Oculogyric Crises

Oculogyric Crises

1. Oculogyric Crises Summarized from: Slow EJ, Lang AE. Oculogyric crises: a review of phenomenology, etiology, pathogenesis, and treatment. Movement Disorders. 2017 Feb;32(2):193-202.

2. Outline: Introduction Etiology Pathophysiology Diagnostic Criteria Differential diagnosis Diagnostic Approach Treatment Summary

3. Introduction OGC: an unusual type of dystonic movement disorder characterized by paroxysmal , tonic, conjugate, ocular deviations caused by sustained contractions of ocular muscles Typical episodes last minutes to hours, involve deviation of eyes most often upward and can be associated with other dystonic symptoms A potential complication of medications, most often dopamine-receptor blocking agents ( DRBAs )

4. Pathophysiology

5. Diagnostic Criteria

6. Differential Diagnosis

7. Diagnostic Approach

8. Treatment Anticholinergics are the mainstay of treatment in drug-induced OGC One theory is that the hypodopaminergic state results in a relative cholinergic overactivity Intravenous anticholinergics or diphenhydramine are recommended treatments in acute distonic reactions, typically working quickly (often minutes) to ameliorate the symptoms Benzodiazepines, including diazepam and clonazepam , may also be of benefit in OGC caused by neuroleptics In the neurometabolic disorders, dopamine replacement can completely abolish the occurrence of OGC over time

9. Summary A rare acute dystonic reaction Tonic upward gaze Due to DRBA / neuroleptic agent or neurometabolic disorders Deficiency of dopamine metabolism enzymes Hypodopaminergic  relative hypercholinergic Treatment: Anticholinergics (diphenhydramine)