Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 55, Num. 3, 2009, pp. 231-232

Journal of Postgraduate Medicine, Vol. 55, No. 3, July-September, 2009, pp. 231-232

Letter

Authors' reply

Borade A, Prabhu AS

Department of Pediatrics, Amrita Institute of Medical Sciences Elamakkara (P.O), Kochi - 682 026, Kerala, India

Correspondence Address: Dr. Ashwin Borade, Department of Pediatrics, Amrita Institute of Medical Sciences Elamakkara (P.O), Kochi - 682 026, Kerala, India
ashwinborade@yahoo.com

Code Number: jp09070

Sir,

We thank Drs. Granado and Guillén for their comments ^[1] on our article ^[2] on opthaloplegic migraine (OPM) is a rare variant of migraine seen most commonly in children and presents with palsy of third, fourth or sixth cranial nerves. The phenomenon was considered to be secondary to a microvascular, ischemic etiology. However, recently it has been reclassified as a demyelinating condition. ^[3] Even optimal treatment of OPM remains unclear. Calcium channel blocking drugs such as verapamil or beta-blocking drugs such as propranolol have been tried in patients with frequent attacks. However, efficacy remains unproven. Steroids have been used with mixed results. ^[4]

Usually the ophthalmoplegia is a transient phenomenon. For a longstanding or permanent ophthalmoplegia, one can definitely consider using botulinum toxin A or surgical intervention.

Manzouri et al. described patients with OPM and longlasting sixth nerve palsies, in whom botulinum toxin and squint surgery were found to be useful. ^[5] However, sufficient data is not available to recommend this on a routine basis. We also agree that worldwide large observational studies are required, so as to avoid the longlasting morbidity due to OPM.

References

1.	Granado LIG, Guillén G. Treatment options for ophthalmoplegic migraine. J Postgrad Med 2009;55:231.  Back to cited text no. 1  [PUBMED]
2.	Borade A, Prabhu AS, Kumar S, Prasad V, Rajam L. Magnetic resonance imaging findings in ophthalmoplegic migraine. J Postgrad Med 2009;55:137-8.  Back to cited text no. 2  [PUBMED]
3.	Bek S, Genc G, Demirkaya S, Eroglu E, Odabasi Z. Ophthalmoplegic migraine. Neurologist 2009;15:147-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Levin M, Ward TN. Ophthalmoplegic migraine. Curr Pain Headache Rep 2004;8:306-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.	Manzouri B, Sainani A, Plant G, Lee J, Sloper J. The aetiology and management of long-lasting sixth nerve palsy in ophthalmoplegic migraine. Cephalalgia 2007;27:275-8.   Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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