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Botox

Botox is the brand name for Botulinum Toxin Type A. It is a protein complex produced by the bacterium 'Clostridium botulinum' - the same bacterium that causes the form of food poisoning known as botulism. Botox, however, is a purified form of this bacterium. Dermatologists used it to treat muscle disorders such as uncontrolled blinking. Botox was approved by the FDA in 1989 to treat eye muscle disorders such as blepharospasm, uncontrollable blinking, and strabismus, - crossed eyes. In 2000, it was approved to treat cervical dystonia (a disorder that causes severe neck and shoulder contractions). As an unusual side effect of the eye disorder treatment, doctors observed that Botox softened the frown lines between the eyebrows.


When Botox is injected through the skin into the muscle with a needle, it keeps the muscle from contracting. Because of this temporary paralysis, wrinkles become less obvious. A trained doctor will inject small amounts of Botox into a small part of the muscle to render it immobile. The horizontal wrinkles of the forehead, the vertical 'frown' wrinkles of the brow (between the two eyebrows) and crow's feet beside the eyes are the areas best suited to Botox cosmetic.


Small doses of botox are injected directly into the muscles of the face. Prior to injecting botox, the doctor will first determine the area of injection based on the person's ability to move certain muscles in the brow area. An improvement in frown lines will be noticed within 3- 7 days and could last up to 4 months. However results may vary. Although there is no chance of contracting botulism from Botox injections, there are some risks associated with the procedure. If too much toxin is injected or if it is injected into the wrong facial area, a person can end up with droopy eyelid muscles that could last for weeks. This particular complication was observed in clinical trials. Other botox side effects are:


  • Headache
  • Flu like symptoms
  • Temporary eyelid drop
  • Nausea
  • Squint/Double vision
  • Twitching of eye
  • Facial pain
  • Redness at injection site
  • Muscle weakness

Botox procedures are not recommended for pregnant women or those suffering from neurological disorders. Possible allergies must also be looked into. A qualified dermatologist is the best person to administer botox treatments. This minimizes the potential for misuse. Botox treatment is resorted to by those who do not wish to face the risk of surgery and prefer being treated for a few minutes every three to four months.

Hyperhidrosis

This is a medical condition in which the patient sweats excessively and unpredictably, significantly, even when the temperature is cool or when at rest. Caused by over activity of the nervous system, sweating occurs in the hands or armpit and feet. Interestingly, in 40% of Hyperhidrosis patients, other members of the family also suffer from this disorder. The excessive sweating is usually intermittent, and it can also be continuous and usually increases with stress and elevated temperature.


Hyperhidrosis may lead to narrowing of arteries and excessive stimulation of sweat glands and less blood flow to the hands. This makes the person’s hands cold and clammy. The primary symptom of Hyperhidrosis is wetness. Treatments include, administering antiperspirants, medications like anticholinergics drugs, beta blockers – which may cause side effects such as dry mouth, dizziness, and problems with urination.

Iontophoresis is another FDA approved procedure, which uses electricity to temporarily turn off the sweat gland. Botox is another FDA approved treatment for severe underarm sweating, but this treatment can cause temporary weakness and intense pain. Endoscopic thoracic sympathectomy is a minimally invasive surgical procedure and it may be recommended when other treatments fail.


Nystagmus

'Dancing eyes' or Nystagmus means uncontrolled movements of the eyes, from side to side, up and down or rotary. Thus Nystagmus could be horizontal, vertical or torsional. Sometimes, however the eyes can jerk sideways or up or down. These dance movements in the eyes could be in both or in just one eye. Interestingly, people with nystagmus are usually not aware of their eye movements.


Causes of Nystagmus

Abnormal function in the areas of the brain that control eye movements is usually the cause for the involuntary eye movements. It is that part of the inner ear that senses movement and position. Nystagmus syndrome can be present at birth or develop later in life because of a disease or injury. Nystagmus is usually infantile and is present from a very early age. Studies reveal that about one child out of every several thousand has nystagmus.

While the nystagmus that is present at birth is not severe, acquired nystagmus is caused by certain drugs or medicine. Such drugs include phenytoin or dilatin, an anti- seizure medicine, excessive alcohol or any other sedating medicine that can impair the labyrinth function. Acquired nystagmus may also be caused by any disease of the brain such as multiple sclerosis or brain tumor, when the areas controlling eye movements are damaged. Nystagmus may also be caused by congenital disease of the eye. This is rare and an ophthalmologist should evaluate a child with nystagmus to check any eye disease. Hyperventilation or flashing light in front of one eye, nicotine and vibrations are also known to cause nystagmus, but these are rare. Other causes of nystagmus include:

  • Head injury from road accidents, mostly on motor bikes.
  • Disorders of the inner ear such as labyrinthitis or Meniere's disease
  • Stroke
  • Thiamine or vitamin B12 deficiency.

Clinical manifestations

Nystagmus is a gradually developing condition leading to adverse effects. The severity of this condition is sometimes linked to congenital visual impairment. One of the important conditions associated with nystagmus is the lack of focus at a certain point. This happens because of the dispositional movement of the eye balls when the person turns the head from side to side. The classification of nystagmus gives a better understanding of the disease and its respective prophylaxis.


Different kinds of nystagmus

Manifest nystagmus which is present at all times, whereas latent nystagmus occurs only in one eye.

Manifest-latent nystagmus is continually present, but worsens when one eye is covered.

Congenital nystagmus is present at birth. The eyes swing like a pendulum in this condition. Strabismus is another term for this as the eyes do not necessarily work together all the time. It is associated with the oscillations that are horizontal in origin in the vestibular region. The occurrence of infantile nystagmus requires immediate attention as it may eventually lead to oculomotor disturbances causing permanent loss of vision.

Acquired nystagmus can be caused by diseases such as multiple sclerosis, brain tumor, diabetic neuropathy, accident and resulting head injury, neurological problem which could be side effect of a medication. This form of the disease is also referred as the see-saw nystagmus. It involves the impairment of the central or peripheral vestibular region. In this condition there a periodical oscillation of the eye which occurs in a rhythmic manner. There are many predisposing factors that contribute to the occurrence of this condition which include multiple sclerosis and any form of trauma affecting the head and neck.

There are two basic types of nystagmus. While the one is eye related 'optokinetic', the other is inner ear related 'vestibular'. Those with inner ear problems develop 'jerk nystagmus' where the eyes drift slowly in one direction and jerk back in the other direction. Chances are people with this condition can develop nausea and vertigo. However, this type of nystagmus is quite temporary. It can also occur in persons with Meniere's disease or when water settles into one ear. A decongestant can be taken to clear up nystagmus of this type.


Diagnosis of nystagmus

The following tests are done for diagnosis of nystagmus:

  • CT scan of the head
  • Electro oculography, which is an electrical method of measuring eye movements using tiny electrodes.
  • MRI of the head
  • Vestibular testing by recording the movements of the eyes.

History of the patient is taken and recorded, and a thorough physical examination is performed. The doctor would focus on the nervous system and inner ear. The doctor may ask the patient to wear a pair of goggles so that eyes could be magnified for the examination. Spin the patient for about 30 seconds, and stop and make her/him stare at an object. The patients' eye will first move slowly in one and then suddenly in the opposite direction. The eye movements of those suffering from nystagmus due to a medical condition will depend on the cause.


Treatment of nystagmus

The distressing fact is that there is no treatment for most cases of congenital nystagmus. Treatment for acquired nystagmus depends upon its cause. There are some instances when nystagmus. However, visual function of the patient with nystagmus can improve by some treatment. Prisms, surgeries such as tenotomy and drug therapies are used for infantile nystagmus. There are surgical treatments for people with nystagmus, and surgery usually reduces the null positions. Thus the head tilt is lessened and cosmetic appearance improves. Drug therapies include drugs such as botox or baclofen which reduce some nystagmic movements. But these results are usually temporary. Some with nystagmus benefit from biofeedback training. In some cases, wearing eyeglasses and contact lenses can help people with nystagmus see better. Contact lenses are a superior option to the glasses as the lens move with the eyes.

Some changes at home to help combat dizziness, visual problems or nervous system disorders can also be done to help the patients. And those children with nystagmus need special help in learning to adapt to school work and social conditions.

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Collection of Pages - Last revised Date: October 16, 2017