Oculogyric crises: Etiology, pathophysiology and therapeutic approaches

Abstract

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, hereditary and sporadic movement disorders, and focal brain lesions. Here, we systematically review the literature and discuss the spectrum of disorders associated with OGC in order to aid clinicians place this rare but distinctive clinical sign into the appropriate diagnostic context. We also provide a brief synthesis of putative pathophysiological mechanisms, as well as therapeutic recommendations based on the literature and our own experience.

Lurasidone-induced Oculogyric Crisis

“…[ 3 ] OGC can be due to hereditary, focal, or functional disruption of nigrostriatal pathway. [ 1 ] Here, in our case, there is no history in the family which suggest hereditary disorder. In addition, CT scan does not reveal any focal lesion.…”

“…Neuroleptics are the main culprit in 60% drug-induced cases, with predominance of typical than atypical as in case of all dystonic reactions. [ 1 ] Lurasidone is a comparatively new drug which was approved by FDA to use in Bipolar Depression. It antagonizes dopamine D 2 receptors and serotonin 5-HT 2A and 5-HT 7 receptors along with partial agonist at 5-HT 1A receptors.…”

Recurrent Dystonic Crisis and Rhabdomyolysis Treated with Dantrolene in Two Patients with Aromatic L-Amino Acid Decarboxylase Deficiency

“…11 The etiology of OGC is not clear and the proposed mechanisms for OGC include an imbalance between striatal dopamine and cholinergic tones, hypersensitivity of striatal dopamine receptors, and maladaptive synaptic plasticity. 12 A dystonic storm can lead to rhabdomyolysis. Rhabdomyolysis is a syndrome characterized by breakdown of muscle cells leading to the release of intracellular components including, myoglobin, CK, aldolase lactate dehydrogenase, and electrolytes into the extracellular space as well as the circulation.…”

Oculogyric Crises

“…These episodes generally last minutes, but can range from seconds to hours. 1 At the same time there is often increased blinking of the eyes and these episodes are frequently accompanied by pain. The patient can also experience neck dystonia and/or tongue protrusion.…”

“…Oculogyric crises can also be seen secondary to different neurological conditions such as those affecting the production of dopamine, like neurotransmitter disorders, or disorders affecting certain parts of the brainstem, such as multiple sclerosis and encephalitis. 1 …”