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)

5. Pathophysiology

6. Diagnostic Criteria

7. Differential Diagnosis

8. Diagnostic Approach

9. 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

10. 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)