1
|
Reinink H, Bloem BR. Sutton's law applies to functional neurology. J Neurol 2023; 270:5110-5112. [PMID: 37428203 DOI: 10.1007/s00415-023-11857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Hendrik Reinink
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
- Department of Neurology, Spaarne Gasthuis Hospital, Haarlem, The Netherlands.
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Kassavetis P, Kaski D, Anderson T, Hallett M. Eye Movement Disorders in Movement Disorders. Mov Disord Clin Pract 2022; 9:284-295. [PMID: 35402641 PMCID: PMC8974874 DOI: 10.1002/mdc3.13413] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
Abstract
Oculomotor assessment is an essential element of the neurological clinical examination and is particularly important when evaluating patients with movements disorders. Most of the brain is involved in oculomotor control, and thus many neurological conditions present with oculomotor abnormalities. Each of the different classes of eye movements and their features can provide important information that can facilitate differential diagnosis. This educational review presents a clinical approach to eye movement abnormalities that are commonly seen in parkinsonism, ataxia, dystonia, myoclonus, tremor, and chorea. In parkinsonism, subtle signs such as prominent square wave jerks, impaired vertical optokinetic nystagmus, and/or the "round the houses" sign suggest early progressive supranuclear gaze palsy before vertical gaze is restricted. In ataxia, nystagmus is common, but other findings such as oculomotor apraxia, supranuclear gaze palsy, impaired fixation, or saccadic pursuit can contribute to diagnoses such as ataxia with oculomotor apraxia, Niemann-Pick type C, or ataxia telangiectasia. Opsoclonus myoclonus and oculopalatal myoclonus present with characteristic phenomenology and are usually easy to identify. The oculomotor exam is usually unremarkable in isolated dystonia, but oculogyric crisis is a medical emergency and should be recognized and treated in a timely manner. Gaze impersistence in a patient with chorea suggests Huntington's disease, but in a patient with dystonia or tremor, Wilson's disease is more likely. Finally, functional eye movements can reinforce the clinical impression of a functional movement disorder.
Collapse
Affiliation(s)
- Panagiotis Kassavetis
- National Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA,Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement NeurosciencesUniversity College London, Institute of NeurologyLondonUK
| | - Tim Anderson
- New Zealand Brain Research InstituteChristchurchNew Zealand,Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
| |
Collapse
|
3
|
Hess K, Schmitt M, Wabbels B. Periorbital injections of botulinum toxin a: a novel therapeutic option for convergence spasm in neuropsychiatric disorders. J Neurol 2022; 269:243-250. [PMID: 34047854 PMCID: PMC8739525 DOI: 10.1007/s00415-021-10613-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Convergence spasm (CS, spasm of near reflex) is characterized by transient attacks of convergence, miosis and accommodation, often associated with functional neurological disorders. To date, no simple and efficient treatment option is available for CS. This study investigates whether periorbital botulinum toxin injections as used in essential blepharospasm are also a treatment option in these patients. METHODS All patients with convergence spasm having been treated with periorbital BoNTA injections in the department of neuro-ophthalmology were identified. Data were extracted from patient files concerning details and subjective effectiveness of botulinum toxin injections and relation to psychiatric or neurological disorders. Patients reporting with a history of closed-head trauma or organic neurologic pathologies possibly causing CS were excluded. A telephone assessment with a standardized questionnaire was performed to evaluate mental health issues as a trigger, as well as the long-term effect and satisfaction with periorbital injections. RESULTS Of 16 patients treated with periorbital botulinum toxin injections for convergence spasm, 9 patients reported depression and/or anxiety disorders ongoing or in the past. A median number of 3 injections (range 1-13) was administered with a variable effect (relief of symptoms) between no effect and effect of up to more than 12 weeks. A longitudinal follow-up revealed ongoing symptoms in five patients. CONCLUSIONS Periorbital botulinum toxin injections are less invasive than injections in the medial rectus muscle and can be a bridging therapeutic option in patients with CS. Mental health exploration is important due to psychiatric comorbidity.
Collapse
Affiliation(s)
- Kristina Hess
- grid.10388.320000 0001 2240 3300Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Str. 2, 53127 Bonn, Germany
| | - Moritz Schmitt
- grid.10388.320000 0001 2240 3300Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Str. 2, 53127 Bonn, Germany
| | - Bettina Wabbels
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW The purpose of this article is to provide an overview of drug-induced maculopathies including their clinical presentations, diagnostic findings, and treatment options. With the increasing pace of development and arrival of drugs to the market, this review aims to inform retina specialists of relevant side effects that may be encountered in a clinical practice setting. RECENT FINDINGS The major themes visited in this article focus on relevant findings of drugs that cause pigmentary and crystalline maculopathy, photoreceptor dysfunction, cystoid macular edema, central serous choroidopathy, uveitis, and vascular damage. SUMMARY The current review reports updated findings and discusses the pathophysiologic mechanisms, presentations, and treatments of drug-induced maculopathies.
Collapse
|
5
|
Mustafa MM, Akram H, Oliva-Domínguez M, Kaski D. Functional positional eye and eyelid movements. J Neurol 2020; 267:3425-3428. [PMID: 32671528 PMCID: PMC7578154 DOI: 10.1007/s00415-020-10071-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Positional manoeuvres are an important part of the neurological examination, particularly in patients with vertigo where the presence and characteristics of provoked nystagmus can help differentiate central from peripheral neurological disorders. METHODS Case series of functional positional eye and eyelid movements. RESULTS We report four patients with functional eye and eyelid movements provoked during positional manoeuvres. The range of abnormalities observed included positional convergence spasm, brief functional saccadic oscillations, and excessive positional blinking mimicking upbeat nystagmus. The functional movements described were present on a background of pre-existing peripheral or central nystagmus, or positional vertigo. CONCLUSION Functional positional eye and eyelid movements may co-exist with organic nystagmus that renders an accurate interpretation of the manoeuvre more challenging. A thorough understanding of the clinical features that differentiate these two categories of eye/eyelid movements makes the analysis easier, thus preventing misdiagnosis and avoiding unnecessary investigations.
Collapse
Affiliation(s)
- Mohamed Mabrouk Mustafa
- Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- Pharmacology Department, Faculty of Medicine and Health Science, Omdurman Islamic University, Omdurman, Sudan
| | - Harry Akram
- Department of Neuro-Otology, Royal National Ear Nose and Throat Hospital, University College London Hospitals, Huntley Street, London, UK
| | | | - Diego Kaski
- Department of Neuro-Otology, Royal National Ear Nose and Throat Hospital, University College London Hospitals, Huntley Street, London, UK.
- Department of Clinical and Motor Neurosciences, University College London, 33 Queen Square, London, UK.
| |
Collapse
|
6
|
Teodoro T, Cunha JM, Abreu LF, Yogarajah M, Edwards MJ. Abnormal Eye and Cranial Movements Triggered by Examination in People with Functional Neurological Disorder. Neuroophthalmology 2019; 43:240-243. [PMID: 31528188 DOI: 10.1080/01658107.2018.1536998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 01/17/2023] Open
Abstract
The diagnosis of functional neurological disorder (FND) relies on the demonstration of positive symptoms and signs, as supported by recent changes in DSM5. We recorded the findings of routine clinical eye movement assessment in 101 consecutive new patients with FND. Clinical examination triggered facial and eye movement disorders in 46% of patients, all with positive characteristics of functional movement disorder. These are useful as supporting features in making a positive diagnosis of FND.
Collapse
Affiliation(s)
- Tiago Teodoro
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Neurologia, Departamento de Neurociências, Hospital de Santa Maria, Lisboa, Portugal
| | - Joana M Cunha
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Psiquiatria, Departamento de Psiquiatria e Saúde Mental do Algarve, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Luis F Abreu
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Neurologia, Departamento de Neurociências, Hospital de Santa Maria, Lisboa, Portugal.,Instituto de Semiótica Clínica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mahinda Yogarajah
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mark J Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
7
|
|
8
|
Perry CG, Holmes KG, Gruber-Baldini AL, Anderson KE, Shulman LM, Weiner WJ, Reich SG. Are Patients with Psychogenic Movement Disorders More Likely to be Healthcare Workers? Mov Disord Clin Pract 2016; 4:62-67. [PMID: 30713949 DOI: 10.1002/mdc3.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 11/11/2022] Open
Abstract
Background Reported risk factors for the development of a psychogenic movement disorder (PMD) include young age, female gender, history of abuse, current or past psychiatric disorder, lower levels of education and socioeconomic status, and employment as a healthcare worker. Although employment in healthcare is included in several diagnostic criteria for PMD, as well as in many case series, this association has never been validated. Methods Using the University of Maryland Movement Disorder Database (UMMDD), we identified PMD cases, as well as patients with isolated focal dystonia as controls. An experienced movement disorder specialist diagnosed all patients, and all cases met criteria for clinically established PMD. Demographic and occupational histories were obtained from medical records and were supplemented by telephone interviews. PMD cases and controls were compared using t tests/χ2 tests. Results Controls (n = 148) were older than PMD cases (n = 132), with an average age of 61.4 and 52.1 years, respectively (P < 0.001); there were no significant differences between groups with respect to gender, education level, and ethnicity. The proportion of healthcare workers was not significantly different between PMD cases and controls (25% of PMD cases vs. 20% of controls; P = 0.28). Conclusions In contrast to traditional teaching, this investigation demonstrates that in our patient population, patients with a PMD were no more likely to be employed as healthcare workers than patients with isolated focal dystonia. This study calls into question the use of employment in healthcare as a reliable criterion to support the diagnosis of PMD.
Collapse
Affiliation(s)
- Christina G Perry
- Department of Neurology The University of Maryland School of Medicine Baltimore Maryland USA
| | - Katherine G Holmes
- Department of Neurology The University of Maryland School of Medicine Baltimore Maryland USA
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health The University of Maryland School of Medicine Baltimore Maryland USA
| | - Karen E Anderson
- Department of Psychiatry Georgetown University Medical Center and MedStar Georgetown University Hospital Washington DC USA.,Department of Neurology Georgetown University Medical Center and MedStar Georgetown University Hospital Washington DC USA
| | - Lisa M Shulman
- Department of Neurology The University of Maryland School of Medicine Baltimore Maryland USA
| | - William J Weiner
- Department of Neurology The University of Maryland School of Medicine Baltimore Maryland USA
| | - Stephen G Reich
- Department of Neurology The University of Maryland School of Medicine Baltimore Maryland USA
| |
Collapse
|