Objective: Report and discuss a rare presentation of BS.

Background: Dystonia is described in untreated Parkinson’s disease (PD) patients and is also one of the main motor complications related to chronic dopaminergic therapy, Blepharospasm (BS) is the most common cranial dystonia, in which patients exhibit an increased blink frequency, forced eye closure, or difficulty opening the eyes (Tarsy et al. 2006). Symptoms may be worsened by bright light or reading, but there are no reported cases of chewing-induced BS.

Methods: Literature review and clinical presentation.

Results: A 63 year-old male with a 14-year history of idiopathic PD exhibited rest tremor, rigidity and bradykinesia initially on the left upper limb with good response to therapy. He developed levodopa induced-dyskinesias over time. His prescription consisted of levodopa/carbidopa, pramipexole and anticholinergics for motor symptoms and clonazepam for REM sleep-behavioral disorder. At age 61, he presented with a new complaint: he could not maintain his eyes open during meals. Whenever he tried to eat something, his eyes would close and remain so as long as he kept chewing. On physical examination, there was bilateral moderate rest tremor, rigidity and bradykinesia, predominantly on the left. Eye examination was unremarkable. Then the patient was given a cookie. As soon as he started chewing, his eyes closed and he had a great difficulty trying to open them. By the time he finished swallowing his eyes returned to normal. He had no previous history of facial palsy. EMG showed BS during the process of eating. The patient was submitted to botulin toxin application with improvement of the BS.

Conclusions: Here we presented a case of BS with an unusual feature: it only occurred while chewing. In the literature there are cases of task-specific craniocervical dystonia and other oromandibular dystonias triggered by volitional movement of the mouth or pharyngeal muscles. Of note, there is one case of cervical dystonia induced by mouth utilization for writing (Schramm et al. 2008) and two unusual cases of facial dystonia triggered by eating. Our case does not have the typical pattern of those task-specific dystonias, neither had associated lower face dystonia (as in Meige’s syndrome), therefore, the concept of “overflow" to explain the BS can’t be applied. Interestingly, the BS was triggered by another distant movement corroborating the lack of inhibition hypothesis as part of the BS pathophysiology.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/chewing-induced-blepharospasm-in-parkinsons-disease/