Neurological Sciences

, Volume 31, Issue 1, pp 71–73 | Cite as

Speech-induced blepharospasm

  • Davide Martino
  • Maria Stella Aniello
  • Loredana Catalano
  • Paolo Livrea
  • Giovanni Defazio
Case Report


Primary blepharospasm is an adult-onset dystonia typically present at rest and exacerbated by bright light, stress and voluntary movements of eyes and eyelids. Inconsistency or inducibility by activities involving muscles other than orbicularis oculi muscles are considered incongruous with typical primary blepharospasm, heralding the suspicion of psychogenicity. We report the clinical vignette of two patients manifesting an unusual presentation of primary blepharospasm, specifically triggered by voiced speech and associated with an otherwise ‘typical’ presentation of primary adult-onset dystonia in the lower face, larynx or upper limb. Speech-induced primary blepharospasm seems a rare occurrence, representing 1.3% of our clinic-based series of 149 patients with primary adult-onset primary blepharospasm. In these atypical patients, the feature of speech inducibility suggests that the abnormal surrounding inhibition between cortical subregions representing laryngeal and orbicularis oculi muscles might underlie dystonic overflow to the orbicularis oculi muscles following the voiced speech.


Dystonia Blepharospasm Speech and language disorders Movement disorders 


  1. 1.
    Esteban A, Traba A, Prieto J (2004) Eyelid movements in health and disease. The supranuclear impairment of the palpebral motility. Neurophysiol Clin 34:3–15CrossRefPubMedGoogle Scholar
  2. 2.
    Grandas F, Elston J, Quinn N, Marsden CD (1988) Blepharospasm: a review of 264 patients. J Neurol Neurosurg Psychiatry 51:767–772CrossRefPubMedGoogle Scholar
  3. 3.
    Jankovic J, Ford J (1983) Blepharospasm and orofacial-cervical dystonia: clinical and pharmacological findings in 100 patients. Ann Neurol 13:402–411CrossRefPubMedGoogle Scholar
  4. 4.
    Tolosa E, Martí MJ (1988) Blepharospasm-oromandibular dystonia syndrome (Meige’s syndrome): clinical aspects. In: Jankovic J, Tolosa E (eds) Adv Neurol vol 49, Facial dyskinesias. Raven Press, New York, pp 73–84 Google Scholar
  5. 5.
    Williams DT, Ford B, Fahn S (1995) Phenomenology and psychopathology related to psychogenic movement disorders. Adv Neurol 65:231–257PubMedGoogle Scholar
  6. 6.
    Bressman SB (2004) Dystonia genotypes, phenotypes, and classification. In: Fahn S, Hallett M, DeLong MR (eds) Adv Neurol vol 94, Dystonia 4. Lippincott, Philadelphia, pp 101–107 Google Scholar
  7. 7.
    Jacome DE (2000) Synkinetic blepharoclonus. J Neuroophthalmol 20:276–284PubMedGoogle Scholar
  8. 8.
    Hoy KE, Fitzgerald PB, Bradshaw JL, Armatas CA, Georgiou-Karistianis N (2004) Investigating the cortical origins of motor overflow. Brain Res Brain Res Rev 46:315–327CrossRefPubMedGoogle Scholar
  9. 9.
    Hallett M (2004) Dystonia: abnormal movements result from loss of inhibition. In: Fahn S, Hallett M, DeLong MR (eds) Adv Neurol vol 94, Dystonia 4. Lippincott, Philadelphia, pp 1–9Google Scholar
  10. 10.
    Gong S, DeCuypere M, Zhao Y, LeDoux MS (2005) Cerebral cortical control of orbicularis oculi motoneurons. Brain Res 1047:177–193CrossRefPubMedGoogle Scholar
  11. 11.
    Loucks TM, Poletto CJ, Simonyan K, Reynolds CL, Ludlow CL (2007) Human brain activation during phonation and exhalation: common volitional control for two upper airway functions. Neuroimage 36:131–143CrossRefPubMedGoogle Scholar
  12. 12.
    Ludlow CL (2005) Central nervous system control of the laryngeal muscles in humans. Respir Physiol Neurobiol 147:205–222CrossRefPubMedGoogle Scholar
  13. 13.
    Schulz GM, Varga M, Jeffires K, Ludlow CL, Braun AR (2005) Functional neuroanatomy of human vocalization: an H215O PET study. Cereb Cortex 15:1835–1847CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Davide Martino
    • 1
  • Maria Stella Aniello
    • 1
  • Loredana Catalano
    • 1
  • Paolo Livrea
    • 1
  • Giovanni Defazio
    • 1
  1. 1.Department of Neurological and Psychiatric SciencesUniversity of BariBariItaly

Personalised recommendations