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Approaches to the diagnosis and treatment of oculomotor paralyses
OBJECTIVES. We wish to unify current criteria regarding oculomotor paralysis (POM). Based on our experience, we have designed a diagnostic-therapeutic protocol which permits an early approach, especially since botulinum toxin has been used for treatment. DEVELOPMENT. To make things easier to understand, we start with the concept of POM, including the physiopathogenic description of phenomena secondary to eye movements. Then we consider the aetiological-topographical incidence and assess the overall causes of POM and the relative frequency of the involvement of the different cranial oculomotor nerves. Finally, we consider each cranial nerve more fully from two different angles: the aetiologic-topographic diagnosis and therapeutic attitudes.
CONCLUSIONS. The current approach to POM should include a systematic study to classify the disorder as isolated, associated with other neurological causes or of some other type (metabolic, auto-immune, etc). Satisfactory early treatment should include consideration of infilbration with botulinum toxin in all paresis or paralysis presenting with contractures. In cases of total paralysis the contractures may occur within a week of onset of the condition. In partial paralyses close follow-up of three parameters – evolution of the degree of ocular deviation, limitation of movement and exploration of passive movements – makes it possible to determine the best moment to treat the contracture by injection of botulinum toxin: This treatment resolves or improves the diplopia, with recovery of oculomotor equilibrium, when it is given during the acute phase.
Botulinum toxinOculomotor paralysisTreatmentNervios periféricos, unión neuromuscular y músculo