An oculogyric crisis is a type of dystonia in which those affected cannot influence the symptoms and the extent of the neurological and psychological symptoms. The crisis can last a few minutes or much longer.
What is an oculogyric crisis?
The term crisis always stands for a kind of escalation. A problematic situation arises, which usually requires a quick response. Exactly this also applies to the oculogyric crisis. It is a type of dystonia (neurological movement disorder) in which the eyeballs slip uncontrollably in a specific direction (tonic lateral movement). See acronymmonster for Definition of Idiopathic Interstitial Pneumonia in English.
Those affected by an oculogyric crisis cannot exert any influence. Diseases of the basal ganglia (core areas below the cerebral cortex (Cortex cerebri), psychogenic or drug-toxic causes can be responsible for an oculogyric crisis. Experts speak of a non-epileptic movement disorder (movement disorder without epilepsy or convulsions).
This disease is classified in the field of neurology or psychiatry. The crisis is defined by different communication disorders, very differentiated neurological characteristics as well as psychological and physical characteristics of different genesis. When the crisis is over, those affected can experience a mild or pronounced state of exhaustion.
From the range of drug treatment, neuroleptics such as haloperidol or olanzapine, carbamazepine, cisplatin, chloroquine, diazoxide, metoclopramide, nifedipine, domperidone, pemoline, phencyclidine and levopoda are possible causes of an oculogyric crisis.
Due to their sedative and antipsychotic effect, these neuroleptics (from neuron: “nerve”, lepsis: “seize”) combat the loss of reality in people who are ill. Serious mental disorders, fears, restlessness and delusions as well as hallucinations are also treated with neuroleptics, now called antipsychotics.
Other causes of an oculogyric crisis can be found in Parkinson’s disease, Tourette ‘s syndrome and multiple sclerosis. Postencephalitic Parkinson’s syndrome was considered the main cause until after 1920. Since recently ADHD in children, as well as fetal alcohol syndrome and autism, have also been treated with neuroleptics, these diseases must also be considered as secondary causes because of the drug effect.
Because in severe cases obsessive-compulsive disorders, personality disorders and pathological arousal disorders are treated with neuroleptics, these disorders should also be included in the list of diseases that can trigger an oculogyric crisis due to the drug effect. Diseases of the basal ganglia and psychogenic signs can provoke an oculogyric crisis.
Symptoms, Ailments & Signs
The initial symptoms can include, for example, excitement, restlessness and discomfort, but also a stare. This can be followed by a symptomatic upward movement of the eyes. Head movement backwards or to the side, as well as a wide open mouth and eye pain can also occur.
After the crisis, a state of exhaustion cannot be ruled out. In the course of a crisis, multismus (communication disorders, psychogenic silence without a defect in the organs of speech) and palilalia (pathological compulsion to repeat one’s own words and sentences) are just as well known as blinking, tearing and dilation of the pupils.
Other symptoms during a crisis can include high blood pressure, headaches, drooling, depression and paranoia, as well as obsessive thoughts and depersonalization. The use of obscene vocabulary and violence is also known. An oculogyric seizure is defined as an epileptic seizure with a tonic lateral movement of the eyes.
Diagnosis & course of disease
In the further course of oculogyric crises, not only a recurrence but also a spread of the focal dystonia is to be expected. And on other muscle groups. Symptoms similar to those of Meige syndrome can occur.
The oculogyric crisis, i.e. the spasmodic upward movement of the eyes, is already a complication of a neurological or neurodegenerative disease. The crisis can also be triggered by taking certain medications. In most cases, in addition to the upward movements of the eyes, the head only moves backwards or to the side when the mouth is open.
However, the oculogyric crisis can also be associated with other serious complications. In addition to suddenly occurring severe high blood pressure, headaches, tears, dilation of the pupils and excessive salivation, delusions, depression, depersonalization and violent outbursts can also occur. Symptoms may worsen if the affected person is forcibly restrained.
Therefore, it is important to remain calm during an attack. However, bystanders may be injured during a patient’s sudden outburst of violence. Furthermore, it can also happen that the affected person injures himself, for example by biting his tongue. In order to avoid serious complications, the patient should be monitored as closely as possible.
He should be accompanied when traveling or carry an emergency card with him so that the right action can be taken in an emergency. Sharp objects should be kept out of reach because they can endanger themselves and others. Stress and excitement are counterproductive in the seizure state.
When should you go to the doctor?
A doctor’s visit is necessary as soon as the affected person shows unusual changes in personality or behavior. If the appearance is perceived as abnormal, there is a need for action. Staring, hallucinations, or delusions are causes for concern and need to be evaluated by a doctor. Dilation of the pupils, prolonged exhaustion, as well as depressive states must be presented to a doctor. The affected person needs help and drug therapy. Investigations should be initiated if there is uncontrollable salivation, uplift of the eyes, or pain.
A diagnosis is required so that a treatment plan can be drawn up. If the affected person reacts unusually or not at all to social interactions, there is a health disorder. Persistent tearing, an open mouth, or an unusual posture should be reported to a doctor. Compulsions or obsessions are other signs of an irregularity.
If the symptoms listed last for a long time or if the symptoms increase, a doctor’s visit is necessary. If you have high blood pressure or if your head is tilted backwards, you should consult a doctor. If you experience a seizure disorder, sudden outbursts of violence, or signs of depersonalization, see a doctor immediately. In severe cases, an emergency service must be alerted. Until his arrival, measures to limit the injury are necessary to avoid serious complications.
Treatment & Therapy
If an acute oculogyric attack occurs, keep calm. Under no circumstances should the person concerned be detained by force. Putting objects in the mouth to prevent tongue biting should also be avoided. Rather, the person should be placed in a protected body position with a head rest.
It is also important not to leave those affected alone, to loosen their clothing and, if necessary, to remove their glasses. All objects that could endanger the person should be put out of reach. Bystanders must be calmed down so that no further stress factors arise. The next of kin (partner, parents) and the doctor should be informed as soon as possible.
When the seizure is over, the affected person can be spoken to with calming words and taken to a quiet place (separate room or quiet corner). An emergency card with all the relevant information (precise diagnosis, therapy, rules of conduct) that you carry with you at all times should be carried with you at all times to ensure the best possible first aid.
Medical first aid for an oculogyric crisis may consist of intravenous administration of benzatropine. An effect usually occurs after about five minutes. However, the full effect can only set in after half an hour.
Outlook & Forecast
An oculogyric crisis is a side effect of an existing disease. It is a medical emergency that must always be treated. Otherwise, the general state of health of the person concerned can permanently deteriorate to a significant extent. Violence can also break out, which poses a potential threat to those affected and those around them. Medical care is needed as quickly as possible so that the state of the crisis can be overcome.
The patients have diseases that are mostly chronic in character. Although the prognosis depends on the development of the underlying disease, recovery is often not to be expected. Rather, long-term therapy is necessary so that the patient’s state of health can be stabilized.
In some cases, the cause can be found in the administration of neuroleptics. If it is possible to discontinue these medications permanently because the underlying mental illness has been treated, there is also a significant improvement in the health of the person affected. The best prospects are in people suffering from OCD. Good therapeutic successes can be achieved here with professional treatment. The cooperation of the patient is absolutely necessary. It is more difficult to improve in personality disorders or addictions. The overall prognosis here is worse.
As with other neurodegenerative diseases, a molecular pathological diagnosis should be made. The basis for this are the current developments in causal therapeutic approaches. Close cooperation in primary care with specialized centers is essential for this. Anyone who knows that an oculogyric crisis can occur at any time should keep an eye on optical targets in the distance in the car, on the bus or when traveling by train.
In this way, you can exercise your own visual control. Logopedic care and physiotherapeutic measures are recommended in order to avoid new oculogyric seizures as far as possible or at least to limit their intensity. Drug therapy is essential in most cases.
After an eye spasm, the doctor should be consulted at least once more. Follow-up care for an oculogyric crisis focuses on various physical examinations and a patient interview. The doctor assesses the risk of the disease coming back and clarifies any open questions the patient may have as part of the anamnesis.
In some cases, the doctor will consult a therapist, especially for severe seizures that involve physical impairment. Damage can be ruled out by examining the eyes. If there are injuries to the eyes or to other parts of the body as a result of an accident, these are diagnosed and treated. The family doctor consults other specialists for this purpose.
After the treatment is completed, the patient must visit the doctor again so that the doctor can complete the follow-up examination. If necessary, the medication that the patient is taking must be adjusted. As part of the follow-up care, other measures are also discussed, such as the prevention of epileptic seizures or the prescription of emergency medication. The necessary steps are then taken to eliminate the causes and to optimize patient safety. The aftercare is carried out by the responsible ophthalmologist or general practitioner.
You can do that yourself
In the event of an oculogyric seizure, an ambulance must be called. The person concerned should take the rescue medication and then lie on their back. In the event of a severe seizure, any first aiders must calm the person affected and, if necessary, administer the antiepileptic drugs. The paramedic must be informed of the condition so that the necessary measures can be taken immediately.
In the case of a mild attack, the patient has usually recovered after half an hour. In the case of a severe seizure, an inpatient stay is necessary. The patient should rest sufficiently and avoid stress . Diet does not need to be changed after an oculogyric crisis. The most important self-help measure is to always carry the emergency medication with you and to avoid seizures by adopting a prudent lifestyle. Patients should avoid flashing lights and loud and fast sounds. An emergency card must also be carried so that the necessary steps can be taken in the event of an emergency.
Finally, it is important to optimally adjust the living conditions to the symptoms in order not to risk an attack and, in the event of an attack, to receive the necessary help immediately. The doctor in charge can provide further tips for accompanying self-therapy.