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Ocular motor apraxia

  • 1.  Ocular motor apraxia

    Posted 01-12-2026 10:59
    I have a 48 year old woman with lifelong familial hemiplegic migraine who suffers attacks 2-3 times per week. Because of her insurance and the incompetence of neurologists taking care of her, she is rendered substandard care.
    She is developing progressive ocular motor apraxia and now cannot initiate vertical saccades at all and only 3mm of Rward saccades and none to the left. 
    Does anyone know if more aggressive Rx of her hemiplegic migraine would help this or has anyone seen this before??
    Thank you.
    +=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=
    Scott Forman, MD
    Senior Fellow North American Neuro-ophthalmology Society

    Adult and Pediatric Neuro-ophthalmology
    Comprehensive Ophthalmology
    Functional Medicine











  • 2.  RE: Ocular motor apraxia

    Posted 01-12-2026 11:09
    Any parkinsonism or midbrain atrophy? 

    Evan Schloss MD
    Neuro-Ophthalmology
    Optum Tri-state
    Mt Kisco, NY



    Original Message


  • 3.  RE: Ocular motor apraxia

    Posted 01-12-2026 11:24

    Lamotrigine is touted as the #1 choice for hemiplegic migraine although I am not sure why any good preventive wouldn't be effective. As with all patients with migraine, they are all different and sometimes there is trial and error involved. I don't know of a connection between HPM and ocular motor apraxia and a quick PubMed search didn't reveal anything.

    Deb

     




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  • 4.  RE: Ocular motor apraxia

    Posted 01-12-2026 13:07
    I know. Pub med did not come up with anything. I have called authors of review papers about hemiplegic migraine and no one has any clues. Just saw her again today and it is slightly progressive too. 
    +=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=
    Scott Forman, MD
    Senior Fellow North American Neuro-ophthalmology Society

    Adult and Pediatric Neuro-ophthalmology
    Comprehensive Ophthalmology
    Functional Medicine












    Original Message


  • 5.  RE: Ocular motor apraxia

    Posted 01-12-2026 17:50
    Do we really want to call our colleagues incompetent?

    I would've sent this to you personally, but I don't have your direct email address at this time and I thought I would forget if I didn't do this now.

    When you go to two different doctors with the same question, you're lucky if you get the same answer. Sometimes when you go to the same doctor on two different days with the same question, you don't get the same answer either.

    Your thoughts best wishes to weil for a good new year.


    Edward M. Cohn, MD, mba, mph
    3535 W 13 Mile (506)
    Royal Oak, MI 48073
    Ph: 248-551-8282
    http://www.umich.edu/~edcohnmd

    Sent from my iPhone



    Original Message


  • 6.  RE: Ocular motor apraxia

    Posted 01-12-2026 19:03
    Randall 
    I agree. I did a thin section MRI with and without GAD. All normal . I am trying to find her a good neurologist to treat her migraine attacks to see if this has any effect on her O. M. Apraxia
    S Forman



    Original Message


  • 7.  RE: Ocular motor apraxia

    Posted 01-12-2026 14:12

    Sounds like an interesting case. Has FHM been confirmed? I'm curious if thin cut brain stem MRI has been performed to evaluate for ischemic or other injury.

    In 50% of FHM families, cerebellar ataxia develops independently of these attacks. I think this raises the question of an independent process developing as others have prompted.

    -------------------------------------------

    Original Message


  • 8.  RE: Ocular motor apraxia

    Posted 01-12-2026 15:49
    Has the patient had a mitochondrial evaluation? Migraine can be a manifestation of mitochondrial disorder as well as CPEO. 




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  • 9.  RE: Ocular motor apraxia

    Posted 01-12-2026 19:04
    No she has not, Andrew. I will get one. 
    Scott Forman

    On Jan 12, 2026, at 7:03 PM, Scott Forman <opticnerve22@gmail.com> wrote:

    
    Randall 
    I agree. I did a thin section MRI with and without GAD. All normal . I am trying to find her a good neurologist to treat her migraine attacks to see if this has any effect on her O. M. Apraxia
    S Forman



    Original Message


  • 10.  RE: Ocular motor apraxia

    Posted 01-12-2026 19:06
    Thank you Ed. You are correct. That was a big mistake on my parent. They were PA 's who told her because she had Medicaid, no 'good' neurologist would see her. n awful thing to say.
    Scott

    On Jan 12, 2026, at 7:04 PM, Scott Forman <opticnerve22@gmail.com> wrote:

    
    No she has not, Andrew. I will get one. 
    Scott Forman

    On Jan 12, 2026, at 7:03 PM, Scott Forman <opticnerve22@gmail.com> wrote:

    
    Randall 
    I agree. I did a thin section MRI with and without GAD. All normal . I am trying to find her a good neurologist to treat her migraine attacks to see if this has any effect on her O. M. Apraxia
    S Forman



    Original Message


  • 11.  RE: Ocular motor apraxia

    Posted 01-12-2026 23:04
    Scott, I remember a long time ago a case of recurring hemiplegic migraines being treated with sphenopalatine blocks that decreased the frequency and intensity of the attacks.   Marc Levy
    Sent from my iPho



    Original Message


  • 12.  RE: Ocular motor apraxia

    Posted 01-12-2026 23:31
    This is the closet to "OMA in FHM" on the pubmed.

    Cambron M, Anseeuw S, Paemeleire K, Crevits L. Saccade behaviour in migraine patients. Cephalalgia. 2011 Jul;31(9):1005-14. doi: 10.1177/0333102411410085. Epub 2011 May 31. PMID: 21628442.

    The abstract says 
    However, the biggest difference was that the patients who received migraine prophylactic therapy made significantly more anti-saccade errors in the anti-saccade with gap paradigm, suggesting that inhibitory saccade control is impaired in migraine patients depending on the severity of the migraine.

    I wonder if it has anything to do with the prophylactic drugs than the migraine itself.
    Need to read up the whole paper


    Dr Shikha Bassi
    Sankara Nethralaya 
    Chennai
    India



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