Objective: To investigate the differences of non-motor symptoms and the alteration of intrinsic brain networks in patients with blepharospasm and hemifacial spam.

Background: Blepharospasm (BSP) and hemifacial spasm (HS) may share a similar clinical feature of involuntary twitching around the eyelids, but their pathophysiologies are different. BSP patients may possess more non-motor symptoms than HS ones due to higher risk of involvement of the basal-cortical-limbic and the striato-thalamo-cortical pathways, but not all studies supported this hypothesis. There are scanty studies discussing the issue of alteration of the intrinsic brain activity in BSP and HS patients.

Methods: Twelve healthy volunteers, 12 BSP subjects and 10 HS patients were included. Assessment of sensory impairment with temperature discrimination (QST), of depression (BDI-II), of anxiety (BAI), of impulsiveness (BIS), of sleep problems (ESS, PSQI), of cognitive dysfunction (MMSE, MoCA and WST), and of quality of life (SF-36) were performed. The participants received brain magnetic resonance imaging (MRI) by using one 3-Tesla Philips scanner.

Results: Age and gender were compatible in the three groups of participants, while the education level was higher in the normal control group (NC). (NC: 13.42±3.42 years, BSP: 8.75±5.46 years, HS: 8.70±4.55 years, p=0.026) BSP patients had worse performance in the number of categories completed of the Wisconsin card sorting test. (NC: 4.00±1.10, BSP: 2.58±1.88, HS: 4.20±1.40, p=0.032) Resting state functional MRI (fMRI) data analyzed by CONN, a Matlab-based cross-platform software, disclosed trends of decreasing connectivity in the executive, attention, default mode (DMN) and salience networks in the BSP patients using seed-based analysis. (Figure 1) The variability of the dynamic activation analyzed by independent component analysis (ICA) method revealed significant difference in the executive, salience and visual networks between NC and BSP subjects and DMN between NC and HS participants. (Table 1)

Conclusions: The preliminary results supported the hypothesis that BSP patients had a higher risk of executive dysfunction, which may come from its involvement of the basal-cortical-limbic and the striato-thalamo-cortical pathways. Resting state fMRI may be a tool to disclose alteration of the related brain networks before onset of clinical symptoms.

References: 1. Valls-Sole, J. & Defazio, G. Blepharospasm: Update on Epidemiology, Clinical Aspects, and Pathophysiology. Front Neurol 7, 45, doi:10.3389/fneur.2016.00045 (2016). 2. Barkhof, F., Haller, S. & Rombouts, S. A. Resting-state functional MR imaging: a new window to the brain. Radi-ology 272, 29-49, doi:10.1148/radiol.14132388 (2014).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-and-alteration-of-brain-networks-in-patients-with-blepharospasm-and-hemifacial-spasm/