title: Objective, computerized video-based rating of blepharospasm severity.
abstract: OBJECTIVE
  To compare clinical rating scales of blepharospasm severity with involuntary eye closures measured automatically from patient videos with contemporary facial expression software.
  
  
  METHODS
  We evaluated video recordings of a standardized clinical examination from 50 patients with blepharospasm in the Dystonia Coalition's Natural History and Biorepository study. Eye closures were measured on a frame-by-frame basis with software known as the Computer Expression Recognition Toolbox (CERT). The proportion of eye closure time was compared with 3 commonly used clinical rating scales: the Burke-Fahn-Marsden Dystonia Rating Scale, Global Dystonia Rating Scale, and Jankovic Rating Scale.
  
  
  RESULTS
  CERT was reliably able to find the face, and its eye closure measure was correlated with all of the clinical severity ratings (Spearman ρ = 0.56, 0.52, and 0.56 for the Burke-Fahn-Marsden Dystonia Rating Scale, Global Dystonia Rating Scale, and Jankovic Rating Scale, respectively, all p < 0.0001).
  
  
  CONCLUSIONS
  The results demonstrate that CERT has convergent validity with conventional clinical rating scales and can be used with video recordings to measure blepharospasm symptom severity automatically and objectively. Unlike EMG and kinematics, CERT requires only conventional video recordings and can therefore be more easily adopted for use in the clinic.
authors: From the Computational Neurobiology Laboratory (D.A.P., T.J.S.) and Howard Hughes Medical Institute (T.J.S.), Salk Institute for Biological Studies; Institute for Neural Computation (D.A.P., G.C.L., M.S.B., T.J.S.), Kavli Institute for Brain and Mind (D.A.P., T.J.S.), Machine Perception Laboratory (G.C.L., M.S.B.), and Division of Biological Sciences (T.J.S.), University of California, San Diego, La Jolla; Sobell Department of Motor Neuroscience and Movement Disorders (A.M.), National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, UK; Departments of Neurology, Radiology, and Anatomy and Neurobiology, and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University, Atlanta, GA; and Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD. dap@salk.edu.
authors: David A
authors: DA
authors: Peterson
authors: From the Computational Neurobiology Laboratory (D.A.P., T.J.S.) and Howard Hughes Medical Institute (T.J.S.), Salk Institute for Biological Studies; Institute for Neural Computation (D.A.P., G.C.L., M.S.B., T.J.S.), Kavli Institute for Brain and Mind (D.A.P., T.J.S.), Machine Perception Laboratory (G.C.L., M.S.B.), and Division of Biological Sciences (T.J.S.), University of California, San Diego, La Jolla; Sobell Department of Motor Neuroscience and Movement Disorders (A.M.), National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, UK; Departments of Neurology, Radiology, and Anatomy and Neurobiology, and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University, Atlanta, GA; and Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors: Gwen C
authors: GC
authors: Littlewort
authors: From the Computational Neurobiology Laboratory (D.A.P., T.J.S.) and Howard Hughes Medical Institute (T.J.S.), Salk Institute for Biological Studies; Institute for Neural Computation (D.A.P., G.C.L., M.S.B., T.J.S.), Kavli Institute for Brain and Mind (D.A.P., T.J.S.), Machine Perception Laboratory (G.C.L., M.S.B.), and Division of Biological Sciences (T.J.S.), University of California, San Diego, La Jolla; Sobell Department of Motor Neuroscience and Movement Disorders (A.M.), National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, UK; Departments of Neurology, Radiology, and Anatomy and Neurobiology, and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University, Atlanta, GA; and Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors: Marian S
authors: MS
authors: Bartlett
authors: From the Computational Neurobiology Laboratory (D.A.P., T.J.S.) and Howard Hughes Medical Institute (T.J.S.), Salk Institute for Biological Studies; Institute for Neural Computation (D.A.P., G.C.L., M.S.B., T.J.S.), Kavli Institute for Brain and Mind (D.A.P., T.J.S.), Machine Perception Laboratory (G.C.L., M.S.B.), and Division of Biological Sciences (T.J.S.), University of California, San Diego, La Jolla; Sobell Department of Motor Neuroscience and Movement Disorders (A.M.), National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, UK; Departments of Neurology, Radiology, and Anatomy and Neurobiology, and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University, Atlanta, GA; and Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors: Antonella
authors: A
authors: Macerollo
authors: From the Computational Neurobiology Laboratory (D.A.P., T.J.S.) and Howard Hughes Medical Institute (T.J.S.), Salk Institute for Biological Studies; Institute for Neural Computation (D.A.P., G.C.L., M.S.B., T.J.S.), Kavli Institute for Brain and Mind (D.A.P., T.J.S.), Machine Perception Laboratory (G.C.L., M.S.B.), and Division of Biological Sciences (T.J.S.), University of California, San Diego, La Jolla; Sobell Department of Motor Neuroscience and Movement Disorders (A.M.), National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, UK; Departments of Neurology, Radiology, and Anatomy and Neurobiology, and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University, Atlanta, GA; and Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors: Joel S
authors: JS
authors: Perlmutter
authors: From the Computational Neurobiology Laboratory (D.A.P., T.J.S.) and Howard Hughes Medical Institute (T.J.S.), Salk Institute for Biological Studies; Institute for Neural Computation (D.A.P., G.C.L., M.S.B., T.J.S.), Kavli Institute for Brain and Mind (D.A.P., T.J.S.), Machine Perception Laboratory (G.C.L., M.S.B.), and Division of Biological Sciences (T.J.S.), University of California, San Diego, La Jolla; Sobell Department of Motor Neuroscience and Movement Disorders (A.M.), National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, UK; Departments of Neurology, Radiology, and Anatomy and Neurobiology, and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University, Atlanta, GA; and Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors: H A
authors: HA
authors: Jinnah
authors: From the Computational Neurobiology Laboratory (D.A.P., T.J.S.) and Howard Hughes Medical Institute (T.J.S.), Salk Institute for Biological Studies; Institute for Neural Computation (D.A.P., G.C.L., M.S.B., T.J.S.), Kavli Institute for Brain and Mind (D.A.P., T.J.S.), Machine Perception Laboratory (G.C.L., M.S.B.), and Division of Biological Sciences (T.J.S.), University of California, San Diego, La Jolla; Sobell Department of Motor Neuroscience and Movement Disorders (A.M.), National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, UK; Departments of Neurology, Radiology, and Anatomy and Neurobiology, and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University, Atlanta, GA; and Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors: Mark
authors: M
authors: Hallett
authors: From the Computational Neurobiology Laboratory (D.A.P., T.J.S.) and Howard Hughes Medical Institute (T.J.S.), Salk Institute for Biological Studies; Institute for Neural Computation (D.A.P., G.C.L., M.S.B., T.J.S.), Kavli Institute for Brain and Mind (D.A.P., T.J.S.), Machine Perception Laboratory (G.C.L., M.S.B.), and Division of Biological Sciences (T.J.S.), University of California, San Diego, La Jolla; Sobell Department of Motor Neuroscience and Movement Disorders (A.M.), National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, UK; Departments of Neurology, Radiology, and Anatomy and Neurobiology, and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology, Human Genetics, and Pediatrics (H.A.J.), Emory University, Atlanta, GA; and Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
authors: Terrence J
authors: TJ
authors: Sejnowski
mesh_terms: D000328:Adult; D000368:Aged; D001764:Blepharospasm / Q000000981:diagnostic imaging*; D004421:Dystonia / Q000000981:diagnostic imaging; D005149:Facial Expression; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010363:Pattern Recognition, Automated / Q000379:methods*; D012720:Severity of Illness Index; D012984:Software; D014741:Video Recording / Q000379:methods*