[Myokymia of the obliquus superior muscle and cryptogenetic epilepsy].
BACKGROUND
Myokymia of the obliquus superior muscle is a rare episodic microtremor caused by uncontrolled activities of the trochlearis nerve fibres. Epilepsy is also caused by spontaneous discharges of neurons. In our report we present an associated epilepsy which to the best of our knowledge is described for the first time.


METHODS
An 61-year old man with twitches of the right eye for 6 weeks and a subjective feeling of eye movement was investigated at our hospital. His history was void of any ophthalmologic diseases. However, he suffered from cryptogenetic epilepsy known since childhood. The morphological and orthoptical findings of his eyes were normal. During the slit-lamp investigation a unilateral rotating microtremor of the right eye induced by looking downward was seen. The neurologic investigation, magnetic resonance imaging and assessment of the thyreoid function did not show further pathological results. The patient underwent treatment with carbamazepine. Under this therapy he did not show any symptoms of myokymia during follow-up.


CONCLUSIONS
To the best of our knowledge this is the first case of myokymia of the obliquus superior muscle associated to epilepsy. To our opinion, any case of this syndrome should be investigated for epilepsy. A causal relation is unlikely since the most probable etiologies are either spontaneous discharges of trochlear nucleus neurons or a close contact between vessel and nerve analogously to trigeminal neuralgia.
Schnitzler
Eckbert S
ES
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Erlangen.
Gusek-Schneider
Gabriele C
GC
Lang
Christoph J G
CJ
D000927:Anticonvulsants / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D017029:Epilepsy, Complex Partial / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014321:Trochlear Nerve / Q000187:drug effects / Q000503:physiopathology; D020432:Trochlear Nerve Diseases / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology
D000927:Anticonvulsants; D002220:Carbamazepine