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), id iopathic blepharospasm (BSP, 20 patients, including 4 familial cases), progressive supranuclear palsy (PSP, 7 patients), and dystonic parkin sonian syndrome (2 patients). Twenty-nine patients treated with botuli num toxin into the orbicularis oculi muscle were rated before and afte r 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. Several patients also improved on anticholinergic drugs. Besides medi cal treatment, lid crutches, in conjunction with botulinum toxin injec tions, were useful in some patients. ALO is not a true apraxia; it con stitutes an eyelid dystonia as shown by its clinical and electrophysio logical features as well as pharmacological reactions and is encounter ed in a clinical spectrum ranging from an isolated form to predominant BSP. It was an important cause of treatment failures in botulinum tox in-treated BSP but by modifying our injection strategy and by adding a nticholinergic drugs and also lid crutches, we obtained a good functio nal benefit.