The phenomenology of the geste antagoniste in primary blepharospasm and cervical dystonia

Martino, Davide; Liuzzi, Daniele; Macerollo, Antonella; Aniello, Maria Stella; Livrea, Paolo; Defazio, Giovanni

doi:10.1002/mds.23011

Cited by 73 publications

(76 citation statements)

References 23 publications

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“…This reinforces the idea that the application of a geste antagoniste could exert a modulation of the sensorymotor intergration that is disturbed in dystonia [38][39][40][41]. This effect could be age dependent [17].…”

Section: Discussionsupporting

confidence: 84%

“…It is characterized by its clinical heterogeneity and the possible coexistence of different forms of geste antagoniste in the same patient that allow different degrees of relief [14][15][16][17][18][19]. This gesture can take the form of a classical sensory trick or of a 'forcible' trick [17,20]. A 'forcible trick' consists of performing a forceful counter-pressure in opposition to the dystonic head turn, which may become necessary in more severe forms of dystonia where a purely sensory trick may not be sufficient to counteract the dystonia.…”

Section: Discussionmentioning

confidence: 99%

“…This can be responsible for a shorter time of relief and/or an increasing need for more forceful sensory stimulation to maintain the beneficial effects [15,18]. In some cases, the geste antagoniste even becomes ineffective [15][16][17][18]. The geste antagoniste has also been used as a therapeutic strategy [21].…”

Section: Discussionmentioning

confidence: 99%

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History of the ‘geste antagoniste’ sign in cervical dystonia

et al. 2012

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The geste antagoniste is a voluntary maneuver that temporarily reduces the severity of dystonic posture or movements. It is a classical feature of focal and particularly cervical dystonia. However, the precise historical aspects of geste antagoniste still remain obscure. The goals of this review were (1) to clarify the origin of the geste antagoniste sign; (2) to identify the factors that led to its diffusion in the international literature; (3) to follow the evolution of that term across the twentieth century. We used medical and neurological French, German and English literature of the late nineteenth and early twentieth centuries, and the PubMed database by entering the terms geste antagoniste, antagonistic gesture and sensory trick. The geste antagoniste sign is a legacy of the Paris Neurological School of the end of the nineteenth century. The term was introduced by Meige and Feindel in their 1902 book on tics, written in the vein of their master, Brissaud, who first described this sign in 1893. The almost immediate translations of this book by Giese into German and Kinnier Wilson into English contributed to the rapid spreading of the term geste antagoniste, which is still in use worldwide today. The term antagonistic gesture is the translation proposed by Kinnier Wilson, which also led to the use of the term geste antagonistique. The geste antagoniste sign has long been considered a solid argument for the psychogenic origins of dystonia until the 1980s when Marsden made strong arguments for its organic nature.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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History of the ‘geste antagoniste’ sign in cervical dystonia

et al. 2012

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“…4 Diagnosing BSP and assessing the impact of treatments on the condition are major needs in clinical practice and research. Although a new scale specifically developed for rating the severity of BSP has been validated, 5 the diagnosis of BSP is presently based on clinical grounds and is open to bias.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a clinical guideline for diagnosing blepharospasm

et al. 2013

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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. Blepharospasm (BSP) is characterized by involuntary orbicularis oculi (OO) muscle spasms that are usually bilateral, synchronous, and symmetrical.1 Other signs and symptoms possibly accompanying BSP include sensory symptoms in the eyes often indicating ocular diseases (e.g., dry eye syndrome), 2 an increased spontaneous blink rate (BR), 3 and sensory tricks that can transiently improve eyelid spasms. 4 Diagnosing BSP and assessing the impact of treatments on the condition are major needs in clinical practice and research. Although a new scale specifically developed for rating the severity of BSP has been validated, 5 the diagnosis of BSP is presently based on clinical grounds and is open to bias. The lack of validated diagnostic criteria sometimes makes it difficult to distinguish BSP from other conditions of involuntary eyelid closure such as eyelid tics, hemifacial spasms, facial chorea, apraxia of eyelid opening, frequent blinking, and lid ptosis due to myasthenia or other causes. 6 BSP may be diagnosed several years after the first symptoms manifest, and in the interim, many patients visit numerous physicians, delaying access to treatment. 7 Family studies indicate that up to half of people with dystonia may be undiagnosed or misdiagnosed. 8,9 The lack of a diagnostic biomarker makes it essential to demarcate accurate diagno...

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“…Functioning as a sensory trick, vision may have allowed subjects to better define their head orientation in space and minimize the disruptive effects of dystonia. Although sensory tricks are traditionally associated with cutaneous input by touching the cheek (Deuschl et al,1992;Kaegi et al,2013;Martino et al,2010;Muller et al,2001), recent studies have shown that vision can also act as a sensory…”

Section: Accepted Manuscriptmentioning

confidence: 99%