Involuntary eyelid closure after STN-DBS: Evidence for different pathophysiological entities

Daniel Weiss, Tobias Wächter, Sorin Breit, Simon N. Jacob, Jörn K. Pomper, Friedrich Asmus, Josep Valls-Solé, Christian Plewnia, Thomas Gasser, Alireza Gharabaghi, Rejko Krüger*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

25 Citations (Scopus)

Abstract

Objective: Involuntary eyelid closure (IEC) may occur after deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson's disease (PD) and is often categorised as apraxia of lid opening (ALO), albeit the appropriateness of this term is under debate. To gain insight into the hitherto undefined pathophysiology of IEC after STN-DBS, we performed a comprehensive clinical and electrophysiological characterisation of lid function in a total of six PD patients. Methods: The study was carried out in six PD patients who developed IEC after STN-DBS. They underwent neurological examination and electromyography recording of activity in the orbicularis oculi muscle (OO) upon varying stimulation patterns. Intraoperative studies were performed in one patient. Results: Increasing STN-DBS intensity induced IEC in four patients, whereas it improved the condition in two. Needle EMG showed tonic hyperactivity of the OO in STN-DBS induced IEC, while variable patterns of OO activity (irregular and tonic) were seen in patients with STN-DBS-relieved IEC. Intraoperative analysis in one patient showed evidence for IEC being induced by activation of corticobulbar fibres. Conclusions: We identified two groups of IEC after STN-DBS based on clinical and EMG patterns: (1) STN-DBS induced IEC associated with tonic OO overactivity and (2) STN-DBS relieved IEC presenting with variable EMG patterns. Our findings provide relevant information on pathophysiology of STN-DBS related IEC and implications for its therapeutic management.

Original languageEnglish
Pages (from-to)1002-1007
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume81
Issue number9
DOIs
Publication statusPublished - Sept 2010
Externally publishedYes

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