Spotlight on Oculogyric Crisis: A Review

Abstract

Background: Oculogyric crisis (OGC) is a form of acute dystonia characterized by sustained dystonic, conjugate, and upward deviation of the eyes. It was initially reported in patients with postencephalitic parkinsonism. But later, other factors such as medications, movement disorders, metabolic disorders, and focal brain lesions were also found to be associated with OGC. Methods: The literature regarding OGC was searched via PubMed, Google Scholar, and through citations in relevant articles till December 2019, with keywords including OGC, oculogyric eye movements, tonic eye movement, neuroleptics and OGC, antipsychotics and OGC, and all combinations of these. Only original articles (abstract or full text) that were published in the English language were reviewed. Results: Hypodopaminergic state is implicated in the pathogenesis of OGC. Common risk factors are younger age, male sex, severe illness, high neuroleptic dose, parenteral administration of neuroleptics, high potency of neuroleptic drugs, abrupt discontinuation of anticholinergic medication, and family history of dystonia. Conclusion: OGC is an acute dystonic reaction leading to tonic upward deviation of eyes. It is associated with various neurometabolic, neurodegenerative, and movement disorders and medications such as antipsychotics, antiemetics, antidepressants, antiepileptics, and antimalarials. OGC can adversely impact the compliance and prognosis of the primary illness. Hence, it needs to be managed at earlier stages with appropriate medication, primarily anticholinergics.

Aripiprazole-Associated Acute Dystonia During Dose Reduction in Patient With Schizophrenia and Dementia

“…More unusually, the withdrawal-emergent oculogyric crisis has been reported in patients treated with clozapine or olanzapine but yet has been reported in aripiprazole treated patients 8,9 . Previous reported risk factors of oculogyric crisis, including younger age, male sex, high dose, and parenteral administration of antipsychotic medication, 10 also did not correspond with this patient's clinical characteristic. Possible mechanisms of withdrawal OGC were described in previous studies 8,11 .…”

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

“…First, the classes of medications that are most frequently associated with OGCs, such as antiemetics or antipsychotics, often act by disrupting dopaminergic transmission. Additionally, the pathogenesis of neurological disorders that are associated with OGCs, such as Parkinson's disease or Wilson's disease, are related to the disruption of dopamine synthesis [4,5]. Finally, in patients who have OGCs in the setting of focal brain lesions, damage to the midbrain or basal ganglia, where the nigrostriatal pathway lies, has been reported [2].…”

“…Ocular dyskinesias last for a few seconds, and patients remain unaware of their condition, whereas OGCs last for minutes to hours and cause significant discomfort or distress. Ocular tics are brief and can be voluntarily suppressed, whereas OGCs cannot be suppressed [5]. Once other causes of eye deviations are ruled out, the cause of the OGC must be investigated.…”

Adverse ocular effects of neuroleptic therapy: semiotics, pathogenesis and treatment

“…Может сопровождаться сгибанием шеи, открытием рта, блефароспазмом, болевым синдромом, тахикардией [42], ларингоспазмом [43]. Частота выявления окулогирных кризов при приеме нейролептиков оценивается в 0,9-3,4 % [44]. В основном (68% случаев) лекарственноиндуцированные кризы вызваны применением антипсихотических препаратов, как типичных, так и атипичных [42].…”

“…Oculogyric crisis [42,44] Отмена препарата + бензтропин 2 мг внутривенно / бипериден 5 мг внутримышечно / дифенгидрамин 50 мг внутривенно Drug withdrawal + benztropine 2 mg intravenously / biperiden 5 mg intramuscularly / diphenhydramine 50 mg intravenously [42,45] Приступы зрительной гиперчувствительности Visual hypersensitivity attacks [46] Снижение дозы препарата Reducing the dose of the drug [46] Фенотиазины (редко -атипичные нейролептики [25]) Phenothiazines (rarely -atypical antipsychotics [25])…”