1/5. Treatment of aberrant facial nerve regeneration with botulinum toxin A.PURPOSE: To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining eyelid synkinesia in aberrant facial nerve regeneration, while concurrently observing for the presence of side effects to differing treatment doses. methods: A prospective interventional study of five patients with eyelid synkinesia resulting from aberrant regeneration of the facial nerve. patients were treated with injections of either 120, 80 or 40 units of BTX-A (Dysport) into the orbicularis oculi. Objective and subjective reduction in synkinesia, maintenance of response and presence of side effects were recorded. RESULTS: All five patients had improvement of the synkinesia with BTX-A treatment. Lower doses were found to be as effective as higher doses. Mean duration of abolished synkinesia was three months. Two patients developed a ptosis which resolved spontaneously. None of the patients treated with the lowest dose of 40 units developed a ptosis. CONCLUSION: Low-dose BTX-A has a lower incidence of ptosis and is effective in the treatment of aberrant facial nerve regeneration.- - - - - - - - - - ranking = 1keywords = eye (Clic here for more details about this article) |
2/5. Dominance of ipsilateral corticospinal pathway in congenital mirror movements.OBJECTIVE: To clarify the mechanism of congenital mirror movements. DESIGN: The triple stimulation technique (TST) and the silent period were used to investigate a patient with congenital mirror movements. The TST was used to calculate the ratio of ipsilateral to contralateral corticospinal tracts from the two hemispheres to the spinal motor neurones. RESULTS: transcranial magnetic stimulation over unilateral M1 induced larger ipsilateral than contralateral motor evoked potentials on both sides. Only 9% of spinal motor neurones innervating the abductor digitorum minimi were excited by contralateral primary motor cortex (M1) stimulation, while 94% were excited by the ipsilateral M1 stimulation. The silent period was examined during mirror movements and with voluntary contraction of the right first dorsal interosseus mimicking mirror movements. Left M1 stimulation (through the crossed corticospinal tract) did not show any difference in silent period between the two conditions, while right M1 stimulation (through the uncrossed tract) caused a longer silent period during mirror movements than during voluntary contractions. CONCLUSIONS: The results suggest that mirror movements may be caused by a strong connection between ipsilateral M1 and the mirror movements conveyed through a dominant ipsilateral corticospinal pathway.- - - - - - - - - - ranking = 0.5keywords = eye (Clic here for more details about this article) |
3/5. Congenital oculomotor nerve synkinesis associated with fetal retinoid syndrome.INTRODUCTION: isotretinoin (RA), used for the treatment of cystic acne, is a powerful teratogen, causing craniofacial dysmorphisms and neural tube defects. We present two patients with RA embryopathy and oculomotor nerve synkinesis. methods: Retrospective review of patient records. RESULTS: Two patients presented with third nerve synkinesis and fetal RA exposure. Both had marked elevation of the upper eyelids on adduction such that the lid fissures alternately opened and closed on gaze from side to side. Both patients showed typical dysmorphisms of RA embryopathy. The first patient had complete agenesis of the cerebellar vermix and died at 2 years. The second patient had restricted extraocular muscles in one eye and was exotropic and hypotropic. DISCUSSION: Both patients demonstrated simultaneous innervation of the medial rectus and levator palpebrae muscles causing coincident lid elevation in adduction. This evidence of oculomotor nerve synkinesis is consistent with animal studies showing abnormalities in the formation of cranial nerve ganglia following fetal RA exposure. CONCLUSION: RA is a powerful teratogen. These patients provide additional clinical evidence of its influence on neural migration during early development.- - - - - - - - - - ranking = 2.6838286204256keywords = ocular, eye (Clic here for more details about this article) |
4/5. Correction of congenital blepharoptosis in oculomotor-abducens synkinesis.A 4-year-old boy was referred for blepharoptosis. Examination revealed the presence of oculomotor-abducens synkinesis (right upper eyelid elevation with right gaze). Reports of congenital oculomotor-abducens synkinesis syndromes are rare. Two surgeries required more levator resection than anticipated to obtain the first, to our knowledge, reported successful result in this condition.- - - - - - - - - - ranking = 0.5keywords = eye (Clic here for more details about this article) |
5/5. Abducens-oculomotor synkinesis associated with internuclear ophthalmoplegia and acquired abducens nerve palsy.We report a case of acquired abducens-oculomotor synkinesis, internuclear ophthalmoplegia, and abducens nerve palsy following brainstem hemorrhage. Weakening surgery on the medial rectus muscle did not eliminate the synergistic movement. The mechanism responsible for the abducens-oculomotor synkinesis is discussed.- - - - - - - - - - ranking = 55158.470284781keywords = internuclear ophthalmoplegia, internuclear, ophthalmoplegia (Clic here for more details about this article) |