Journal of Neurology

, Volume 266, Issue 5, pp 1136–1140 | Cite as

Writing, reading, and speaking in blepharospasm

  • Gina Ferrazzano
  • Antonella Conte
  • Daniele Belvisi
  • Andrea Fabbrini
  • Viola Baione
  • Alfredo Berardelli
  • Giovanni FabbriniEmail author
Original Communication


The aim of the study was to evaluate the effects of writing, reading, and speaking on orbiculari oculi (OO) muscle spasms and on the blink rate in patients with blepharospasm (BSP). Patients with hemifacial spasm (HFS) and healthy subjects (HS) acted as control subjects. Thirty patients with BSP, 20 patients with primary HFS and 20 age-matched healthy subjects were videotaped according to a standardized procedure: at rest with eyes open; while writing a standard sentence on paper; while writing a standard sentence on a blackboard keeping the head straight; during a conversation based on a simple topic (speaking task); and while reading a standard text aloud. Two independent movement disorders specialists reviewed the videotapes and measured the number of OO spasms and blinks in each segment. Writing and reading reduced the number of OO spasms in BSP patients, whereas speaking did not. On the other hand, writing, reading, and speaking did not modify spasms in HFS patients. These tasks modulated the blink rate in all the three groups of subjects (BSP, HFS, and HS). Our hypothesis is that the modulation of OO spasm in BSP during writing and reading depends on influences coming from occipital areas onto the brainstem circuits. Whether cognitive training with reading and writing may be used to improve OO muscle spasms is an issue that warrants further investigation.


Blepharospasm Verbal language task Writing Reading Speaking Blink rate 



We thank Lewis Baker for the English language editing.


This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflicts of interest

None of the authors have any potential conflicts of interest to disclose.

Ethical standards

The experimental procedure was approved by the institutional review boards and was conducted in accordance with the Declaration of Helsinki.

Informed consent

Written informed consent was obtained from every participant.


  1. 1.
    Defazio G, Hallett M, Jinnah HA, Conte A, Berardelli A (2017) Blepharospasm 40 years later. Mov Disord 32:498–509CrossRefGoogle Scholar
  2. 2.
    Defazio G, Hallett M, Jinnah HA, Berardelli A (2013) Development and validation of a clinical guideline for diagnosing blepharospasm. Neurology 81:236–240CrossRefGoogle Scholar
  3. 3.
    Bentivoglio AR, Daniele A, Albanese A, Tonali PA, Fasano A (2006) Analysis of blink rate in patients with blepharospasm. Mov Disord 21:1225–1229CrossRefGoogle Scholar
  4. 4.
    Defazio G, Hallett M, Jinnah HA, Stebbins GT, Gigante AF, Ferrazzano G, Conte A, Fabbrini G, Berardelli A (2015) Development and validation of a clinical scale for rating the severity of blepharospasm. Mov Disord 30:525–530CrossRefGoogle Scholar
  5. 5.
    Conte A, Defazio G, Ferrazzano G, Hallett M, Macerollo A, Fabbrini G, Berardelli A (2013) Is increased blinking a form of blepharospasm? Neurology 80:2236–2241CrossRefGoogle Scholar
  6. 6.
    Peterson DA, Sejnowski TJ (2017) A dynamic circuit hypothesis for the pathogenesis of blepharospasm. Front Comput Neurosci 11:11CrossRefGoogle Scholar
  7. 7.
    Martino D, Defazio G, Alessio G, Abbruzzese G, Girlanda P, Tinazzi M, Fabbrini G, Marinelli L, Majorana G, Buccafusca M, Vacca L, Livrea P, Berardelli A (2005) Relationship between eye symptoms and blepharospasm: a multicenter case–control study. Mov Disord 20:1564–1570CrossRefGoogle Scholar
  8. 8.
    Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, Armstrong MJ, Gloss D, Potrebic S, Jankovic J, Karp BP, Naumann M, So YT, Yablon SA (2016) Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 86:1818–1826CrossRefGoogle Scholar
  9. 9.
    Ferrazzano G, Conte A, Fabbrini G, Bologna M, Macerollo A, Defazio G, Hallett M, Berardelli A (2015) Botulinum toxin and blink rate in patients with blepharospasm and increased blinking. J Neurol Neurosurg Psychiatry 86:336–340CrossRefGoogle Scholar
  10. 10.
    Berardelli I, Pasquini M, Conte A, Bologna M, Berardelli A, Fabbrini G (2018) Treatment of psychiatric disturbances in common hyperkinetic movement disorders. Expert Rev Neurother. Google Scholar
  11. 11.
    Karson CN (1989) Blinking. Bull Soc Belg Ophtalmol 237:443–457Google Scholar
  12. 12.
    Bologna M, Agostino R, Gregori B, Belvisi D, Ottaviani D, Colosimo C, Fabbrini G, Berardelli A (2009) Voluntary, spontaneous and reflex blinking in patients with clinically probable progressive supranuclear palsy. Brain 132:502–510CrossRefGoogle Scholar
  13. 13.
    Berardelli A, Rothwell JC, Day BL, Marsden CD (1985) Pathophysiology of blepharospasm and oromandibular dystonia. Brain 108(Pt 3):593–608CrossRefGoogle Scholar
  14. 14.
    Tolosa E, Montserrat L, Bayes A (1988) Blink reflex studies in focal dystonias: enhanced excitability of brainstem interneurons in cranial dystonia and spasmodic torticollis. Mov Disord 3:61–69CrossRefGoogle Scholar
  15. 15.
    Conte A, Ferrazzano G, Defazio G, Fabbrini G, Hallett M, Berardelli A (2017) Increased blinking may be a precursor of blepharospasm: a longitudinal study. Mov Disord Clin Pract 4:733–736CrossRefGoogle Scholar
  16. 16.
    Jinnah HA, Berardelli A, Comella C, Defazio G, Delong MR, Factor S, Galpern WR, Hallett M, Ludlow CL, Perlmutter JS, Rosen AR (2013) The focal dystonias: current views and challenges for future research. Mov Disord 28:926–943CrossRefGoogle Scholar
  17. 17.
    Chen F-P, Evinger C (2006) Cerebellar modulation of trigeminal reflex blinks: interpositus neurons. J Neurosci 26:10569–10576CrossRefGoogle Scholar
  18. 18.
    Kaminer J, Powers AS, Horn KG, Hui C, Evinger C (2011) Characterizing the spontaneous blink generator: an animal model. J Neurosci 31:11256–11267CrossRefGoogle Scholar
  19. 19.
    Yoon HW, Chung J-Y, Song M-S, Park H (2005) Neural correlates of eye blinking; improved by simultaneous fMRI and EOG measurement. Neurosci Lett 381:26–30CrossRefGoogle Scholar
  20. 20.
    Oh J, Jeong S-Y, Jeong J (2012) The timing and temporal patterns of eye blinking are dynamically modulated by attention. Hum Mov Sci 31:1353–1365CrossRefGoogle Scholar
  21. 21.
    Schicatano EJ (2016) The effects of attention on the trigeminal blink reflex. Percept Mot Skills 122:444–451CrossRefGoogle Scholar
  22. 22.
    Chouinard PA, Paus T (2006) The primary motor and premotor areas of the human cerebral cortex. Neuroscientist 12:143–152CrossRefGoogle Scholar
  23. 23.
    Potgieser ARE, van der Hoorn A, de Jong BM (2015) Cerebral activations related to writing and drawing with each hand. PLoS One 10:e0126723CrossRefGoogle Scholar
  24. 24.
    Planton S, Jucla M, Roux F-E, Démonet J-F (2013) The “handwriting brain”: a meta-analysis of neuroimaging studies of motor versus orthographic processes. Cortex 49:2772–2787CrossRefGoogle Scholar
  25. 25.
    Allison T, McCarthy G, Nobre A, Puce A, Belger A (1994) Human extrastriate visual cortex and the perception of faces, words, numbers, and colors. Cereb Cortex 4:544–554CrossRefGoogle Scholar
  26. 26.
    Pugh KR, Mencl WE, Jenner AR, Katz L, Frost SJ, Lee JR, Shaywitz SE, Shaywitz BA (2001) Neurobiological studies of reading and reading disability. J Commun Disord 34:479–492CrossRefGoogle Scholar
  27. 27.
    Guenther FH (2006) Cortical interactions underlying the production of speech sounds. J Commun Disord 39:350–365CrossRefGoogle Scholar
  28. 28.
    Guenther FH, Ghosh SS, Tourville JA (2006) Neural modeling and imaging of the cortical interactions underlying syllable production. Brain Lang 96:280–301CrossRefGoogle Scholar
  29. 29.
    Baker RS, Andersen AH, Morecraft RJ, Smith CD (2003) A functional magnetic resonance imaging study in patients with benign essential blepharospasm. J Neurophthalmol 23:11–15CrossRefGoogle Scholar
  30. 30.
    Conte A, Falla M, Diana MC, Bologna M, Suppa A, Fabbrini A, Colosimo C, Berardelli A, Fabbrini G (2015) Spread of muscle spasms in hemifacial spasm. Mov Disord Clin Pract 2:53–55CrossRefGoogle Scholar
  31. 31.
    Colosimo C, Bologna M, Lamberti S, Avanzino L, Marinelli L, Fabbrini G, Abbruzzese G, Defazio G, Berardelli A (2006) A comparative study of primary and secondary hemifacial spasm. Arch Neurol 63:441–444CrossRefGoogle Scholar
  32. 32.
    Shamay-Tsoory SG, Abu-Akel A (2016) The social salience hypothesis of oxytocin. Biol Psychiatry 79:194–202CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Gina Ferrazzano
    • 1
  • Antonella Conte
    • 1
    • 2
  • Daniele Belvisi
    • 1
  • Andrea Fabbrini
    • 2
  • Viola Baione
    • 2
  • Alfredo Berardelli
    • 1
    • 2
  • Giovanni Fabbrini
    • 1
    • 2
    Email author
  1. 1.IRCCS NeuromedPozzilliItaly
  2. 2.Department of Human NeurosciencesSapienza University of RomeRomeItaly

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