August 2006

pROSHI and the Rapid Response with Magstims in a Case of Oculogyric Crisis

-Marie Green, DSW and Shanna Jackson

Meet Shanna, a woman who is now 46 years old. She works as a teacher’s aide in a classroom with handicapped preschool children. When I met her over 23 years ago she was referred to me by her brother who was a student of mine in social work. He spoke with tears in his eyes as he described his 23 year old sister who had just lost her job. She was shaking and had illegible handwriting, difficult-to understand-speech and drooling. She was a hard worker and is to this day, and the job loss was a tremendous insult to her integrity. The company supervisor fired her because they thought she was using drugs and she was not.

The brother described the symptoms and told me she was severely depressed due to the job loss and the symptoms.

Shanna and the MagStims The Successful Treatment for Oculogyric Crisis (OCG)

Her primary care doctor could make no sense of her symptoms and referred her for psychiatric care. The brother was very dismayed that maybe his sister was going crazy. I told him that the symptoms sounded more neurological than psychological and asked him if she would come and talk with me.

pRoshi and Mag Stims

She came in and we had a pleasant conversation and I was impressed that the symptoms were more neurological than psychological. I referred her to Dr Schmidt, the neurologist. He diagnosed Parkinson’s, but due to the unusual symptoms and her young age, he referred her to the University Medical Center. After numerous tests and a thorough work up she had stumped the physicians at the research hospital. When I called to query the physician his comment was, “Well, it’s not specifically Parkinson’s, but we think it is some kind of a neuro-virus.” She did not responded to the anti-Parkinson’s medications and the OGC was beyond their treatment ability.

What is Oculogyric Crisis?
OGC is a condition in which the eyes roll up and the person is unable to see anything below. The eyes may roll down also making it difficult for the person to see anything straight ahead. This condition is described as “eyes into distortion.” It can be painful and can cause severe headache. This condition lasts an indefinite amount of time and in Shanna’s case initial events would last up to four hours at a time. “When my eyes would go out I couldn’t do anything,” she said. On one occasion when she had surgery with general anesthetic, her eyes went out for 12 hours. At that time she was kept in the hospital an additional five days for a further neurological work up. The diagnosis was made and no treatments were available.    Medical students and staff alike were fascinated to see their first case of OGC. Although Dingwall (1987) reported a case of oculogyric crisis after anesthesia, in Shanna’s case, she had had episodes of OCG prior to this surgical event.

These OGC continued with a frequency of approximately 4 times per week lasting 30 minutes to 4 hours and this continued for 10 years. I had spent a lot of time researching this condition looking for something that would help her. Each event would increase her anxiety and compromise her ability to be at ease. Fortunately she had sufficient warning to pull her car to the side of the road when she felt her eyes were going into distortion. Friends arranged to get her a CB radio so that she could call for help and not have to be worried that a cop would come and arrest her because he would think she was out of control. She would get very nervous and cry easily when this condition occurred and it would be difficult for her to talk.

Initially we set up a system where she would let us know when she was going from point A to point B so that friends could monitor her success in travel. If she was late upon arriving one friend would go and find her and calm her and help her get to her destination. Her independence was most treasured and she did not want anything to interfere with that.

Removal of Mercury Amalgam Decreased OCG Frequency and Duration by 50%
At the 10 year point, there was nothing that we found to treat this condition. She had been able to successfully obtain the job as a teacher’s aide and her co-workers were very grateful for her participation in their team because of her dedication, forethought and high capability in planning details and basically, taking care of things. She helps run a very smooth classroom. After 10 years the only remote possibility in the literature was that she might have a condition that had been precipitated or aggravated by mercury amalgam poisoning. She had all the amalgam removed from her teeth and used some nutritional supplements to help chelate the mercury out of her body. That alone caused a decrease in frequency and duration of about 50%. “I think that getting the mercury out of my teeth helped out a lot. It was a really good investment and I’m so glad I did that,” she reports.

At that time she was taught to do Thought Field Therapy and even accompanied the trainer to assist in training therapists in this method. She learned the process very well and used it on herself very successfully to lower her anxiety. This also brought another decrease in frequency and duration of the OGC. Frequently when she would be highly stressed or very fatigued an OGC would occur and she found that a cold cloth on her eyes and a good drink of vodka and orange juice helped her to relax. Still, no remedy worked to alleviate the crisis. The occulogyric crises settled into a frequency of about twice per month for 15 to 30 minutes at a time.

Routine pROSHI Use Decreased OCG Another 20%
In January 2006, Shanna began using the pROSHI routinely about once per week. After approximately 4 weeks the frequency of the OGC decreased another 20% in her estimation. Then in May 2006 she was in the middle of an OGC when it was possible to use the MagStims. The MagStims were applied like sunglasses over her eyes and the duration of the crisis was reduced to one-minute instead of 15 to 30 minutes. We had tried earlier, using regular bio- magnets with the negative side toward the eyes. This also brings the eyes out of distortion but requires five to ten minutes whereas the MagStims bring the eyes back to normal position in about one minute. This truly was an amazing discovery for Shanna. It has resulted in fewer headaches from prolonged OGC, a greater sense of peace and confidence and the ability to use an effective treatment to resolve the crisis rather than waiting for it to resolve.

Brief Literature Review of Oculogyric Crisis
A review of the literature in terms of symptomatology shows a greater collection of information than has been available previously. Interesting pieces of Shanna’s history point to clues about the illness. She was reared on a dairy farm and born with ambliopia (crossed eyes) which required one surgery on the left eye and two surgeries on the right eye to correct this problem. In 1979 Quere wrote about abnormal occular movements in ambliopia. She spent her childhood milking cows and working on the farm. Early on physicians suspected an encephalopathy which precipitated the Parkinson’s like symptoms. However she had never suffered with encephalopathy. Japanese authors Furumoto, et al, (1989) reported oculogyric crisis as an initial symptom of juvenile Parkinsonism-like disease. Clough, et al., in 1983, reported a case of oculogyric crisis occurring in a Parkinson’s patient. It puzzled the doctors who could find no precipitating event or genetic factors.    Another track following her history was organophosphate poisoning which has been noted by _Hsieh, Deng, Ger, and Tsai (2001) in the Journal of Neurotoxicology as having a consequence of precipitating OGC. Organophospates are used in farming as fertilizers and she reported that she had minimal or no exposure except when going out to change water in the growing fields of the dairy farm.

Drug exposure is most often a noted cause of oculogyric crisis precipitated by many psychotropic and other drugs and these are reported in numerous articles in the literature (Abe, 2006; Fraunfelder FW, Fraunfelder FT, 2004). In someone diagnosed with Parkinson’s at age 23, a first suspicion is excessive drug use. An interesting read along this line is the book called The Case of the Frozen Addicts by Langston (1996). He describes the occurrence of a Parkinson’s in drug addicts in which they became frozen into a catatonic state yet retained their complete awareness. Fortunately, Shanna had never used drugs and this was quickly ruled out. She did however have the cogwheel tremors, drooling and stiffness associated with Parkinson’s but did not respond to anti-Parkinson’s medications.

We began to consider the mercury poisoning as a precipitant and wondered if the early ambliopia may have weakened the sensory motor system in charge of eye movement. Coupland and Nutt reported in the Journal of Clinical Psychoparmacology in 1995 the successful treatment of tardive oculogyric spasms with vitamin E. Shanna’s OGC however
were not related to any type of extra pyramidal symptoms of tardive dyskinesia because she was not using any drugs.

Some reports of OCG in pediatrics relate to tyrosine hydroxylase deficiency along with clinical manifestations of catecholamine insufficiency in infancy. Grattan-Smith described this condition in 2002 in the Journal of Movement Disorders. Brautigam (1999) describe the biochemical and molecular genetic characteristics of the severe form of tyrosine hydroxylase deficiency in the Journal of Clinical Chemistry. These syndromes usually become evident in infancy and respond to treatment of the deficiencies in some cases. The fact that Shanna’s condition was diagnosed at age 23 may point to a less severe condition which might be related to a mild form of tyrosine depletion.


Shanna without OCG
Recent efforts at improving symptoms have focused on improving nutrition through the addition of orthomolecular nutritional supplements over the past ten years, including niacinamide 1500 mg, vitamin c 2000mg, Source of Life (mega)Multi Vitamin and Mineral, B complex 100, calcium arginate 1500mg, magnesium arginate 500mg and Isagenix(aminorich)milkshakes(1daily). PrescriptionsincludeEldapryl5mgtwice/daytoslowtheagingofthe brain, Cogentin 2mg 1-2/day for the drooling.

So why did the pROSHI and MagStims work?
Authors Bumpass and Knoll report an interesting hypothesis in Emotional Factors in Oculogyric Crisis: “…When combined with an increased state of emotional arousal and/or a reduction in the ability of the neuromuscular system to compensate, the OGC would occur. The increased state of emotional arousal could result from either internal or external stress. Internal stresses occurred when there was a diminished external stimulus to aid repression. Fatigue was the most obvious factor altering the ability of the neuromuscular system to compensate (1982) …”

It is anticipated that the pROSHI actually decreases the state of arousal from both internal and external stress which helps the neuromuscular system to compensate and resume homeostasis. The MagStims with their gentle magnetic field frequency modulation help the muscles connected to the eyes to bring them back from distortion. The MagStims also stimulate the midbrain areas and focus on the limbic system. Use of the pROSHI with MagStims placed on top of the head at the sensory motor area has a more direct connection to the C3 and C4 areas which are influential in controlling the work of the eyes through the deep inner areas of the brain.

We are still early pioneers when it comes to the science of what makes the brain work or what makes it malfunction. While oculogyric crisis is still a rare condition, it is one that leaves its victims in a state of anxiety due to the lack of control and inability specifically to control ocular movements to see and process the world around them through their eyes. Although this is a transient condition which repeats over and over its occurrence is not predictable. Stress seems to increase its frequency and duration. The pROSHI decreases the stress and thus decreases the frequency and duration. When an actual oculogyric crisis is in progress as in Shanna’s case, putting the MagStims over the eyes brings the eyes out of distortion within about a minute. Without the pROSHI and Mag Stims the crisis lasts from 15 to 30 minutes and in others it can last longer. There are no known treatments for this condition until now and this is just one case. However, it would have been a delightful discovery to have found the pROSHI and MagStims years ago and by now we may have stopped the entire cascade. As it is we will continue to work on this complex problem with ongoing use of the pROSHI and MagStims. This article is written mainly to inform others who may be aware of a person who has this condition and that pROSHI works where nothing else does.

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