Objective: To describe clinical features of the frontalis behavioral trick in blepharospasm.

Background: Blepharospasm is a form of dystonia that is characterized by stereotyped, bilateral spasm of the orbicularis oculi and nearby muscles. In addition to these spasms, patients may have an increased frequency of blinking and others may have difficulty opening their eyes without visible spasm. Some patients utilize a behavioral trick to open their eyes by contracting the frontalis muscle. It is important to identify the clinical features associated with this trick to improve recognition and optimize management. In patients who utilize this trick, botulinum toxin injection in the upper orbicularis oculi near the frontalis may inadvertently worsen symptoms or cause a pseudo-ptosis.

Method: Patients with idiopathic blepharospasm (N=50) were evaluated with standardized video assessments. Cases of patients who utilize the frontalis behavioral trick were identified (N=5). Clinical features and electrophysiologic characteristics were described in patients using this trick as compared to patients who do not appear to use the trick.

Results: Representative cases were identified who demonstrate use of the frontalis behavioral trick. Analysis of the demographics (average age and sex), clinical features (duration of dystonia, distribution of dystonia, severity of dystonia, and treatment), and electrophysiologic data is ongoing.

Conclusion: Increasing recognition of the frontalis behavioral trick is critical so providers can avoid or minimize injection of botulinum toxin to regions that may impact the frontalis muscle and worsen symptoms of blepharospasm. The use of objective measures from standardized video assessments is valuable in advancing our understanding of blepharospasm phenomenology.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-frontalis-behavioral-trick-in-blepharospasm/