Objective: 1) To investigate if the categories of psychogenic dystonia (PD) proposed by Gupta and Lang could be applied to psychogenic blepharospasm (PB); 2) To identify specific motor patterns for this aetiology.

Background: Essential blepharospasm (EB) consists of involuntary, bilateral and stereotyped contraction of the orbicularis oculi (OO), together with an inability to voluntarily suppress it. Its onset is insidious; its progression, gradual, without remission; it worsens during voluntary movement. A psychogenic cause may be suspected when incongruity with the expression of EB, or inconsistency over time, is found.

Methods: The findings of eight patients with suspected PB are reviewed. Each proband had a normal neurological examination, cranial MRI, blood caeruloplasmin and copper levels, and no history of psychoactive drug treatments. The author analyzed whether each patient could fit into one category of psychogenic dystonia, as proposed by Gupta and Lang.

Results: No patient exhibited stereotyped, bilateral and synchronous spasms of OO, ruling out essential blepharospasm. Documented PD refers to dystonic symptoms relieved by psychotherapy, suggestion, placebo, or when the patient is seen free of symptoms when supposedly unobserved [2]. Here, 4 patients experienced sustained relief of blepharospasm following administration of subcutaneous saline solution, and one was witnessed asymptomatic when supposedly unobserved. Clinically established PD plus other features refers to movement inconsistent over time, or incongruous with organic dystonia, associated with psychogenic neurological signs or obvious psychiatric disturbances. Eyelid narrowing in the absence of OO spasm, ocular convergence spasm, and inconsistency over time were found in three patients. Conversion disorder, schizophrenia and depression had previously been diagnosed. Clinically established PD minus other features refers to unequivocal clinical features incompatible with organic disease, without additional features. One patient showed spontaneous resolution of isolated eyelid narrowing, in the absence of overt psychogenic or neurological disease.

Conclusions: Gupta and Lang’s categories of psychogenic torsion dystonia, proved adequate to diagnose PB in each patient of this series. Narrowing of eyelid fissure and frowning of the eyebrows in the absence of OO spasms was found in PB in this series, but could not be considered specific for PB.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/categories-of-psychogenic-movement-disorders-to-functional-blepharospasm/