"Apraxia of eyelid opening" induced by levodopa therapy and apomorphine inatypical parkinsonism (possible progressive supranuclear palsy): A case report

We report a female patient in whom so-called apraxia of eyelid opening (AEO ) developed after the onset of possible progressive supranuclear palsy (Nat ional Institute of Neurological Disorders and Stroke criteria) and the intr oduction of antiparkinsonian medications including levodopa. Although parki nsonian symptoms responded poorly to levodopa, AEO worsened after increasin g levodopa dosage and disappeared when levodopa was discontinued. Later, a dose of apomorphine widely accepted for acute tests had no significant effe ct on limb motor activity but induced AEO. Overall, these observations are grounds for thinking that AEO developing in the course of parkinsonism may be either disease- or drug-related. The possibility of manipulating dopamin ergic treatment should always be considered when dealing with AEO associate d with parkinsonism.