We studied five patients with a combination of Meige's syndrome (blepharospasm-oromandibular dystonia) and myasthenia gravis. The coexistence of two disorders impairing eyelid opening led to diagnostic confusion and delayed appropriate therapy. Detailed oculographic monitoring of one patient indicated that eye position drifting due to myasthenic oculomotor fatigue was corrected by eye blinks, and that blinks tended to occur with slower saccades. Our observations suggest that fatigue of extraocular muscles may lead to synkinetic blinking and perhaps eventually to autonomous blepharospasm.

Aged↗

PubMed1987

Botulinum toxin injection of the vocal fold for spasmodic dysphonia. A preliminary report.

A number of different therapies have been used in the management of spasmodic dysphonia. None are curative, and the results of the most widely used surgical procedure (resection of the recurrent laryngeal nerve) are not universally good, with a high recurrence rate in some series. Furthermore, the procedure is not reversible. Using a special electromyographic hypodermic needle, we injected botulinum A toxin into one of the vocal folds of two patients with severe spasmodic dysphonia. Both had significant improvement without any complications. Although the resultant paresis is not permanent, the injection can be repeated as needed as an outpatient procedure.

Adult↗

PubMed1987

The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part I. Exposure estimates.

The vermiculite ore and concentrate of a mine and mill near Libby, Montana, was found to be contaminated with fibrous tremolite-actinolite. Of 599 fibers (length greater than 5 microns and width greater than 0.45 micron) counted in eight airborne membrane filter samples, 96% had an aspect ratio greater than 10 and 16% had an aspect ratio greater than 50. Additionally, 73% of the fibers were longer than 10 microns, 36% were longer than 20 microns, and 10% were longer than 40 microns. Estimates of exposure before 1964 in the dry mill were 168 fibers/cc for working areas, 182 fibers/cc for sweepers, 88 fibers/cc for skipping, and 13 fibers/cc for the quality control laboratory. In 1964-1971, exposure estimates for these areas were 33, 36, 17, and 3 fibers/cc, respectively. Estimates of exposures in the mine before 1971 ranged from 9-23 fibers/cc for drillers and were less than 2 fibers/cc for nondrilling jobs. All 8-hr TWA job exposure estimates decreased from 1972-1976, and from 1977-1982 were less than 1 fiber/cc.

Air Pollutants, Occupational↗

PubMed1987

Blepharospasm and autoimmune diseases.

We studied two patients, one with systemic lupus erythematosus and the other with myasthenia gravis, both of whom had coexistent blepharospasm. The blepharospasm occurred during exacerbations of the autoimmune diseases and improved with immunosuppressive therapy. These cases illustrate the possible association of blepharospasm and autoimmune disorders.

Adult↗

PubMed1987

Tardive myoclonus.

We describe a 46-year-old, schizophrenic woman with late-onset myoclonus after treatment with antipsychotic drugs. The myoclonic jerking of the neck with synchronous contractions of the face persisted after all the antipsychotic drugs had been discontinued. Tardive myoclonus has not been documented previously.

Dibenzoxazepines↗

PubMed1987

Motor, behavioral and pharmacologic findings in Tourette's syndrome.

We studied 112 patients with Tourette's syndrome (TS); the male-to-female ratio was 3.8, the mean age of onset was 7.3 years, and the average duration of symptoms prior to the initial evaluation was 15.2 years. Seventy-nine percent of the patients had at least one family member with motor or vocal tics, and an additional 10 percent had a family member with marked obsessive-compulsive behavior. Simple motor tics occurred as the presenting symptom in about one-third of patients; one-third had multiple motor tics at the onset, and another third started with vocal tics. During the course of the illness all patients developed multifocal motor tics and 86 percent had vocal tics. Verbal and mental coprolalia was present in 44 percent of the patients. Copropraxia was seen in 19 percent of patients, and both coprolalia and copropraxia were more frequent among the males than expected. Attentional deficit disorder was diagnosed in 36 percent of the patients and 32 percent had obsessive-compulsive personality. Sleep disturbances were reported by 62 percent of the patients and polysomnographs in 34 patients showed motor and vocal tics during all stage of sleep, sleep apnea, abnormal arousal pattern, and other sleep disturbances. Patients with mild symptoms improved with clonidine or clonazepam, but those with more advanced disorder required fluphenazine, pimozide, haloperidol or tetrabenazine.

Adolescent↗

PubMed1987

Coexistent tardive dyskinesia and parkinsonism.

Forty-six patients with tardive dyskinesia (TD) were studied to characterize the relationship between TD and parkinsonism. In two patients idiopathic parkinsonism (PD) preceded the use of neuroleptic drugs and in 15 patients TD was associated with drug-induced parkinsonism. Patients with TD alone were compared with patients who had the combination of TD and parkinsonism. Only age at onset of TD symptoms differentiated between the two groups (p less than 0.02); patients with associated parkinsonism had onset of TD later than patients with TD alone. Patients with PD may develop TD and the latter may be triggered by levodopa. When TD and parkinsonism are combined, the symptoms may be controlled by a careful use of dopamine depletors and levodopa.

Adult↗

PubMed1987

Movement disorders and AIDS.

We studied seven patients with AIDS or AIDS-related complex (ARC) and movement disorders. Three had hemichorea-ballismus, two had segmental myoclonus, one had postural tremor with dystonia, and one had paroxysmal dystonia. Besides the hyperkinesias, two patients had parkinsonism, and one had cerebral Whipple's disease. In two, the movement disorder preceded other evidence of AIDS; in three others, the diagnosis of AIDS was not considered until there was a movement disorder. The movement disorders were attributed to toxoplasmosis in four patients (one confirmed at autopsy), viral encephalitis, vacuolar myelopathy, and CNS Whipple's disease.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Progressive supranuclear palsy and a multi-infarct state.

In 58 patients with progressive supranuclear palsy (PSP), 19 (32.8%) had CT, MRI, or autopsy evidence of a multi-infarct (MI) state. The clinical findings in the infarct syndrome were similar to idiopathic PSP. Five MI-PSP patients had had a stroke, four had focal dystonia, two had hemiparesis, and one had an intention tremor of recent onset. In contrast, only 5.9% (12.9% of those with CT or MRI) of 426 Parkinson's disease patients had evidence of strokes. One case of PSP studied pathologically was attributed to cerebral amyloid angiopathy.

Aged↗

PubMed1987

Botulinum A toxin for cranial-cervical dystonia: a double-blind, placebo-controlled study.

We studied the effects of botulinum A toxin in 12 patients with blepharospasm and 10 patients with oromandibular-cervical dystonia received in a double-blind manner. All blepharospasm patients improved, 71.6% on a clinical rating score, 60.7% by self-assessment, and 38.9% by video-rating; there was no improvement with placebo. The beneficial effects lasted a mean of 12.5 weeks (range, 5 to 28). Only 37.5% of the patients with oromandibular-cervical dystonia improved. Patients with pharyngeal dystonia and spasmodic dysphonia also improved.

Adolescent↗

PubMed1987