Objective: Characterizing gait in blepharospasm patients.

Background: Blepharospasm ranges from frequent blinking to forced eye closure potentially causing functional blindness that can impair walking. Gait characteristics in blepharospasm are unknown. A recent study¹ suggested alterations in step-length adaptation while walking on a treadmill, implicating cerebellar dysfunction. Studies in cervical dystonia demonstrated similar results.^2-3

Method: From the Dystonia Coalition databank, videos were obtained for 100 blepharospasm patients, 50 normal controls, and 50 hemifacial spasm patients. Based on visual observation of standardized examinations, gait was evaluated. If present, gait disorder was classified as:  difficulty with tandem; parkinsonian; posturing while walking; antalgic.  In addition, arm swing and concurrent movement disorders were recorded.

Results: 83 videos, all blepharospasm, were evaluated so far. 48 had abnormal gait findings; 34 were normal. 1 subject had no recorded gait exam. Of 48 with abnormal gait: none had shuffling, freezing, or non-physiologic gait; 11 had leg or foot posturing; 4 had apparent joint disease; 2 had antalgic gait from any pain; and 5 had circumduction of one leg. Only 3 had cautious gait from visual impairment. Ataxic gait, defined as difficulty with tandem, veering, appearing unsteady, or having poor turns, was present in 36, with tandem difficulty being most common.  Three had impaired turns and tandem difficulties;8 had concurrent leg or foot posturing.  Of note, 71/83 had reduced arm swing.  69/71 with reduced arm swing had neck posturing or irregular head tremor.

Conclusion: Incidence and severity of gait disorders in blepharospasm are unknown.  Preliminary analysis of 83 blepharospasm subjects suggests gait dysfunction is common with tandem gait impairment being most frequent.  Only three subjects appeared to have gait difficulty from functional blindness. Therefore, factors other than visual impairment may cause gait impairment, including afferent or cerebellar disturbance, subtle leg dystonia, or pain. This study is limited by videography techniques, duration of walking, and single rater report.  Incorporating additional raters for this study and future research using biometrics and gait analyses in real time assessments of blepharospasm patients may determine incidence of gait disorders and shape treatment paradigms to incorporate balance and gait training.

References: 1. Hoffland BS, Veugen LC, Janssen MMHP, Pasman JW, Weerdesteyn V, et al. A gait paradigm reveals different patterns of abnormal cerebellar motor learning in primary focal dystonias. Cerebellum. 2014; 13: 760-766 2. Barr C, Barnard R, Edwards L, Lennon S, Bradnam L. Impairments of balance, stepping reactions and gait in people with cervical dystonia.Gait Posture. 2017 Jun;55:55-61. doi: 10.1016/j.gaitpost.2017.04.004. 3. Esposito M, Dubbioso R, Peluso S, Picone A, Corrado B, Servodio Iammarone C, Allocca R, Manganelli F, Santoro L, Fasano A. Cervical dystonia patients display subclinical gait changes.Parkinsonism Relat Disord. 2017 Oct;43:97-100. doi: 10.1016/j.parkreldis.2017.07.005.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gait-dysfunction-in-blepharospasm/