Heard of Myokymia?

I have been consuming an average of 3 “Starbucks mug” amount of coffee for the past 2 months. For one, supply of coffee is ‘bottomless’ in my workplace and, given the location and facilities, it’s the only thing I can do to take a break from what I’m doing. Except for frequent trips to the urinal, I wasn’t experiencing any other side effects of excessive caffeine intake, until last week. I started to have lower eyelid twitching several times a day. I knew it was due to caffeine because I read it somewhere before that muscle twitches can sometimes be precipitated by caffeine, among others. I tried to look this up and here is what I found about it.

Myokymia is the spontaneous, fine fascicular contractions of muscle without muscular atrophy or weakness. Eyelid myokymia typically involves the orbicularis oculi muscle of one of the lower eyelids; occasionally, the upper eyelids also can be affected. In most cases, it is benign, self-limited, and not associated with any disease. Intervention is seldom necessary. Rarely, it may occur as a precursor of blepharospasm, Meige syndrome, hemifacial spasm, and spastic-paretic facial contracture.

The pathophysiology of typical eyelid myokymia is not well understood. The focus of irritation is most likely the nerve fibers within the muscle. However, pontine dysfunction in the region of the facial nerve nucleus also has been implicated. Possible precipitating factors include stress, fatigue, and excessive caffeine or alcohol intake.

This is a benign and self-limited condition in most patients, and may occur at any age.

Reassurance and reduction in precipitating factors (like caffeine), if identifiable, are appropriate for most patients. Treatment is usually not needed except when symptoms are severe or when oscillopsia is present. Local subcutaneous botulinum toxin A (BOTOX®) injections of 2.5-5 units each to the affected eyelid region provide relief for 12-16 weeks. If the upper eyelid is involved, the injections should not be placed near the levator palpebrae; otherwise, ptosis lasting weeks will result. Adverse effects include temporary lid laxity, which may produce lagophthalmus, exposure keratopathy, and ptosis. The efficacy of other agents has not been proven.

Comments

Abdominal Epilepsy?

The other day, I encountered an uncommon medical diagnosis, abdominal epilepsy. Maybe I was absent when this was taught in med school or maybe it was mentioned but it just didn't register in my memory bank. Anyway, for those colleagues who haven't heard of this as well, here's what I found out about it, so that next time you are faced with a weird abdominal pain, you will think of abdominal epilepsy as a differential. There are many medical causes of abdominal pain; abdominal epilepsy is one of the rare causes. From a medical perspective, the term epilepsy refers not to a single disease, but to a group of symptoms with numerous causes. The common factor in all forms of epilepsy is an excessive electrical excitability of the brain. The increased excitation is called a seizure and may manifest as a partial or total loss of consciousness and muscle spasms or other involuntary movements. Many conditions can produce epilepsy. For example, a genetic predisposition is...

"Ganacity"

If there's one word that I will never forget from my AGSB experience, it's "ganacity"! A word frequently mentioned by our FinMan professor. What does it mean? It's a combination of the tagalog word "gana" (appetite, zest) and the english suffix "city" which converts an adjective word into a noun. 'Ganacity' therefore refers to one's state of desire or interest in something. I am sharing this because I feel that my 'ganacity' for what I am doing now is spiralling down, and it is so difficult to reverse it back up or just to keep it at a maintained level. It is becoming a struggle on a day to day basis. I am hoping that night and day will alternate fast so that this battle will end soon.

Growths and Tumors of the Mouth

A colleague in the practice of dental medicine referred to me a 40-year old female with a large pinkish, cauliflower-like mass on her lower right buccal gingival. It apparently started 2 months prior to the consult as a small pinkish pedunculated mass, nontender, that was often irritated during teeth brushing. She wanted it removed. Without biopsy, the characteristic of the mass is more consistent with squamous papilloma. I scheduled her for excision biopsy under local anesthesia. More and more people are experiencing some ‘growths’ in their oral cavity. I think this is mainly related to the lifestyle we have adapted these years. Smoking, eating food with irritants or preservatives etc. are the usual culprits. For information, these are the more common growths and tumors that we usually see in the oral cavity. Please be guided and consult your dentists if you notice something similar in your mouth. Abscess This is a soft, pus containing swelling. Th...

Tooth and ENT Doctor

Search This Blog