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AAN: Botulinium Toxin Therapy Treats Apraxia Of Lid Opening By Jill Stein Special to DG News PHILADELPHIA, PA -- May 8, 2001-- Botulinium toxin (Botox) injections in the orbicularis oculi improve delays in eye opening and clinical disability in patients with apraxia of lid opening (ALO), researchers announced at the 53rd Annual Meeting of the American Academy of Neurology (AAN). Dr. Dan Boghen and associates at the Centre Hospitalier de l’Universite de Montreal in Montreal, Canada, simultaneously recorded lid movement and electromyelographic activity of the orbicularis oculi in 12 patients with ALO twice before and once after treatment with botulinium toxin type A. Disability was measured before and after treatment using the Blepharoplasm Disability Scale, a widely validated clinical disability index. Botulinium toxin type A injections were given at four sites in the pretarsal portion of the orbicularis oculi. Patients were first asked to gently close their eyes and then, in response to a sound signal presented at random intervals, to open them "as fast as possible" and to keep them open. This sequence was repeated 20 times. The time latencies to the onset of eye opening and to complete the eye opening, and the time during which eye opening was sustained were determined and correlated with orbicularis oculi activity. After treatment, the time delay to eye opening (764 milliseconds) was significantly shorter than before treatment (1038 milliseconds), Dr. Boghen said. The latency to the onset of lid opening decreased from 441 milliseconds to 322 milliseconds. The time from the signal to the inhibition of orbicularis oculi activity showed a strong tendency to decrease after treatment, while the quantity of electromyelographic during lid opening was significantly reduced after treatment. The clinical disability index improved markedly in 10 of the 12 patients after injections of botulinium toxin type A. Apraxia of lid opening refers to an intermittent ability to open the eyes voluntarily in the absence of apparent orbicularis oculi contractions. A prior study by the same investigators suggested that clinically undetectable but recordable activity of the orbicularis oculi plays an important role in ALO. Related Link: Botulinium toxin (Botox). E-mail this page to a friend or colleague! To print, use this version