| Identifier |
sensory_trick_for_dystonia |
| Title |
Sensory Trick for Dystonias |
| Creator |
Andrew G. Lee, MD; Brandon Le |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (BL) Class of 2022, Baylor College of Medicine, Houston, Texas |
| Subject |
Dystonia; Eyelid Spasms; Blepharospasm |
| Description |
Summary: Dystonias • Spasm/contraction of parts of body o In Neuro-Ophthalmology, will typically see spasms of the face > Spasm of eyelid: Benign essential blepharospasm (BEB) • Bilateral blinking of the face > Spasm of eyelid + face: Meige syndrome • Bilateral spasm of eyelids as well as jaw/tongue > Unilateral spasm of face: Hemifacial spasm • Imaging o Indicated for hemifacial spasm o Not necessarily indicated for BEB or Meige syndrome o Imaging will include MRI, MRA to look for palsies of CN VII o Most common will find a dolichoectatic, or dilated and torturous vessel involving the vertebral arteries and cerebellar arteries • Sensory Trick o Methodology patients use to lessen the dystonia o Involves modulating the sensory-motor system through touching parts of the face > Including forehead, chin, eyelid, cheek, etc. o Can create devices that will constitutively provide the stimulus without having to manually do it o Mainstay of treatment: botulinum toxin |
| Transcript |
Today we're going to be talking about using a sensory trick, and the patients who use this sensory trick are usually trying to relieve some type of dystonia. So, the dystonias that come to Ophthalmology are not like the cervical and body dystonias - they're facial dystonias, and so the facial dystonias that we see are when the lids are spasming, and that's blepharo-. So, we have benign essential blepharospasm, which is bilateral blinking of the eyes (it looks like this), and if it goes into your face, we call it the Meige syndrome, when it's involving your face, but they're basically the same type of dystonia. When it's one side, we call that hemi- and if it's in your face, hemifacial spasm. So, hemifacial spasm looks like this, it's just one side. So, hemifacial is unilateral, benign essential blepharospasm and Meige are bilateral facial dystonias- lid, full face. So, these conditions are usually benign, we don't normally image blepharospasm but if it's hemifacial spasm we're going to do a MRI and an MRA to look at the 7th nerve, and usually there's no lesion, but sometimes there's a cerebellar pontine 7th lesion causing the nerve to be fired. The most common structural lesion that we find is a dolichoectatic (a dilated and torturous vessel) in the posterior fossa, usually a branch of the vertebral system like the cerebellar arteries. And, in blepharospasm you can do a MRI but usually it's normal. So, the sensory trick is a way that patients are able to suppress their firing, and so they can be touching their lid or touching their face or stroking their eyebrow or touching their chin- it's a sensory thing. So, they're using a sensory trick to somehow modulate the sensory-motor balance. It's not really clear how this works, but a lot of patients have this sensory trick. They can also use forcible motion that's voluntary- so they can either lift up their lid like this to keep it from closing or they might press it down or press real hard, and the reason that's important is if we can identify the sensory trick, we can sometimes use a device to mimic the trick so they don't have to keep going like this all the time. So, in patients who have spectacles, we can mount something on the spectacles to press on their forehead and press right on the place where they're already pressing. And so in the lid example we have ptosis crutch, where it can just hold the lid up like this, and there are devices including the press-up device, that can be used to press on your temporal or wherever- it can be modulated to move to wherever the sensory trick is being generated. Interestingly, some patients have a sensory trick that does not require physical contact. They can just imagine doing it, so just imagining themselves doing the sensory trick can make the dystonia less. So, you need to know about sensory trick- it's a symptom that sounds crazy but isn't. I can touch my eye or lid or rub my face here and it makes my jumping of my face less. That sounds like a crazy thing but it's absolutely real and we want to try and image hemifacial spasm, you don't have to image benign essential blepharospasm- they're facial dystonias. And we can use the sensory trick to our advantage using devices that can mimic the sensory trick and of course the mainstay of treatment for all of these spasm conditions is botulinum toxin. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s68m36q7 |
| Setname |
ehsl_novel_lee |
| ID |
1680625 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s68m36q7 |
