Tag Archives: brain regions

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The first time I heard of this disorder, I was confused.  The doctor kept saying, "You know, dis-embarkment, like getting off of a boat!".  Ok, now it made sense.  Some people feel like they are on a boat when they are sitting, standing and/or walking.  I examined a man with disembarkment syndrome the first time about 20 years ago, but I didn't know what to call his condition.  I recently saw a different man with this syndrome.  He said he was looking at his device while on an airplane for about 45 minutes.  When he turned it off, he felt terribly sick and nauseated.  When he got off the plane, he said he felt like he was walking on 6 foot waves.  He said it had been this way for years!  In the examination, I found a severe one sided cerebellar deficit, which we started to change right away.  Unfortunately, this man did not continue with the treatment plan.  However, he was about 50% improved after approximately 2 months of treatment.  I also gave him homework so the neurological changes we made would continue to be stable.

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Here is an interesting article I just read regarding how certain eye movements are events of certain specific brain areas:

2017 Dec;222(9):4163-4185. doi: 10.1007/s00429-017-1461-8. Epub 2017 Jun 23.

Delineating function and connectivity of optokinetic hubs in the cerebellum and the brainstem.

Ruehl RM1,2, Hinkel C3, Bauermann T3, Eulenburg PZ4,3.

Abstract

Optokinetic eye movements are crucial for keeping a stable image on the retina during movements of the head. These eye movements can be differentiated into a cortically generated response (optokinetic look nystagmus) and the highly reflexive optokinetic stare nystagmus, which is controlled by circuits in the brainstem and cerebellum. The contributions of these infratentorial networks and their functional connectivity with the cortical eye fields are still poorly understood in humans. To map ocular motor centres in the cerebellum and brainstem, we studied stare nystagmus using small-field optokinetic stimuli in the horizontal and vertical directions in 22 healthy subjects. We were able to differentiate ocular motor areas of the pontine brainstem and midbrain in vivo for the first time. Direction and velocity-dependent activations were found in the pontine brainstem (nucleus reticularis, tegmenti pontis, and paramedian pontine reticular formation), the uvula, flocculus, and cerebellar tonsils. The ocular motor vermis, on the other hand, responded to constant and accelerating velocity stimulation. Moreover, deactivation patterns depict a governing role for the cerebellar tonsils in ocular motor control. Functional connectivity results of these hubs reveal the close integration of cortico-cerebellar ocular motor and vestibular networks in humans. Adding to the cortical concept of a right-hemispheric predominance for visual-spatial processing, we found a complementary left-sided cerebellar dominance for our ocular motor task. A deeper understanding of the role of the cerebellum and especially the cerebellar tonsils for eye movement control in a clinical context seems vitally important and is now feasible with functional neuroimaging.

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5 weeks ago I examined a 9 year old boy on the autism spectrum. He is amazing. He is similar to the Rain Man. He can calculate numbers and birthdates quickly. However, when he walked in my office for the initial 2 hour evaluation and treatment, he walked right up to me, shoved his middle finger in my face and said, "F**K YOU!" I thought, "Finally, an extrovert! I know what to do with this." I told his mom that there was nothing he could do to make me embarrassed or shame her or him. He proceeded to shout, "F**K YOU!" I said, "Say, "Thank you. I love you."" This continued throughout the visit. He said, "I'm going to take you into my van, cut you into a million pieces, and murder you!" I kept saying, "Say thank you. I love you." We actually got through the exam and treatment. On the next visit, his mom said he had an amazing day after the treatment. After cursing at me and his mom during treatment, at the end of the fourth visit, he calmly sat down on the trampoline in the office, and said, "Mom, I'm really sorry for all those terrible things I said." After the 6th visit, his mom texted to tell me that her son was sitting at the dinner table with the family having a conversation (that never happens) and the he was telling her he wanted to buy her a gift! He also was asking his grandma questions about her life. (You need a right cortex to think about others and plan the future). At the seventh visit, the boy had an actual response in his right medial pupil for the first time. When he came in on the next visit, he bounded in and jumped onto the trampoline. As he was jumping, he said, "Aren't you glad I don't say F You anymore?" I said yes. Then he said, "Aren't you glad I don't have a T-shirt on that says F You?" I couldn't stop laughing. He now repeats after me when I tell him to repeat positive affirmations like, "I am a genius applying my wisdom" and "I have perfect brain balance." You know what............he is a genius. He was just trapped by his brain.

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I've just started treating a 19 year old girl with depression and anxiety.  She also has a mild case of self injury.  I discovered a right frontocortical deficit on examination.  One thing that a healthy cortex is supposed to do is fire down to the amygdala and inhibit it.  The amygdala is part of the emotional brain that spits out depression, sadness, anxiety, fear, rage and anger.  Therefore, her cortex was not able to inhibit her amygdala.  Although the average patient begins to notice changes after about 3 weeks, she looked different after the first treatment.  I asked her how she felt and she said, "Calm and good".  I asked her to take note of how long that feeling lasted.  Specific proteins are made in the neurons when I administer treatment.  They have short half lives and disintegrate sometimes within minutes.  Neuroplasticity happens when the neurons continue to be fired and then they begin to "wire" together.  Physiologically, the proteins should last longer and longer as patients get treated and continue with their homework.  This young woman is experiencing that exact thing.  When I asked her how long the good feelings lasted on her first visit, she said, "about 20 minutes".  When I asked her how long they laster after her last visit (her 4th), she said they lasted the rest of the day.  She also reported that she told her psychiatrist for the first time that for the last week she had been feeling good.  Let's tell people that the brain CAN be changed and that there is so much hope for our bodies to heal!     Dr. Merry