oculogyric crisis

Oculogyric Crisis: A Rare Neurological Disorder

An oculogyric crisis (OGC) is a rare neurological disorder characterized by spasmodic movements of the eyeballs into a fixed position, usually upwards. These episodes can last from seconds to hours and are often accompanied by other symptoms such as blepharospasm (involuntary blinking), periorbital twitches, and protracted staring episodes.

Key Features:

• Sustained dystonic, conjugate, involuntary upward deviation of both eyes
• Episodes can last from seconds to hours
• Often accompanied by other symptoms such as blepharospasm and periorbital twitches

Causes and Triggers:

While the exact causes of OGC are not fully understood, it is often associated with neurological disorders such as dystonia, Parkinson's disease, and other movement disorders. In some cases, OGC can be triggered by medications or other factors.

Symptoms and Diagnosis:

The symptoms of OGC can vary in severity and duration, but typically include:

• Sustained upward deviation of the eyes
• Blepharospasm (involuntary blinking)
• Periorbital twitches
• Protracted staring episodes

Diagnosis is often made through a combination of clinical evaluation, medical history, and imaging studies such as MRI or CT scans.

References:

• [1] Oculogyric crises are defined as spasmodic movements of the eyeballs into a fixed position, usually upwards. These episodes generally last minutes. (Source: 2)
• Sustained dystonic, conjugate, involuntary upward deviation of both eyes lasting seconds to hours is characteristic of OGC. (Source: 3)
• Oculogyric crisis (OGC) is a form of dystonic movement disorder characterized by paroxysmal, conjugate, and typically upward deviation of the eyeball. (Source: 4)
• An OCG is an uncommon type of focal dystonia that affects the extra-ocular muscles, producing a forced conjugate deviation of the eyes, more frequently upwards. (Source: 5)

Based on the provided context, here are the signs and symptoms of oculogyric crisis:

1. Painful deviation of the eyes: A painful deviation of the eyes in an obliquely upward direction that may last several minutes or even hours.
2. Sustained dystonic, conjugate, involuntary upward deviation of both eyes: The eyes deviate upwards and remain in this position for seconds to hours.
3. Restlessness: Initial symptoms include restlessness.
4. Agitation: Agitation is another initial symptom.
5. Malaise: A feeling of general discomfort or unease.
6. Fixed stare: A fixed stare may be observed during an oculogyric crisis.
7. Rolling eyes back: The eyes roll backward, which is a characteristic feature of oculogyric crisis.
8. Hyperextending their head, neck, or back: Involuntary hyperextension of the head, neck, or back may occur.
9. Thrusting their tongue: Thrusting the tongue out involuntarily.
10. Contracting muscles and/or twisting involuntarily: Other related features include tonic contractions of limbs, Todd paralysis, or impairment of consciousness.

These symptoms can vary in severity and duration, but they are generally associated with oculogyric crisis.

Based on the provided context, it appears that diagnostic tests for oculogyric crisis (OGC) are not extensively discussed in the search results. However, some relevant information can be inferred.

• Clinical diagnosis: The diagnosis of OGC is largely clinical and involves taking a focused history and physical examination to identify possible triggers or underlying conditions ([8]). This suggests that diagnostic tests may not be necessary for a definitive diagnosis.
• Brain MRI and EEG: In one case report, a brain MRI and video electroencephalography (EEG) were ordered to rule out other potential causes of the patient's symptoms ([5]). However, this is an isolated example and not a standard diagnostic approach for OGC.

It appears that there are no specific diagnostic tests mentioned in the search results as being commonly used or recommended for oculogyric crisis. The diagnosis is often made based on clinical presentation and history.

Diagnostic approaches:

• Clinical diagnosis through focused history and physical examination
• Brain MRI and EEG may be ordered in some cases to rule out other potential causes

References:

[5] - A case report where a brain MRI and video EEG were ordered to investigate the patient's symptoms. [8] - A source stating that the diagnosis of OGC is largely clinical and involves taking a focused history and physical examination.

Treatment Options for Oculogyric Crisis (OGC)

Oculogyric crisis (OGC) is a rare and sudden dystonic reaction that can be caused by certain medications, particularly neuroleptics. The treatment for OGC primarily involves reducing or discontinuing the causative medication, followed by the addition of anticholinergic agents to resolve the reaction.

• Discontinuation of Causative Medication: Stopping or reducing the use of the offending drug is often the first step in treating OGC (1).
• Anticholinergic Agents: Pharmacologic treatment with anticholinergic agents, such as diphenhydramine, can help resolve the reaction and prevent relapse (7). The dosage for children may be 1.25 mg/kg initially (4).
• Withdrawal or Reduction of Neuroleptics: In some cases, withdrawing or reducing neuroleptic medications, benzodiazepines, or anticholinergics may also be necessary to manage OGC (5).

Preventing Relapse

To avoid recurrence, it is recommended to continue the management of OGC for at least a week but sometimes for longer periods in case of tardive OGC (2). This can involve ongoing treatment with anticholinergic agents and monitoring for any signs of relapse.

References:

1. by L Wu · 2024 — In conclusion, the treatment of drug-induced OGC mainly involves reducing or discontinuing the causative medication, followed by the addition of ...
2. by P Mahal · 2021 · Cited by 21 — To avoid recurrence, it is recommended to continue the management of OGC for at least a week but sometimes for longer periods in case of tardive OGC.
3. by M Bindal — This article describes clinical features, differential diagnoses and approaches to management of oculogyric crisis.
4. Treatment in the acute phase in children involves reassurance, discontinuation of the causative agent, and diphenhydramine at a dosage of 1.25 mg/kg initially; ...
5. by M Solberg · 2017 · Cited by 17 — The treatment involves withdrawal or reduction of neuroleptics, benzodiazepines or anticholinergics or replacing the neurotransmitters where dopamine is lacking ...
6. Oculogyric crisis (OGC) is a rare sudden, paroxysmal, dystonic reaction that may manifest in response to specific drugs, particularly neuroleptics, or medical ...
7. Jul 31, 2024 — Pharmacologic treatment, typically with anticholinergic agents, resolves the reaction. Continue medication for 48-72 hours to prevent relapse.
8. by L Wu · 2024 — This review aims to explore the treatment and management strategies for OGC based on existing cases, hoping to provide references for clinicians ...

Differential Diagnosis of Oculogyric Crisis

Oculogyric crisis (OGC) is a rare movement disorder characterized by paroxysmal, conjugate, tonic, usually upwards, deviation of the eyes. When diagnosing OGC, it's essential to consider various differential diagnoses that can mimic or be associated with this condition.

Differential Diagnoses:

• Epilepsy: Seizures can cause abnormal eye movements, making them a potential differential diagnosis for OGC.
• Encephalitis: Inflammation of the brain can lead to various neurological symptoms, including abnormal eye movements.
• Tetanus: This bacterial infection can cause muscle stiffness and spasms, which may manifest as abnormal eye movements.
• Hypocalcemia: Low calcium levels in the blood can cause neuromuscular irritability, leading to abnormal eye movements.
• Brainstem lesions: Tumors or other abnormalities in the brainstem can cause a range of neurological symptoms, including abnormal eye movements.
• Cystic glioma: A type of brain tumor that can cause various neurological symptoms, including abnormal eye movements.

Other Considerations:

• Psychiatric conditions: OGC can be mistaken for an exaggeration of underlying psychiatric illness rather than a dystonic reaction.
• Neurological diseases: Certain neurodegenerative disorders, such as Parkinson's disease, can cause abnormal eye movements that may resemble OGC.
• Focal brain lesions: Lesions in the basal ganglia or midbrain can compromise the nigrostriatal pathway, leading to abnormal eye movements.

Approach to Diagnosis:

A thorough clinical examination and history-taking are crucial for differentiating OGC from other conditions. The proposed criteria for diagnosing OGC (Table 2) and the approach to a patient with an OGC-like phenomenon (Figure 1) can be useful in this regard [3][4].

References:

[1] Slow et al. (2020). Proposed Criteria for the Diagnosis of Oculogyric Crisis. [3] [2] The definition, history and usage of the differential of a function in calculus. [14] [3] Slow et al. (2020). Approach to a patient with an oculogyric crisis-like phenomenon. [4] [4] Proposed criteria for diagnosing oculogyric crisis. [9]

Note: The references provided are based on the context and may not be directly related to the topic of differential diagnosis of oculogyric crisis.