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Apraxia of Lid Opening Medication

  • Author: Marta Ugarte, MBBS, PhD, DPhil, FRCOphth; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Apr 01, 2016
 

Medication Summary

Drugs used in the management of apraxia of lid opening (ALO) include neuromuscular blocker agents, antiparkinson agents, anticholinergic agents, and anticonvulsants.

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Neuromuscular Blockers, Botulinum Toxins

Class Summary

Neuromuscular blocker agents help produce symptomatic improvement of orbicularis oculi (OO) spasm and autonomic symptoms.

OnabotulinumtoxinA (BOTOX®)

 

A dose of 1 U of botulinum toxin type A corresponds to the calculated median intraperitoneal lethal dose (LD50) in mice. Each vial contains 100 U of Clostridium botulinum type A neurotoxin complex, 0.5 mg of human albumin, and 0.9 mg of sodium chloride in a sterile, vacuum-dried form without a preservative. It blocks neuromuscular transmission by binding to receptor sites on motor or sympathetic nerve terminals, entering the nerve terminals, and inhibiting the release of acetylcholine.

Abobotulinumtoxin A (Dysport)

 

Abobotulinumtoxin A is a type A neurotoxin produced by Clostridium botulinum spore, forming anaerobic bacilli. Its activity appears to affect only the presynaptic membrane of the neuromuscular junction in humans. Muscle inactivation persists until new fibrils grow from the nerve and form junction plates on new areas of the muscle cell walls.

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Antiparkinson Agents, Dopamine Agonists

Class Summary

Antiparkinson agents reduce the morbidity associated with dopamine deficiency.

Carbidopa and Levodopa (Sinemet)

 

Levodopa formulations include benserazide 25 mg plus levodopa 100 mg (not available in the United States) and carbidopa 50 mg plus levodopa 200 mg. Levodopa, the metabolic precursor of dopamine, crosses the blood-brain barrier and presumably is converted to dopamine in the brain to relieve the symptoms of neurologic diseases that are related to depletion of dopamine. Carbidopa inhibits decarboxylation of peripheral levodopa, making more levodopa available for transport to the brain.

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Antiparkinson Agents, Anticholinergics

Class Summary

Anticholinergic agents are thought to work centrally by suppressing conduction in the vestibular cerebellar pathways. They may have an inhibitory effect on the parasympathetic nervous system.

Trihexyphenidyl

 

Trihexyphenidyl is a centrally-acting anticholinergic that tends to diminish muscle spasms.

Benztropine (Cogentin)

 

By blocking striatal cholinergic receptors, benztropine may help balance cholinergic and dopaminergic activity in striatum. This agent can be used as an alternative to trihexyphenidyl.

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Anticonvulsants, Other

Class Summary

Anticonvulsants are used to treat severe muscle spasms.

Valproic acid (Depacon, Depakene, Stavzor)

 

Delayed-release or extended-release formulations of valproic acid are used for prophylaxis of migraine headaches. Although the mechanism of action is not established, the drug's activity may be related to increased brain levels of gamma-aminobutyric acid (GABA) or to enhanced GABA action.

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Contributor Information and Disclosures
Author

Marta Ugarte, MBBS, PhD, DPhil, FRCOphth Clinical Medical Retinal Fellow, Moorfields Eye Hospital, UK

Marta Ugarte, MBBS, PhD, DPhil, FRCOphth is a member of the following medical societies: Association for Research in Vision and Ophthalmology, British Medical Association, Royal Society of Medicine, Royal College of Ophthalmologists, International Society of Ocular Trauma

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Simon K Law, MD, PharmD Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Ron W Pelton, MD, PhD Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

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Diagram of the possible central pathways involved in the generation of inhibitory responses of the levator palpebrae superioris muscle. Caudal central nucleus (CCN), central caudal subdivision of the oculomotor (III) nucleus.
A man with apraxia of lid opening is unable to open his lids at will. Eye movements were full. Attempted eye opening resulted in frontalis muscle contraction, backward thrusting of the head, and pretarsal orbicularis oculi activity. Spontaneous reflex blinking was normal. The lids remained open following manual elevation.
 
 
 
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