|Budget Amount *help
¥3,200,000 (Direct Cost : ¥3,200,000)
Fiscal Year 1991 : ¥700,000 (Direct Cost : ¥700,000)
Fiscal Year 1990 : ¥1,000,000 (Direct Cost : ¥1,000,000)
Fiscal Year 1989 : ¥1,500,000 (Direct Cost : ¥1,500,000)
1. Clinical studies : Patients of so-called blepharospasm were examined retrospectively (44 cases) and prospectively (57 cases) by applying neuropsychiac drugs including clinical, electrophysiological and imaging examinations. They were- classified into 3 groups a) indiopathic blepharospasm, b) blepharospasm coexisting with apraxia of lid opening (mixed type) and. c) apraxia of lidopening. ' Clinico - pharmacological responses of group a) was hyperdopaminergic and group b) and c) were hypodopaminergic by retrospective study, In the present prospective study 57 patients (a) 38, b) 18, c) l, ) were selected and neuropsychiac (dopaminergic, anticliolingergic antidopaminergic, GABAergic) drugs were applied based on previous study. Clinico- pharmacological responses of group a) was varied each other and considered to be a group including variety of pathophysiological conditions. In contrast, group b), mixed type which was proposed by us, showed good response to anticholinergic drug, trihexy
phenydil (Artane) without exceptions indicating hypodopaminergic. To elucidate abnormalities of central nervous system, SPECT, random saccade and blink reflex evoked by supraorbital nerve stimulation were examined. However, specific changes were not found. Dry eye was found about 80% of the patients. Based on present clinical and basic studies, new vitious circle of pathophysiology of blepharospasm was proposed to contribute understanding the mechanism of developing the disorders. (Mukuno et al 1991) Following the proposed vitious circle, adequate treatment including surgery should be selected to improve and recover ; the complex blepharospasm.
2. Neuroanatomical studies Neuroanatomical studies on orbicularis oculi and their motoneurons -were carried out. Clear morphological - functional relationships in the localization of the orbicularis were confirmed for the first time (Sakamoto et al, 1989). Motoneurons of the levator palpebrae superioris was studied by applying neuronal tracers (HRI, fluorescent dyes as double labelling tracer) in the monkey, cat and rabbit. double labelled. neurons indicating collaterals of the axon innervating both levator muscles were found in the monkey, in CCN (central caudal nucleus) about 30% of the motoneurous (Sekiya etyal, 1992 submitted). In contrast, cat did not contain such neurons in CCN. Rabbit showed complete contralateral (crossed) innervation- from the subnucleus in the oculomotor complex (Hiramoto, 1991).
In conclusion, the study promote understanding of so - called complex blephaospasm from clinical and basic point of view and stimulate further plhysiological research of the lid movements and. blinking. Less