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Cheronis C, Silverman A. An Eye-Opening Episode: Oculogyric Crisis Precipitated by Prochlorperazine. J Pediatr 2024:114294. [PMID: 39277079 DOI: 10.1016/j.jpeds.2024.114294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 09/06/2024] [Indexed: 09/17/2024]
Affiliation(s)
- Chrisoula Cheronis
- Child Neurology Division, Department of Neurology, Stanford Medicine, Palo Alto CA. 750 Welch Road, 3rd Floor, Suite 317, Palo Alto, CA 94304
| | - Andrew Silverman
- Child Neurology Division, Department of Neurology, Stanford Medicine, Palo Alto CA. 750 Welch Road, 3rd Floor, Suite 317, Palo Alto, CA 94304
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Malik N, Othman S, Tiwari A, Mantravadi S, Salari S, Dabaja A, Kambhatla S. Oculogyric Crisis Following Dosage Increase of Aripiprazole: A Case Report. Cureus 2024; 16:e65295. [PMID: 39184797 PMCID: PMC11343580 DOI: 10.7759/cureus.65295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
Oculogyric crisis (OGC) is a form of acute dystonia with involuntary conjugated ocular gaze in a fixed position. Common causes include metabolic disorders and medications, primarily typical antipsychotics. A 24-year-old male with a history of persistent depressive disorder and possible bipolar disorder was admitted to the psychiatric unit due to suicidal ideation. He was started on aripiprazole 5 mg and subsequently increased to 10 mg due to uncontrolled mood disorder. The patient subsequently developed OGC, which resolved with benztropine and diphenhydramine. This case report highlights aripiprazole-induced OGC and prompt management with benztropine and first-generation antihistamines.
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Affiliation(s)
- Nikhale Malik
- Internal Medicine, Garden City Hospital, Garden City, USA
| | - Sally Othman
- Internal Medicine, Garden City Hospital, Garden City, USA
| | - Apoorv Tiwari
- Internal Medicine, Garden City Hospital, Garden City, USA
| | | | - Syeda Salari
- Internal Medicine, Garden City Hospital, Garden City, USA
| | - Abed Dabaja
- Internal Medicine, Garden City Hospital, Garden City, USA
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Keys P, Davila-Siliezar P, Laylani N, Lee AG. Stress-Induced Oculogyric Crisis in Septo-Optic Dysplasia: Case Report. Case Rep Ophthalmol 2024; 15:406-410. [PMID: 38682038 PMCID: PMC11052561 DOI: 10.1159/000534493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/03/2023] [Indexed: 05/01/2024] Open
Abstract
Introduction Oculogyric crisis (OGC) is a dystonic movement disorder of varying durations that manifests as bilateral paroxysmal upward eye deviation accompanied by involuntary blinking, tongue protrusion, and autonomic symptoms. Separately, septo-optic dysplasia (SOD) is a congenital disorder involving hypoplasia of the optic nerve as well as hypothalamic and pituitary abnormalities. In the presented case, we report a case of OGC in the setting of SOD with proposed pathogenesis. Case Presentation A 27-year-old female presented with a history of SOD (optic nerve hypoplasia and hypopituitarism) with acute, recurrent, painless, bilateral, intermittent, simultaneous tonic conjugate upward eye deviation (i.e., OGC) and dystonic body posturing. She experienced her first episode upon meeting her biological sister for the first time at a loud, crowded public restaurant with continued episodes of OGC increasing in frequency and duration over the subsequent months. She later responded well to treatment with carbidopa/levodopa. Conclusion Based on our current understanding of OGC, we hypothesize that acute stressful life events in the setting of prior hypothalamic-pituitary axis dysfunction secondary to SOD could lower the threshold for developing OGC. Although most cases of OGC are idiopathic, various etiologies including medications, stress, and hormonal imbalance have been postulated as possible pathogenic mechanisms. We describe a case of SOD with OGC, and based upon our review of the English language ophthalmic literature, we believe that our case is novel.
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Affiliation(s)
- Phillip Keys
- Department of Ophthalmology, University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Pamela Davila-Siliezar
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Noor Laylani
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Andrew G. Lee
- Department of Ophthalmology, University of Texas Medical Branch School of Medicine, Galveston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A and M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Lv T, Wu L, Li L, Zhang M, Tan Q, Liu P. Oculogyric crisis symptoms related to risperidone treatment: a case report. BMC Psychiatry 2023; 23:875. [PMID: 38001400 PMCID: PMC10675969 DOI: 10.1186/s12888-023-05379-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Oculogyric crisis (OGC) is a rare focal dystonia of the ocular muscles that not only interferes with patients' medication adherence but also negatively affects the course and prognosis of the primary disease. Early detection and treatment of OGC can improve patients' medication adherence and quality of life. CASE PRESENTATION This paper reports a case of a 19-year-old Asian female with a diagnosis of schizophrenia who was treated intermittently with atypical antipsychotics aripiprazole or risperidone for 2 years, with improvement of psychotic symptoms during the course of medication, and then developed double eye rolling and staring with irritability when treated with risperidone 4 mg/d or 6 mg/d. Then, we changed the medication to clozapine, and the patient's psychotic symptoms were controlled and stable. The symptoms of double eye rolling and gaze disappeared. CONCLUSION Oculogyric crisis (OGC) is a rare focal dystonia of the oculogyric muscle. This case provides clinicians with a basis for the early recognition and management of oculogyric crisis during the use of atypical antipsychotics (risperidone).
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Affiliation(s)
- Tao Lv
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China.
| | - Liping Wu
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
| | - Longlong Li
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
| | - Min Zhang
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
| | - Qingyu Tan
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
| | - Ping Liu
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
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Koul R, Maiwall R, Sarin SK, Bhatia V, Deshmukh A, Kumar C, Khajuria R, Rudra OS, Papneja S, Kantale P, Pamecha V. Unusual Facial Movements (Ictal Blinking, Oculogyric Crises, and Jaw Seizure) in Severe Liver Disease: A Case Series. J Clin Exp Hepatol 2023; 13:1149-1155. [PMID: 37975048 PMCID: PMC10643264 DOI: 10.1016/j.jceh.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/10/2023] [Indexed: 11/19/2023] Open
Abstract
Background Seizures are reported in about one-third of patients with severe liver disease in association with acute or chronic liver failure. The majority of the seizures are of focal type. Occasionally generalized tonic-clonic seizures are seen when there is ethanol withdrawal. Not much is known about ictal blinking (IB) in severe liver disease. IB is the rare form of seizures and was reported in severe liver disease recently from this institute. Oculogyric crisis (OGC) is rarely reported in relation to the severe liver disease. OGC was also noted first time in our intensive care unit. Methods At the Institute of Liver and Biliary Sciences (ILBS), data on patients with IB and OGC were analyzed from October 2018 to January 2023 (52 months). All the patients had video electroencephalograph (video-EEG) recording after proper permission/consent. The patients were followed up later for the course of the illness. Results A total of 16 (12M:4F) patients were seen. Majority 12 (75%) were IB and 3 OGC. EEG was abnormal in nine (75.0%) of IB patients. Brain imaging had nonspecific findings. The outcome was based on the severity and recovery of the underlying liver disease. Conclusions Unusual facial movements in the form of IB and OGC are reported, which are most of the time missed. This report highlights the importance of recognition of these events and proper in time management to improve the outcome.
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Affiliation(s)
- Roshan Koul
- Department of Neurology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Akhil Deshmukh
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Chandan Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Rahul Khajuria
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Omkar S. Rudra
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Sangam Papneja
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Priyanka Kantale
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Vineyndra Pamecha
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
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Yogi TN, Bhusal A, Limbu S, B.C. P, labh S, Kafle R. Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: a case report. Ann Med Surg (Lond) 2023; 85:5255-5258. [PMID: 37811096 PMCID: PMC10553192 DOI: 10.1097/ms9.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance Oculogyric crisis (OGC), marked by upward eye deviation, is rare and linked to diverse causes, including drugs and neurological conditions. This study details a 16-year-old male's OGC onset after olanzapine treatment for an initial mania episode, highlighting the need to recognize this potential side effect. Case presentation A 16-year-old male with nonpsychotic mania was treated with olanzapine and sodium valproate. On day 30, he developed OCG due to olanzapine, managed with medication. After discharge, similar ocular symptoms emerged. Gradual olanzapine tapering alongside anticholinergic administration led to symptom relief. The Young Mania Rating Scale score decreased; psychoeducation was provided to the patient and family. Discussion This study presents an exceptional case of olanzapine-induced OGC, a rare dystonic eye movement reaction. The patient's presentation matched OGC criteria, confirmed by a high Adverse Drug Reaction Probability Scale score. Unusually, symptoms appeared 30 days postolanzapine initiation. A thorough assessment ruled out alternative causes. Mechanisms, possibly related to dopamine-choline balance and receptor sensitivity, remain uncertain. Despite atypical antipsychotics' lower risk, olanzapine's moderate D2 receptor binding led to this unusual response. Management involved dose reduction and anticholinergic therapy. Conclusion This case report highlights the rare occurrence of olanzapine-induced OCG in a patient with nonpsychotic mania. Effective management requires proper history taking, examination, regular follow-up, monitoring, and appropriate medication use. The case demonstrates the need for caution when increasing olanzapine dose in manic patients with untreated mental illness and a history of neurological symptoms.
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Affiliation(s)
- Tek N. Yogi
- Department of Psychiatry, MD, BP Koirala Institute of Health Sciences (BPKIHS), Nepal
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Oliveira DS, Grebe HP. Oculogyric crisis: the girl who stared at the ceiling. Pract Neurol 2023; 23:348-349. [PMID: 36914252 DOI: 10.1136/pn-2022-003653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Daniela Santos Oliveira
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Aveiro, Portugal
| | - Hans Peter Grebe
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Aveiro, Portugal
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Oculogyric Crisis after Initiation of Aripiprazole: A Case Report of an Active Duty Service Member. Case Rep Psychiatry 2023; 2023:9440028. [PMID: 36660180 PMCID: PMC9845035 DOI: 10.1155/2023/9440028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Oculogyric crisis is an acute dystonic reaction characterized by sustained, bilateral, and upward deviation of the eyes. It is a relatively uncommon extrapyramidal side effect of antipsychotic medications. Aripiprazole is an atypical antipsychotic that is FDA-approved for the treatment of schizophrenia, bipolar disorder, Tourette's disorder, and treatment resistant major depressive disorder. Compared to other antipsychotics, it is thought to have a lower propensity for causing dystonic side effects. Clinical Case. This case report is of a 19-year-old male who was psychiatrically hospitalized for first episode psychosis and initiated on low-dose oral aripiprazole. Three days after initiation of the medication, the patient was found to be markedly anxious and pacing around his room. Exam was notable for intermittent upward eye rolling, sustained upward conjugate gaze, and limited downward gaze. No other facial dyskinetic movements were observed. Treatment. The patient's oral aripiprazole was held, and he was administered 50 mg of oral diphenhydramine with improvement in symptoms within one hour. Ocular symptoms, dizziness, frontal headache, and pacing were resolved the following morning. He declined reinitiation of an antipsychotic medication. Conclusion Aripiprazole-induced acute dystonia, specifically OGC, is a rare potential adverse effect of aripiprazole. Risk factors include male gender, young age, use of typical antipsychotics, and initiation or uptitration of an antipsychotic. Even though atypical antipsychotics including aripiprazole are associated with lower risk for extrapyramidal symptoms, the possibility of oculogyric dystonia merits close monitoring especially in young, male, and drug naive patients. Anticholinergic agents such as diphenhydramine can treat symptoms of acute dystonia.
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Bergkvist M, Stephens C, Schilling T, Wang A, Yu X, Goodwin E, Golden L, Kristensen A, Klein M. Aromatic L-amino acid decarboxylase deficiency: a systematic review. FUTURE NEUROLOGY 2022. [DOI: 10.2217/fnl-2022-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aim: To gain greater knowledge regarding the natural history of aromatic L-amino acid decarboxylase (AADC) deficiency, a genetic disorder that causes severe deficits in motor and cognitive development. Materials & methods: A systematic literature review was performed of all case reports and clinical studies published through December 2019 of patients with AADC deficiency. The data were summarized descriptively. Results: The search identified 94 publications that described 237 unique patients. Mean (standard deviation) age at diagnosis was 3.2 (±5.7) years and 16 deaths were reported. Most patients (57%) received the standard of care therapies, which showed limited efficacy in this patient population. Conclusion: AADC deficiency is a devastating disease and prospectively defined natural history studies are warranted to further understand this disease.
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Affiliation(s)
| | | | | | - Antonia Wang
- PTC Therapeutics, Inc., South Plainfield, NJ 07080, USA
| | - Xiaojin Yu
- PTC Therapeutics, Inc., South Plainfield, NJ 07080, USA
| | | | - Lee Golden
- PTC Therapeutics, Inc., South Plainfield, NJ 07080, USA
| | | | - Matthew Klein
- PTC Therapeutics, Inc., South Plainfield, NJ 07080, USA
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Aripiprazole-Associated Acute Dystonia During Dose Reduction in Patient With Schizophrenia and Dementia: A Case Report. J Clin Psychopharmacol 2022; 42:508-509. [PMID: 35788549 DOI: 10.1097/jcp.0000000000001581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ruiz de Villa A, Haider AA, Frimer L, Bazikian Y. Oculogyric Crisis in the Setting of Low Dose Risperidone and Benztropine Mesylate Use in a Patient With Schizophrenia: A Case Report and Review of Literature. Cureus 2022; 14:e27217. [PMID: 36035042 PMCID: PMC9399662 DOI: 10.7759/cureus.27217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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Baizabal-Carvallo JF, Jankovic J. The clinical phenomenology and correlations of oculogyric tics. Acta Neurol Belg 2022; 122:925-930. [PMID: 35397742 DOI: 10.1007/s13760-022-01944-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oculogyric tics are identified in a substantial proportion of patients with Tourette syndrome (TS) and related tic-disorders. Nevertheless, studies assessing its frequency and clinical correlations are lacking. MATERIALS AND METHODS We reviewed video-recordings and clinical history of 201 patients with TS and chronic motor/phonic tic disorder, diagnosed according to DSM-5. RESULTS Oculogyric tics presented in 22.4% of our patients. Transient upward gaze was the most common phenomenology in patients with simple oculogyric tics; whereas eye-closure followed by upward and lateral deviations was the most commonly observed phenomenon in patients with combined oculogyric tics. Oculogyric tics have a median duration of 799 ms (range 299-34,500 ms). Patients with oculogyric tics were younger (P = 0.023) and had a higher frequency of cranial tics (P = 0.037) compared to those without oculogyric tics. No differences in tic severity, frequency of attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or use of dopamine receptor antagonists were observed in patients with and without oculogyric tics. CONCLUSIONS Oculogyric tics are a common phenomenology in chronic tic disorders. They are more common in younger patients with TS and are markers of other cranial tics, but not of TS severity or comorbid neuropsychiatric syndromes.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
- Department of Sciences and Engineering, University of Guanajuato, Ave León 428, Jardines del Moral, CP 37320, León, Guanajuato, Mexico.
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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