Does anyone remember the elderly gentleman who I'm treating who had the stroke 9 years ago? Well, I'm still treating him twice/week with nice results. A challenge we have is that he is a minimizer. His blood pressure is now 20-30 points lower in the systolic on a regular basis. He no longer chokes on his food. I can also understand him better when he speaks. His family and I all notice these wonderful differences. But, when I ask him if he notices these good things, he usually huffs and grunts, "Not really". A classic minimizer! Today when he came in he said, "Guess what? I think I notice something with all this stuff you're doing. When I was reading scripture last night, I didn't have to close one eye. For the last many years, whenever I read, I start to see double and have to close one eye if I want to continue. Last night was the first time in a very long time I didn't have to do that." He's happy and so am I.
Here is an interesting article I just read regarding how certain eye movements are events of certain specific brain areas:
Delineating function and connectivity of optokinetic hubs in the cerebellum and the brainstem.
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.
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.
I saw a 25 year old woman who was having 1-3 seizures per day since the summer. When she came in for her first visit last week, she said, "I've been holding this seizure at bay for hours. I'm about to have a seizure now so you can see it!" She proceeded to pull a neck brace out of her backpack, rushed to lie down on the table, and had a massive seizure for 5 minutes. I videotaped 3 minutes of it. Her examination showed some very interesting and diverse things. Her primary problem is a deficit in her left frontal cortex. On her third visit she said she hadn't had a seizure for 2 days. On her 4th visit, which was 4 days later, she walked in, turned on the timer on her phone, threw it on the floor, got out her neck brace and had another seizure. After one minute and 20 seconds (exactly), I asked her to sit up, as the seizure was about 50% as intense. She did. I had a very mild green light on my scope, which I shone in her left medial pupil. As I did this, her movement stopped completely! I gently did this several times. Each time I moved the light away from her eye, the seizure movements returned, but they were less and less intense each time. Each time the gentle light was in her pupil, the movement stopped completely! Then I used the optokinetic tape and moved it towards her left. As soon as her eyes engaged to watch the tape towards the left, the seizures also completely stopped. I gently did this over and over again until her seizure was gone completely. I wish I had that on video. This young lady has a very fragile nervous system. The plan is to gently make the neurons stronger and stronger in the weakest areas of her brain (neuroplasticity) so she can hopefully get to drive and work again.