Involuntary eyelid closure after STN-DBS: evidence for different pathophysiological entities.
OBJECTIVE
Involuntary eyelid closure (IEC) may occur after deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson's disease (PD) and is often categorised as apraxia of lid opening (ALO), albeit the appropriateness of this term is under debate. To gain insight into the hitherto undefined pathophysiology of IEC after STN-DBS, we performed a comprehensive clinical and electrophysiological characterisation of lid function in a total of six PD patients.


METHODS
The study was carried out in six PD patients who developed IEC after STN-DBS. They underwent neurological examination and electromyography recording of activity in the orbicularis oculi muscle (OO) upon varying stimulation patterns. Intraoperative studies were performed in one patient.


RESULTS
Increasing STN-DBS intensity induced IEC in four patients, whereas it improved the condition in two. Needle EMG showed tonic hyperactivity of the OO in STN-DBS induced IEC, while variable patterns of OO activity (irregular and tonic) were seen in patients with STN-DBS-relieved IEC. Intraoperative analysis in one patient showed evidence for IEC being induced by activation of corticobulbar fibres.


CONCLUSIONS
We identified two groups of IEC after STN-DBS based on clinical and EMG patterns: (1) STN-DBS induced IEC associated with tonic OO overactivity and (2) STN-DBS relieved IEC presenting with variable EMG patterns. Our findings provide relevant information on pathophysiology of STN-DBS related IEC and implications for its therapeutic management.
Weiss
Daniel
D
Center of Neurology, Hertie Institute for Clinical Brain Research, and German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.
Wächter
Tobias
T
Breit
Sorin
S
Jacob
Simon N
SN
Pomper
Jörn K
JK
Asmus
Friedrich
F
Valls-Solé
Josep
J
Plewnia
Christian
C
Gasser
Thomas
T
Gharabaghi
Alireza
A
Krüger
Rejko
R
D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods; D004576:Electromyography / Q000379:methods; D005141:Eyelid Diseases / Q000150:complications / Q000503:physiopathology*; D005143:Eyelids / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D011712:Pyramidal Tracts / Q000503:physiopathology; D020531:Subthalamic Nucleus / Q000503:physiopathology*