Treatment. Severe or painful oculogyric crises can be treated acutely with benztropine, 2 mg intramuscularly or intravenously, or diphenhydramine, 50 mg intramuscularly or intravenously.419 A dose can be repeated in 30 minutes if there is no response.
What are the treatment options for oculogyric crises?
Some patients with oculogyric crises owing to neuroleptic use may require short-term treatment with oral benztropine, 2–6 mg q.d., or oral trihexyphenidyl, 4–15 mg q.d., for 2 weeks following the acute episode. 419 One reported patient improved with vagus nerve stimulation. 429 Seizures should be excluded with an electroencephalogram (EEG).
How is oculogyric crisis diagnosed?
The diagnosis of oculogyric crisis is largely clinical and involves taking a focused history and physical examination to identify possible triggers for the crisis and rule out other causes of abnormal ocular movements.
Which medications are associated with oculogyric crises?
Although there are case reports of oculogyric crises from other classes of drugs, including H 2 antagonists, erythromycin and antihistamines, the majority of patients will have received an antiemetic or an antipsychotic drug.
What is oculogyric crisis in pharmacology?
Oculogyric crisis (OGC) is the name of a dystonic reaction to certain drugs or medical conditions characterized by a prolonged involuntary upward deviation of the eyes. The term "oculogyric" refers to the bilateral elevation of the visual gaze, but several other responses are associated with the crisis.
Is oculogyric crisis reversible?
The management is the same as for dystonias caused by antipsychotics, that is, anticholinergics and reassurance. Our case report highlights the fact that oculogyric crises caused by drugs may be reversible and prognosis may be good.
What is the recommended pharmacological treatment for a severe acute dystonic?
The most commonly available drugs in the emergency setting for the treatment of acute dystonic reactions are diphenhydramine and benztropine. Symptoms usually improve or resolve dramatically within 10 to 30 minutes of administration of parenteral anticholinergics.
Which antipsychotic causes oculogyric crisis?
Risperidone or olanzapine (alone or in combination with a second antipsychotic) seemed causative in each case. Also implicated in the onset or recurrence of oculogyric episodes were ziprasidone, quetiapine, clozapine, aripiprazole, and the first-generation antipsychotic loxapine.
How is drug induced dystonia treated?
Treatment for acute dystonia includes discontinuing the offending drug and treatment with anticholinergics or antihistamines (i.e. diphenhydramine), often injected or intravenously. Even without medical treatment, most cases resolve within 12 to 48 hours.
What causes Oculogyric crisis?
Oculogyric crises can be triggered by neuroleptics or other medication such as dopamine receptor antagonists. Oculogyric crises are rarely reported with quetiapine in the literature. Emotional stress and fatigue seem to worsen or induce these episodes. The onset of these attacks is often abrupt.
What is the best medication for dystonia?
Anticholinergic agents are generally the most successful oral medications for the treatment of dystonia, with trihexyphenidyl being the most commonly used agent.
What is fluphenazine used to treat?
Fluphenazine is an antipsychotic medication used to treat schizophrenia and psychotic symptoms such as hallucinations, delusions, and hostility. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Is chlorpromazine an antidepressant?
Chlorpromazine is a psychiatric medication that belongs to the class of drugs called phenothiazine antipsychotics. It works by helping to restore the balance of certain natural substances in the brain.
Can Abilify cause oculogyric crisis?
The repeat challenge with aripiprazole 20 mg orally in two divided dosages resulted into oculogyric crisis within 4 days.
Does drug induced dystonia go away?
In almost all instances, drug induced dystonias are reversible, resolving after the discontinuation of the offending drug. Tardive dystonia is a rare exception to this rule with a potential for becoming permanent.
What medications make dystonia worse?
High potency antipsychotic drugs such as haloperidol, fluphenazine, and pimozide cause dystonia more frequently than do low potency drugs such as chlorpromazine and thioridazine.
Does Benadryl treat dystonia?
Unfortunately, few medications are completely effective for the treatment of dystonia. Exceptions to this rule include the use of Benadryl to treat acute drug-induced dystonia and the use of dopamine to treat certain forms of inherited dystonia, such as Segawa syndrome.
Oculogyric crisis Definition
The Oculogyric crisis can be termed as the acute dystonic reactions. As the name suggests this particular reaction can be effect bodily functions particularly eye balls. In other words it can be suggested that the contraction of the muscles is directly involved.
Oculogyric crisis Symptoms
Like other medical issues, there are some definite symptoms that are associated with the Oculogyric crisis. It is kind of disease that can develop gradually and slowly. Most of the people suffering from this particular disease are found to have a hectic routine.
Oculogyric crisis Causes
There can be multiple causes for the Oculogyric crisis. People who drink too much are prone to this particular disorder. Drugs like cocaine can also play active role in this disorder. Researchers have suggested that people suffering from Parkinson’s disease can have oculogyric disorder as well.
Oculogyric crisis Treatment
Like other diseases, the Oculogyric crisis can be treated immediately. There are various suggestions that can be given to the patient suffering from oculogyric disorder. The one common drug than be given to the patient intravenously is Procyclidine. The effects of the drugs given can be observed within 10 to 30 minutes after the infusion.
Signs and symptoms
Initial symptoms include restlessness, agitation, malaise, or a fixed stare. Then comes the more characteristically described extreme and sustained upward deviation of the eyes. In addition, the eyes may converge, deviate upward and laterally, or deviate downward.
Causes
Drugs that can trigger an oculogyric crisis include neuroleptics (such as haloperidol, chlorpromazine, fluphenazine, olanzapine ), carbamazepine, chloroquine, cisplatin, diazoxide, levodopa, lithium, metoclopramide, lurasidone, domperidone, nifedipine, pemoline, phencyclidine ("PCP"), reserpine, and cetirizine, an antihistamine.
Diagnosis
The diagnosis of oculogyric crisis is largely clinical and involves taking a focused history and physical examination to identify possible triggers for the crisis and rule out other causes of abnormal ocular movements.
Treatment
Immediate treatment of drug-induced OGC can be achieved with intravenous antimuscarinic benzatropine or procyclidine; these are usually effective within 5 minutes, although they may take as long as 30 minutes for full effect. Further doses of procyclidine may be needed after 20 minutes. Any causative new medication should be discontinued.
What is the oculogyric crisis?
Oculogyric crisis was originally described in patients with encephalitis lethargica, but these days are more commonly observed after exposure to a variety of medications (e.g., antiemetics, antidepressants, and antipsychotics) that cause acute dystonic reactions or tardive phenomena ( Thenganatt and Jankovic, 2015 ).
What is a crises oculogyres?
In the 1920s the French described crises ( crises oculogyres) as complications of postencephalitic Parkinsonism, 403,408 but today they are usually acute or tardive extrapyramidal reactions to neuroleptics. 404–407,409–411 We have also seen oculogyric crisis with some of the newer agents such as aripiprazole.
What is a dystonia of the ocular muscles?
Oculogyric crises. Oculogyric crises are a dystonia of ocular muscles 402 characterized by dramatic involuntary conjugate deviation of the eyes. 403 The eyes usually inadvertently move straight upwards or up and to the left or right, and the position can change from crisis to crisis. Oculogyric crises are often associated with thought ...
How long does an ocular spasm last?
Oculogyric crisis refers to spasms of extraocular muscles leading to tonic eye deviation (usually upward), with each spasm lasting from seconds to several hours; the entire episode may last up to several weeks or months (Poston and Frucht, 2008 ). Oculogyric crisis was originally described in patients with encephalitis lethargica, ...
Can benztropine be used for oculogy?
Severe or painful oculogyric crises can be treated acutely with benztropine or diphenhydramine, intramuscularly or intravenously. 361 A dose can be repeated in 30 minutes if there is no response. If these are unsuccessful, then diazepam or lorazepam, intramuscularly or intravenously, can be used.
What is OGC in medical terms?
Oculogyric crisis (OGC) describes the clinical phenomenon of sustained dystonic, conjugate and typically upward deviation of the eyes lasting from seconds to hours. It was initially observed in patients with postencephalitic parkinsonism, but since then a number of conditions have been associated with OGC. These include drug-induced reactions, ...
What is OGC in etiology?
Oculogyric crises: Etiology, pathophysiology and therapeutic approaches. Oculogyric crisis (OGC) describes the clinical phenomenon of sustained dystonic, conjugate and typically upward deviation of the eyes lasting from seconds to hours.
What is an oculogyric crisis?
Oculogyric crises were first described by doctors who studied patients with encephalitis lethargica, or post-ence phalitic Parkinsonism, a brain disease occurring in the years following World War I . Even though encephalitis lethargica is very rare today, oculogyric crises can be observed after a patient has been exposed to certain drugs. For example, some antipsychotics, which affect dopamine signaling in the midbrain, may lead to an acute dystonic response. First generation antipsychotics may produce these symptoms since they directly modulate dopamine signaling, but oculogyric crises have also been reported after treatment with second and third generation neuroleptics, such as aripiprazole and olanzapine. It is estimated that about 2% of patients taking neuroleptics may experience oculogyric crisis, especially in young men.
How many muscles are involved in the movement of the eyeball?
The movement of the eyeball is controlled by the actions of six different muscles, each one responsible for moving the eyeball in a different direction. Collectively, they are called the extraocular muscles. Normally, these muscles work in concert with each other to move the eyeballs in the intended direction.
When did oculogyric crises start?
Oculogyric crises were first described in association with post-encephalitic Parkinsonism (PEP) following the European epidemic of encephalitis lethargica (EL) from 1910-1930. The dystonic reaction was later identified as a side effect of certain drugs.
What are the triggers of OGC?
However, there is evidence that antiemetics, antidepressants, anticonvulsants and other agents (e.g. cetirizine, levodopa, nifedipine) may also be potential triggers. OGC has been identified as occurring most often in diseases of dopamine synthesis and signaling.
Why do I have episodes of OGC?
OGC is most commonly described as the involuntary upward deviation of both eyes due to spasms and increased tone in the extraocular muscles. Episodes typically last minutes and may occur in conjunction with other dystonic symptoms. Neuroleptic drugs are the most common cause, though there are many other reported etiologies.
What is the pathophysiology of OG?
There are multiple theories regarding the pathophysiology of OG including inhibition of dopamine receptors and disruption of dopamine metabolism. Overall, the pathophysiology remains ill-defined but suggests an underlying hypodopaminergic state of the brain.
What is the most common cause of OGC?
The most commonly described causative drugs are neuroleptics such as haloperidol, flupentixol, fluphenazine and perphenazine. Atypical neuroleptics (e.g. quetiapine) are also reported to cause OGC. However, there is evidence that antiemetics, antidepressants, ...
How long does it take for OGC to start?
In the case of drug-induced OGC, the first episode usually occurs within 4 days of starting (or changing the dosage of) the causative drug. However, there are reported cases in which the first episode has occurred up to two months after the change in medication.
What is the second hypothesis of OGC?
A second hypothesis points at an altered ratio of cholinergic to dopaminergic stimulation. This is supported by the successful use of anticholinergic drugs in treating OGC. Therefore, an increase in cholinergic input relative to dopamine input may be the triggering factor.
