxia" of lid closing. These patients as a group had more severe upgaze paresis but no greater disease duration than the patients without supranuclear lid dysfunction.

Involuntary closure of eyelids in parkinsonism. Electrophysiological evidence for prolonged inhibition of the levator palpebrae muscles.

Involuntary closure of eyelids (ICE), a phenomenon variously interpreted as blepharospasm and apraxia of lid opening, is occasionally observed in parkinsonism. Nine patients (4 with Parkinson's disease, 2 with post-encephalitic parkinsonism, and 3 with supranuclear palsy) with prominent ICE, were studied by electromyographic recording of the eye muscles. ICE episodes were shown to be dependent upon prolonged, irregular inhibition of the normal tonic activity of the levator palpebrae superioris (LPS) muscle causing drooping of the upper eyelid without any corresponding activation of the orbicularis oculi (OO) muscle.

Lid-opening apraxia in Wilson's disease.

A student was diagnosed as having Wilson's disease only after the severe, intermittent inability to open his eyes led him to seek neurologic evaluation. Although lid-opening apraxia is usually a symptom of diffuse extrapyramidal disease, it has not previously been reported in Wilson's disease.

Blepharospasm-oromandibular dystonia syndrome (Meige's syndrome): clinical aspects.

Meige's syndrome is a form of cranial dystonia characterized by the presence of bilateral dystonic spasms of the facial muscles and frequently of other cranial muscles as well. Its most common and disabling manifestation is blepharospasm which can render the patient functionally blind. Several types of orbicularis oculi spasms occur in Meige's syndrome: brief clonic spasms, prolonged dystonic spasms, constant tonic contraction, and "apraxia" of lid opening.

Eyelid movement disorders and motor impersistence in acute hemisphere disease.

The aim of this study was to evaluate, in an acutely brain-damaged population, the occurrence of motor impersistence and its relation to the side of lesion. All the patients hospitalized in a 10-month period for a stroke involving one hemisphere and able to cooperate were given, in the early days of illness, a motor impersistence battery requiring the maintenance of a position of eyelids, gaze, mouth, and limbs for 10 seconds. A control group of 50 patients without brain damage provided the basis for evaluating pathologic performance.

"Apraxia" of eyelid opening: an involuntary levator inhibition.

Apraxia of lid opening was described by Goldstein and Cogan as "a non paralytic motor abnormality characterized by the patient's difficulty in initiating the act of lid elevation." We studied six such patients with this finding accompanied by vigorous frontalis contraction and no evidence of ongoing orbicularis oculi contraction, dysfunction of the oculomotor nerve, or loss of ocular sympathetic innervation. Four patients had Parkinson's disease or atypical parkinsonism, one had progressive supranuclear palsy, and one had Shy-Drager syndrome.

[Disorders of voluntary eyelid movements (author's transl)].

Isolated disturbances of voluntary lid movements are a symptom which has been rarely described, and to which widely differing labels have been applied. Three different symptoms can be described from the cases reported in the literature: disorder of voluntary lid closing and/or opening, cortical ptosis, and inability to keep the eyes closed for more than a few seconds ("motor impersistance"). This last symptom can be considered as an unspecific sign of brain-damage.

Eyelid movement disorders following unilateral hemispheric stroke.

The presence of voluntary eyelid movement disorders was systematically checked in 51 patients with a recent stroke supposedly confined to one hemisphere and presenting with contralateral gaze impairment. Inability to initiate lid closure was found in 5 patients, inability to keep the eyes closed for more than 1-3 sec in 5 patients and inability to initiate eyelid opening in 1 patient. One patient failed both to close his eyes and to open them when closed.