Tardive blepharospasm.

BACKGROUND: Tardive syndromes may present with variable movement disorders. Blepharospasm (BSP), while typically idiopathic in origin, may be drug-induced, but there is little information regarding frequency and phenomenology of tardive BSP. OBJECTIVES AND METHODS: We aimed to assess the clinical features of tardive BSP and compare them with patients with idiopathic BSP. The Abnormal Involuntary Movement Scale (AIMS) was used to assess the severity of movements and the Jankovic Rating Scale (JRS) was used to evaluate the severity of BSP. RESULTS: Among 72 consecutive patients with tardive syndromes, 15 (20.8%) were identified with BSP. Patients with tardive BSP had a younger age at onset, higher AIMS scores, and a greater frequency of associated akathisia and facial dystonia, compared with patients who had other tardive phenomena (P < 0.05, for all comparisons). Compared with 37 patients with idiopathic BSP, those with a tardive etiology were also younger and had more frequently associated orobuccolingual (OBL) stereotypy, limb/trunk stereotypies, akathisia, and facial dystonia (P ≤ 0.009), whereas apraxia of eyelid opening was only observed in patients with idiopathic BSP. Alleviating maneuvers (sensory tricks) predominated in patients with idiopathic BSP, but this difference did not reach statistical significance (P ≥ 0.05). Furthermore, there was no difference in BSP severity, as assessed by JRS, between the two groups. Comorbid limb/trunk stereotypies and OBL dyskinesia had the greatest diagnostic accuracy supporting tardive origin. CONCLUSIONS: Tardive BSP, identified in one-fifth of patients with diverse tardive syndromes, has distinct features differing from idiopathic BSP.