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Acta Neurologica Belgica Apr 2023As new treatments are becoming available for patients with myasthenia gravis (MG), it is worth reflecting on the actual status of MG treatment to determine which... (Review)
Review
INTRODUCTION
As new treatments are becoming available for patients with myasthenia gravis (MG), it is worth reflecting on the actual status of MG treatment to determine which patients would most likely benefit from the new treatments.
METHODS
We reviewed the clinical files of all MG patients seen at the Department of Neurology of the Antwerp University Hospital during the years 2019, 2020 and 2021.
RESULTS
163 patients were included. Age at diagnosis varied from the first to the eighth decades, with a peak of incidence from 60 to 70 years for both genders, and an additional peak from 20 to 30 years in women. Diplopia and ptosis were by far the most common onset symptom. At maximum disease severity, 24% of the patients still had purely ocular symptoms and 4% needed mechanical ventilation. 97% of the patients received a treatment with pyridostigmine and 68% with corticosteroids, often in combination with immunosuppressants. More than half reported side effects. At the latest visit, 50% of the patients were symptom-free. Also, half of the symptomatic patients were fulltime at work or retired with no or mild limitations in daily living. The remaining patients were working part-time, on sick leave, or retired with severe limitations.
DISCUSSION AND CONCLUSION
The majority of MG patients are doing well with currently available treatments, but often at the cost of side effects in the short and in the long term. A significant group is in need of better treatments.
Topics: Humans; Female; Male; Belgium; Myasthenia Gravis; Pyridostigmine Bromide; Blepharoptosis; Diplopia
PubMed: 36658451
DOI: 10.1007/s13760-023-02187-0 -
Annals of Maxillofacial Surgery 2020Orbital floor fractures are common among mid-face fractures. The general aim of treatment is to restore orbital volume and anatomy with grafts or reconstructive...
INTRODUCTION
Orbital floor fractures are common among mid-face fractures. The general aim of treatment is to restore orbital volume and anatomy with grafts or reconstructive materials. Malpositioning of the implants and inadequate volume restorations are common complications of these procedures. The aim of our study is to present the surgical outcomes of orbital reconstruction aided by our algorithm of patient-specific virtual planning.
MATERIALS AND METHODS
The current study was performed on 77 patients with orbital wall fractures who were categorized into two groups: Group A - 42 patients (virtual planning) and Group B - 35 patients (traditional approach). Criteria of analysis included the presence of diplopia postoperatively and duration of surgical procedures.
RESULTS
Diplopia was recorded right after surgery in 16 cases (38.1%) of Group A and in 12 cases (34.3%) of Group B. However, 6 months postreconstruction, residual diplopia was recorded in 4 cases (9.5%) of Group A and in 12 cases (34.3%) of Group B. Mean operation time in Group A for the patients with isolated zygoma fracture was 2.23 h; for isolated orbital wall fracture was 1.98 h; and for combined zygoma, orbital wall, and facial bone fracture was 3.07 h. In Group B, these indexes were 3.47, 2.05, and 3.31 h, respectively.
CONCLUSIONS
Application of virtual planning could significantly improve postoperative outcomes in orbital reconstruction. However, application of this technology could be limited by complicated defects of the orbital walls, which would require complex shape of the implant that might be difficult to be prevent virtually.
PubMed: 32855907
DOI: 10.4103/ams.ams_183_19 -
Turkish Journal of Ophthalmology Feb 2021To determine and evaluate the rate of diplopia after Ahmed glaucoma valve (AGV) implantation surgery.
OBJECTIVES
To determine and evaluate the rate of diplopia after Ahmed glaucoma valve (AGV) implantation surgery.
MATERIALS AND METHODS
The records of patients who underwent AGV implantation in our hospital between the years of 2010 and 2017 were retrospectively reviewed. Patients who were referred to our strabismus department due to binocular diplopia after AGV implantation surgery were included. The details of postoperative day 1, day 7, day 15, and 1 month examinations were recorded. In the postoperative period, the onset time of diplopia complaints, diplopia type, and the presence of diplopia at distance and near fixation were noted. Ocular motility examination and deviation measurements were evaluated.
RESULTS
Ten (47%) of 211 patients who underwent AGV implantation in our hospital between 2010 and 2017 met the study inclusion criteria. Six of the 10 patients were men (60%) and 4 were women (40%). The mean age of the patients was 44.5 (34-63) years. Complaints of diplopia developed at a mean of 14.5±12.3 (1-30) days after AGV implantation. The prism measurements of the patients were found to be 8.4±1.4 prism diopters (PD) exotropia and 7.1±8.8 PD hypotropia. While 8 patients had diplopia only at near distance, 2 patients had diplopia at both distance and near. Three patients were treated with prismatic glasses, and their complaints of diplopia recovered spontaneously in 5.11±4.10 months. The other 7 patients were followed up without treatment, and their diplopia complaints resolved spontaneously in 6.11±4.40 months.
CONCLUSION
Although most of the diplopia that develops after AGV implant surgery resolves without treatment, prismatic glasses might be considered as a treatment option in patients whose diplopia affects their daily lives.
Topics: Adult; Diplopia; Female; Glaucoma; Glaucoma Drainage Implants; Humans; Intraocular Pressure; Male; Middle Aged; Retrospective Studies; Trabeculectomy; Visual Acuity
PubMed: 33631898
DOI: 10.4274/tjo.galenos.2020.12269 -
JAMA Ophthalmology Feb 2023Thyroid eye disease (TED) results in varying degrees of proptosis and diplopia negatively affecting quality of life (QoL), producing possibly substantial visual changes,...
IMPORTANCE
Thyroid eye disease (TED) results in varying degrees of proptosis and diplopia negatively affecting quality of life (QoL), producing possibly substantial visual changes, disfigurement, and disability.
OBJECTIVE
To determine the association of varying TED severities with QoL in a non-TED population by assessing health state utility scores.
DESIGN, SETTING, AND PARTICIPANTS
This qualitative study, conducted from April 20, 2020, to April 29, 2021, assessed health states for active, moderate-severe TED, and values were elicited using time trade-off methods. Six health states of varying severity were determined from 2 placebo-controlled clinical trials (171 patients with TED and clinical activity score ≥4, ±diplopia/proptosis) and refined using interviews with US patients with TED (n = 6). Each health state description was validated by interviews with additional TED patient advocates (n = 3) and physician experts (n = 3). Health state descriptions and a QOL questionnaire were piloted and administered to a general population. Visual analog scales (VASs) were also administered to detect concurrence of the findings.
MAIN OUTCOMES AND MEASURES
TED health state utility scores and whether they differ from one another were assessed using Shapiro-Wilk, Kruskal-Wallis, pairwise Wilcoxon rank sum, and paired t tests.
RESULTS
A total of 111 participants completed time trade-off interviews. The mean (SD) utility value was 0.44 (0.34). The lowest (worse) mean utility value was observed in the most severe disease state (constant diplopia/large proptosis) with 0.30 (95% CI, 0.24-0.36), followed by constant diplopia/small proptosis (0.34; 95% CI, 0.29-0.40), intermittent or inconstant diplopia/large proptosis (0.43; 95% CI, 0.36-0.49), no diplopia/large proptosis (0.46; 95% CI, 0.40-0.52), and intermittent or inconstant diplopia/small proptosis (0.52; 95% CI, 0.45-0.58). The highest (best) mean value, 0.60 (95% CI, 0.54-0.67), was observed for the least severe disease state (no diplopia/small proptosis).
CONCLUSIONS AND RELEVANCE
These findings suggest that patients with active, moderate-severe TED may have substantial disutility, with increasing severity of proptosis/diplopia more likely to have detrimental associations with QoL. These health state scores may provide a baseline for determining QoL improvement in these TED health states (utility gains) treated with new therapies.
Topics: Humans; Graves Ophthalmopathy; Quality of Life; Exophthalmos; Surveys and Questionnaires; Diplopia
PubMed: 36580313
DOI: 10.1001/jamaophthalmol.2022.3225 -
Annals of Indian Academy of Neurology Oct 2022Ocular nerve palsies are among the most common cranial neuropathies in neurological practice. Nerves can get affected anywhere along their path from the brainstem to the...
Ocular nerve palsies are among the most common cranial neuropathies in neurological practice. Nerves can get affected anywhere along their path from the brainstem to the orbit. There can be isolated involvement of multiple cranial nerves together. The etiologies differ according to the type of presentation. The steps toward the diagnosis need to be strategically planned and must be based on clinical localization. It is crucial to make proper localization to plan further investigations and thus treatment of the etiology. This review covers the approach toward the diagnosis, etiologies involved, and management of ocular cranial neuropathies.
PubMed: 36589037
DOI: 10.4103/aian.aian_167_22 -
Neurology(R) Neuroimmunology &... Jul 2023Jaw dystonia and laryngospasm in the context of subacute brainstem dysfunction have been described in a small number of diseases, including antineuronal nuclear antibody...
Jaw dystonia and laryngospasm in the context of subacute brainstem dysfunction have been described in a small number of diseases, including antineuronal nuclear antibody type 2 (ANNA-2, also known as anti-Ri) paraneoplastic neurologic syndrome. Severe episodes of laryngospasms causing cyanosis are potentially fatal. Jaw dystonia can also cause eating difficulty, resulting in severe weight loss and malnutrition. In this report, we highlight the multidisciplinary management of this syndrome associated with ANNA-2/anti-Ri paraneoplastic neurologic syndrome and discuss its pathogenesis.
Topics: Humans; Laryngismus; Diplopia; Dystonia; Antibodies, Antinuclear; Paraneoplastic Syndromes, Nervous System
PubMed: 37311643
DOI: 10.1212/NXI.0000000000200128 -
Frontiers in Neurology 2021To provide a new classification system for diplopia and evaluate the etiology and clinical features of diplopia subtypes in south China.
PURPOSE
To provide a new classification system for diplopia and evaluate the etiology and clinical features of diplopia subtypes in south China.
METHODS
In this retrospective study, all patients presenting with diplopia over the period from 2012 to 2014 in south China were reviewed. Patients were categorized into 3 groups according to their extraocular muscle (EOM) dysfunction: single EOM (sEOM), multiple EOMs (mEOMs), and a comitant strabismus group. Clinical data evaluated included age, sex, medical history, etiology and duration of diplopia, ocular alignment, and ocular motility.
RESULTS
A total of 303 patients were enrolled. The most common type of EOM dysfunction was sEOM (158 cases, 52.1%), followed by mEOMs ( = 119, 39.3%), and finally the comitant strabismus group ( = 26, 8.6%). Overall, the most common cause of diplopia involved orbital diseases. Within the sEOM group, microangiopathy ( = 42, 26.6%) and trauma ( = 41, 25.9%) were the major etiologies, with the lateral rectus (LR) ( = 86, 54.4%) being the most frequently involved. There were 12 (4.0%) patients who were considered as nasopharyngeal carcinoma (NPC)-associated diplopia (10 caused by radiation neuropathy following radiation therapy). Thyroid associated ophthalmopathy (TAO, 56 cases, 47.1%) was the predominant etiology found in the mEOMs group. Acute acquired comitant esotropia (AACE, 14 cases, 53.9%) was the most common etiology in the comitant strabismus group.
CONCLUSIONS
This new classification system for assessing diplopia as based on EOM dysfunction represents an easy-to-follow approach that can be readily adapted for the clinical use. While microangiopathy and trauma represent common etiologies of diplopia, both orbital diseases and NPC-associated diplopia also warrant special attention when assessing diplopia within patients in south China.
PubMed: 35250794
DOI: 10.3389/fneur.2021.805253 -
Journal of Family Medicine and Primary... Aug 2019Diabetic cranial neuropathy is one of the important complications of diabetes with up to 10-fold increase in incidence. It usually affects 3, 4, and 6 cranial nerves....
Diabetic cranial neuropathy is one of the important complications of diabetes with up to 10-fold increase in incidence. It usually affects 3, 4, and 6 cranial nerves. Recurrent cranial neuropathy is lesser reported, and its incidence is not very clear. Course is usually benign with spontaneous remission within months. A 47-years diabetic male presented with acute onset diplopia and right sided ptosis with history of 3 previous episodes of sudden facio-ocular complications of diabetes over a period of 5 years all of which had improved completely over 6 to 8 weeks. On examination he was found to have right-sided pupil sparing 3 cranial nerve palsy. Visual acuity was normal. Examination of fundus showed early nonproliferative diabetic retinopathy changes. Motor, sensory system, bladder, and bowel were normal. Blood tests revealed FBS 133 mg%, PPBS 333 mg%, HbA1C 8.8, Creatinine 1.8 mg%, normal electrolytes, and LFT. CSF study showed 4 cells with Protein 68 mg% and Sugar 83 mg%. CT scan of the brain showed normal brain parenchyma. MRI of brain did not reveal any acute infarct or mass lesion and visualized cranial nerves were normal. Other work ups were negative. His sugars were controlled with oral antidiabetic drugs. Patient improved with oral steroids.
PubMed: 31548966
DOI: 10.4103/jfmpc.jfmpc_476_19 -
Movement Disorders Clinical Practice Jul 2021Some patients with Parkinson Disease (PD) report double vision, but its prevalence and determinants are unknown.
BACKGROUND
Some patients with Parkinson Disease (PD) report double vision, but its prevalence and determinants are unknown.
OBJECTIVES
To determine the prevalence and risk factors for diplopia in PD.
METHODS
Using data from 26,790 PD patients and 9257 controls in the Fox Insight Study, we compared the prevalence of diplopia using the Non-Movement Symptom Questionnaire. Associations with age, race, gender, disease duration, and scores on MDS-UPDRS part II, and Penn Parkinson's Daily Activity Questionnaire were assessed with generalized estimating equations.
RESULTS
The point prevalence of diplopia was higher in PD (18.1%) than controls (6.3%, < 0.001) at baseline, and 28.2% of all PD patients reported diplopia at least once during the study (period prevalence). PD patients with diplopia were more likely to be older, non-white, have greater disease duration, and report greater motor, non-motor, and daily activity limitations.
CONCLUSIONS
Diplopia is common and associates with motor and non-motor severity in PD.
PubMed: 34307743
DOI: 10.1002/mdc3.13220 -
Studies in History and Philosophy of... Aug 2022In contrast to earlier theorists within the Greek optical tradition, who relied almost exclusively on geometrical diagrams to articulate and explain vision, Ptolemy...
In contrast to earlier theorists within the Greek optical tradition, who relied almost exclusively on geometrical diagrams to articulate and explain vision, Ptolemy employed several material instruments in his investigation of sight. These included rulers, glass cylinders, mirrors, and a bronze plaque designed to measure angles of incidence and reflection. These devices allowed Ptolemy to expand the operational definition of vision far beyond that of his predecessors, as he explicated several previously unexamined visual behaviors, including binocular vision, diplopia, and refraction. This article argues that these tools did more than make new phenomena visible; they also set the parameters for what these phenomena looked like-sometimes to such a degree that features of these instruments merged with the visual behaviors that they rendered visible. In some cases, this occurred as a type of "double-exposure," where the investigative tool became layered over top of the process of sight, such as when Ptolemy's "ruler" for investigating binocular vision became a template for imagining the mechanism of spatial perception employed by the eyes. In other cases, this merging occurred as a type of "technological afterimage," where the instrument provided an implicit model for phenomena it was not directly investigating. Ptolemy's bronze plaque stands as an example of this second type, insofar as it inspired his account of ocular geometry and facilitated novel assertions about the eye's operations, even though it did not directly inspect these features. In general, this article thus outlines how the technologies of investigation can structure patterns of thought and naturalize certain physical arguments, whether for the phenomena that they directly articulate or for those indirectly associated with their particular use cases.
Topics: Afterimage; Diplopia; Humans; Male; Optics and Photonics; Refraction, Ocular; Vision, Binocular
PubMed: 35843010
DOI: 10.1016/j.shpsa.2022.06.011