RESOLUTION OF VISUAL DISTURBANCES DURING EXERCISE RELATED TO OCULAR MIGRAINE WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION
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1
Independent researcher, United States
Background: a 42 year old female patient presented to a private clinic with symptoms related to ocular migraine. The patient claims that while doing yoga that portions of her visual field would "turn red or orange." This would happen with both gentle and rigorous routines. The patient was diagnosed by a medical neurologist with ocular migraine. The patient claims a previous history of migraines that included what she described as "shaky vision."
Methods: Neurological exam included saccodometry, computerized dynamic posturography (CDP), tilt table testing and video infrared goggles to observe the eyes without fixation. CDP testing revealed abnormal stability patterns with the head to the left with the eyes closed on a perturbed surface. Testing with the head in flexion with the eyes closed on a perturbed surface revealed abnormal stability patterns. Testing with the head in extension with the eyes closed on a perturbed surface caused the patient to abandon the test ( a fall ). Saccade testing of 100 saccades to a 20 degree target revealed hypometria bilaterally. Velocity of saccades were slow to both the right and left. Latency of right and left saccades were slowed. Romberg's position produced abnormal sway patterns. Tandem stance revealed ataxia. Pursuits in the horizontal plane revealed saccadic intrusions to both the left and right. Pursuits in the vertical plane revealed saccadic intrusions on both up and down directions. Horizontal saccades revealed slowed reaction times. Balance assessment with the head in a bias of the left posterior canal revealed an abnormal sway pattern. Balance assessment on a perturbed surface with the head in extension caused the patient to lose balance (fall). Left side finger tapping was slowed. Palpation revealed several areas of aberrant spinal segmental movement in the cervical and thoracic spine. A program of multimodal neurorehabilitation included vestibular rehabilitation (VR), spinal manipulative therapy (SMT) and Low Level Laser Therapy (LLLT). VR included gaze stability exercises, passive and active vestibular canal stimulation on firm and perturbed surfaces, and eye movement exercises both in office and at home.
Results: Saccadic intrusions in the horizontal and vertical planes improved. Balance assessment on perturbed surfaces with the head in the position of the various semicircular canals revealed improvement in sway patterns. Balance assessment with the eyes closed on a perturbed surface with the head in extension improved without a fall being produced. Spinal segmental dysfunction improved with motion and static palpation. The patient claims total resolution of her visual disturbances and has been able to return to full activity.
Conclusion: this author recommends further investigation into multimodal neurorehabilitation protocols that include VR, LLLT and SMT for the treatment of visual disturbances related to ocular migraine.
Keywords:
ocular migraine,
Visual disturbance,
Headache,
dysautonomia,
Vestibular Rehabilitation,
Spinal manipulative therapy,
Low level laser therapy ( LLLT),
vestibular migraine,
Migraine,
Computerized dynamic posturography (CDP),
saccodometry
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Schiller
D
(2019). RESOLUTION OF VISUAL DISTURBANCES DURING EXERCISE RELATED TO OCULAR MIGRAINE WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00045
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Received:
02 Apr 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Dr. David Schiller, Independent researcher, Avon, United States, drschiller@comcast.net