Development and validation of a clinical guideline for diagnosing blepharospasm

Giovanni Defazio, Mark Hallett, Hyder A. Jinnah, Alfredo Berardelli

Research output: Contribution to journalArticle

Abstract

Objective: To design and validate a clinical diagnostic guideline for aiding physicians in confirming or refuting suspected blepharospasm. Methods: The guideline was developed and validated in a 3-step procedure: 1) identification of clinical items related to the phenomenology of blepharospasm, 2) assessment of the relevance of each item to the diagnosis of blepharospasm, and 3) evaluation of the reliability and diagnostic sensitivity/specificity of the selected clinical items. Results: Of 19 clinical items initially identified, 7 were admitted by content validity analysis to further assessment. Both neurologists and ophthalmologists achieved satisfactory interobserver agreement for all 7 items, including "involuntary eyelid narrowing/closure due to orbicularis oculi spasms," "bilateral spasms," "synchronous spasms," "stereotyped spasm pattern," "sensory trick," "inability to voluntarily suppress the spasms," and "blink count at rest." Each selected item yielded unsatisfactory accuracy in discriminating patients with blepharospasm from healthy subjects and patients with other eyelid disturbances. Combining the selected items, however, improved diagnostic sensitivity/specificity. The best combination, yielding 93% sensitivity and 90% specificity, was an algorithm starting with the item "stereotyped, bilateral, and synchronous orbicularis oculi spasms inducing eyelid narrowing/closure" and followed by recognition of "sensory trick" or, alternatively, "increased blinking." Conclusion: This study provides an accurate and valid clinical guideline for diagnosing blepharospasm. Use of this guideline would make it easier for providers to recognize dystonia in clinical and research settings.

Original languageEnglish
Pages (from-to)236-240
Number of pages5
JournalNeurology
Volume81
Issue number3
DOIs
Publication statusPublished - Jul 16 2013

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Blepharospasm
Spasm
Guidelines
Eyelids
Sensitivity and Specificity
Blinking
Dystonia
Healthy Volunteers
Physicians
Research
Diagnostics
Specificity

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Development and validation of a clinical guideline for diagnosing blepharospasm. / Defazio, Giovanni; Hallett, Mark; Jinnah, Hyder A.; Berardelli, Alfredo.

In: Neurology, Vol. 81, No. 3, 16.07.2013, p. 236-240.

Research output: Contribution to journalArticle

Defazio, Giovanni ; Hallett, Mark ; Jinnah, Hyder A. ; Berardelli, Alfredo. / Development and validation of a clinical guideline for diagnosing blepharospasm. In: Neurology. 2013 ; Vol. 81, No. 3. pp. 236-240.
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