EpistemisLid apraxia
Specialty: Neurology.
Why it occurs
- Advanced idiopathic Parkinson's disease
- Progressive Supranuclear Palsy (PSP)
- Multiple System Atrophy (MSA)
- Corticobasal Degeneration
- Extensive right hemispheric lesions (frontoparietal stroke)
Initial workup
Evaluation of eyelid opening ruling out active blepharospasm (absence of visible contraction of the orbicularis oculi muscle) and neurological ptosis (the patient can open the eyes after sensory stimuli or manually without muscular resistance); High resolution brain MRI; Video-EEG to monitor focal inhibitory motor seizures.
red flags
Sudden-onset inability to open the eyes associated with contralateral hemiparesis, neck rigidity, aphasia, or altered wakefulness, pointing to an acute bilateral frontal lobar or brainstem stroke.
Standard management
- Modification or increase in the dose of Levodopa/Carbidopa if the symptom occurs predominantly in periods of motor inactivity ("off") in Parkinson's disease
- Infiltration of botulinum toxin in the pretarsal portion of the orbicularis — paradoxically useful to interrupt the cycle of reflex inhibition of eyelid opening
- Adaptive facial physiotherapy.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3