Objective: We aimed to assess the cumulative incidence of apraxia of eye lid opening (AOELO) in patients who have undergone bilateral subthalamic nucleus deep brain stimulation (STN DBS) for Parkinson’s disease (PD), examine the factors associated with it and to describe the response to the management strategies tried.

Background: AOELO is a disabling symptom in advanced PD with a possible relation to STN-DBS.1 There is little data on its incidence, risk factors and potential management strategies to be tried.

Method: We retrospectively analysed the data on the incidence of AOELO and the pre- and post-operative clinical characteristics and treatment response of patients who developed AOELO, from our surgical cohort between 2000 and 2017. All patients with PD who had undergone STN DBS and had standard protocol-based follow-up data of at least a year were included.

Results: AOELO was noted in 10 (5.5%) patients. Eight among those with AOELO developed it after a mean duration of 24 months after surgery (Range: 12- 48 months) while two had AOELO even before surgery and reported worsening following surgery. The AOELO was reported to be mild to moderate in six patients and severely disabling in the remaining four. Clinical characteristics including age at onset of PD, duration of motor symptoms, age, severity of motor symptoms (UPDRS 3 scores in OFF state), presence of freezing of gait or levodopa equivalent daily dosage (LEDD) at surgery or the post-operative improvement in UPDRS 3 or LEDD did not differ significantly in the group with AOELO from those without. None improved with reduction / temporary switching off of stimulation. Four patients (40%) reported transient improvement with increase in stimulation intensities (increasing the voltage or changing to interleaved stimulation). Four patients who had disabling symptoms received botulinum toxin injection to pre-tarsal muscles and all but one noted symptom relief lasting 2-3 months. One patient who had levodopa responsive AOELO before surgery continued to respond to levodopa after STN-DBS.

Conclusion: AOELO is an infrequent neuro-ophthalmic dysfunction in patients with advanced PD, particularly those who undergo STN DBS. Management strategies need to be individualised and the options include increasing stimulation intensities, dopaminergic treatment and botulinum toxin injections.

References: Hariz MI, Rehncrona S, Quinn NP, Speelman JD, Wensing C. Multicenter Study on Deep Brain Stimulation in Parkinson ’ s Disease : An Independent Assessment of Reported Adverse Events at 4 Years. Mov Disord. 2008;23(3):416–21

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MDS Abstracts - https://www.mdsabstracts.org/abstract/apraxia-of-eye-lid-opening-in-patients-with-advanced-parkinsons-disease-undergoing-subthalamic-stimulation-a-single-centre-experience/