title: Combination of blepharospasm and apraxia of eyelid opening: a condition resistant to treatment.
abstract: Blepharospasm is seen in many cases of Parkinsonism including progressive supranuclear palsy. These patients usually respond well to botulinum toxin, however some patients subsequently fail to respond to even higher doses of botulinum toxin after an initial good response. They should not be considered failure of treatment with botulinum toxin, as a significant number of these patients have underlying apraxia of eyelid opening in addition to blepharospasm, which may be the cause of failure to respond to botulinum toxin. Combination of eyelid crutches or myomectomy with botulinum toxin is more effective in these patients as compared to an individual treatment modality. In this report, we present two patients with progressive supranuclear palsy who failed to respond to botulinum toxin because they had underlying apraxia of lid opening. Partial myomectomy in one patient and eyelid crutches in the other in combination with botulinum toxin lead to a much better response to botulinum toxin.
authors.affiliation: Parkinson's Clinic of Eastern Toronto and Movement Disorders Centre, 404-2863 Ellesmere Rd, Toronto, ON M1E5E9, Canada. ranaaq@yahoo.com
authors.forename: Abdul Qayyum
authors.initials: AQ
authors.lastname: Rana
authors.forename: Reema
authors.initials: R
authors.lastname: Shah
mesh_terms: D000368:Aged; D001072:Apraxias / Q000150:complications* / Q000188:drug therapy; D001764:Blepharospasm / Q000150:complications* / Q000188:drug therapy; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D005143:Eyelids / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000627:therapeutic use
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A