When winking isn’t flirtatious

Dear Dr. Gott: For some time now, I have had a left eye that twitches. It began mildly about five years ago and now when it occurs, it closes my left eye and distorts my face. It has proven to be a mystery to me. Owing to this problem, I am not willing to engage in some social activities.
One doctor told me it was not Bell’s palsy. Some of my friends tell me to think of other things to divert the spasm.

Dear Reader: Eye twitching is the involuntary movement of the eyelid. It is most commonly a harmless annoyance that often disappears after a day or two, but on rare occasion and in the presence of facial spasms, it may indicate an early sign of a brain or movement disorder, such as Parkinsonism, Tourette syndrome, dystonia and Bell’s palsy. Parkinsonism is a movement abnormality of Parkinson’s disease and refers to tremors, impaired speech, muscle stiffness and more. Please remember that not everyone with Parkinsonism has Parkinson’s disease. Tourette syndrome is a neurological disorder in which a person may make unusual sounds or movements at seemingly inappropriate times, over which they have little or no control. Dystonia represents the involuntary contraction of muscles that results in twisting of the involved body part. Focal dystonia can affect the muscles that control blinking of the eye. Bell’s palsy, as you have likely already been told, is inflammation and swelling of the nerve that controls the facial muscles on one side of the face only. If you have been told this is not your problem, you can rule that particular disorder out and move on.
Twitching has been associated with stress, eyestrain, a lack of sleep, eye irritation, fatigue, smoking or being in the presence of a smoker, physical exertion, a nutritional imbalance, allergies and the excessive use of alcohol and/or caffeine. Until an actual cause is determined, it is difficult to determine how to remedy the situation. How long has it been since you have had a routine examination and laboratory testing? Perhaps it is time. Nutritional imbalances can be addressed easily. Our bodies are fickle things, and each one reacts differently. If you have an eating disorder, tap into your local hospital’s dietary program for direction.
My guess is that you do not wear contact lenses. If you do, you might switch to prescription glasses on a trial basis. I also recommend that you keep a journal and make a notation as to what precedes the twitching. Perhaps you or a neighbor in the next apartment is using a cleaning solution that you are particularly susceptible to. Do you have a new cat that could be to blame? Are there chemicals at work or cleaning solutions used on the floors that affect you adversely? Do you have an air freshener in your car? Do you use fabric softener when doing laundry? Is a food the element that triggers the spasms? Do you use scented candles in your home? There are countless possibilities that could easily be to blame. Once a link has been identified, you might be on the road to recovery. Surprisingly, the most minor trigger and the one you might never consider could solve the annoying problem you experience. Start with the simple steps over which you have control before advancing. Then you can move on to relaxation techniques, Botox therapy or surgery for relief of your symptoms with your doctor’s approval. You may also wish to try soy lethicin.
If you eye is still twitching and if the facial distortion continues, then all bets are off. You should be seen by a neurologist, who can get to the bottom of the issue. Good luck.
Readers who would like additional information can order my Health Report “Medical Specialists” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form/pdf.

Dear Dr. Gott: I recently had an MRI that showed some brain atrophy. A few days ago, I read a report that people whose mothers had Alzheimer’s show more rapid progression of brain atrophy.
I’m 67, and my mother had what I believe was the Alzheimer’s/vascular combo dementia. No autopsy was performed. She showed symptoms in her early 70s, died at 85, and had two sisters who also had dementia.
The recent MRI will have to be my “base.” How soon should I have another to monitor possible deterioration? What is the probability of me getting Alzheimer’s?

Dear Reader: Atrophy of any tissue translates to a loss of cells. In the case of the brain, this can mean either the entire brain or a limited focal area has shrunk. When both cerebral hemispheres are affected, thought and behavioral function may be impaired. Atrophy is not the same as Alzheimer’s.
As we age, the risk of developing Alzheimer’s increases. A family history will further increase that risk. Other factors include being female, long-standing hypertension and trauma to the head. Early-onset Alzheimer’s is defined as appearing before the age of 65, is relatively uncommon, may be hereditary, and advances rather rapidly. Late-onset Alzheimer’s can affect those 65 or older.
As symptoms become apparent, a person may be confused, forgetful, unable to find the way home, have hallucinations, use incorrect words when speaking or speak in unintelligible sentences, may misplace things, suffer from depression, experience a change in sleep patterns and a great deal more. Most of us lose our car keys on occasion, repeat ourselves or forget an important appointment. It’s a situation I refer to as having “overloaded circuits.” It happens. However, with the presence of Alzheimer’s, the situation worsens and symptoms become more pronounced.
Treatment is initially provided in the form of medication aimed at slowing progression of the disease. There are a number of medications available on the market to do just that and to control aggressive behavior that might be present. There are also support groups for the patient and caregivers.
The only true means of diagnosing Alzheimer’s is through brain-tissue samples after death, which will likely reveal twisted protein fragments within nerve cells that clog those cells, areas of dying nerve cells around protein and abnormal clusters of dead and dying nerve cells. Prior to death, a physician will base his thoughts on the results of a physical and mental examination to include testing of coordination, balance, muscle strength and tone, in-depth memory testing, asking the date, the name of the president, remembering three key words presented and more. Laboratory testing might be ordered to rule out thyroid abnormalities. Radiologic testing to include a PET scan, CT or MRI might be appropriate. Be sure to ask your neurologist when he or she recommends follow-up testing.
Herbs and alternative medications have been promoted to delay or even prevent Alzheimer’s; however, an expert panel convened by the National Institutes of Health determined there is insufficient evidence to justify taking vitamins B, C, E, folic acid or beta carotene. Foods high in omega-3 fatty acids hold more promise; however, there is still inadequate evidence. Currently, the strongest evidence suggests that reducing your risk of heart disease may also decrease your risk of developing Alzheimer’s. You can’t control your gene pool but you can control your lifestyle.
Readers who would like additional information should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.

Dear Dr. Gott: “The King’s Speech” movie has everyone talking about stuttering. We at The Stuttering Foundation are seeing a four-fold increase in inquiries. So are therapists. Please consider answering the simple question, “What is stuttering?” for the benefit of your readers. Our website, www.StutteringHelp.org, has a trove of helpful materials and can make referrals. President Jane Fraser can offer thoughts and advice. I’ve searched your site and did not see any information on stuttering. Thank you.

Dear Reader: I have not written about stuttering since 2009.
Stuttering, sometimes known as stammering, is a communication disorder. It is characterized by repetition, prolongation or abnormal stoppages in the flow of the speech. It can also be associated with unusual facial or body movements that occur when having difficulty speaking. Stuttering is not a sign of reduced mental capacity or intelligence.
Stuttering affects approximately 68 million people worldwide. There are more than 3 million sufferers in the United States. Men are affected four times more frequently than women. About 5 percent of all children will experience stuttering that lasts for six or more months. Of that, nearly 4 percent resolve by late childhood. The remaining 1 percent will have long-term problems.
About 60 percent of those who stutter have another family member who also does, suggesting a genetic cause. Children with other speech and language problems or developmental delays are more likely to develop a stutter than other children. Families with high expectations and fast-paced lifestyles can also contribute to stuttering. Recent research has also shown that those who stutter process speech and language slightly differently than those with otherwise normal speech. Stuttering may also be the result of a combination of factors, and the cause may not be the same for everyone. It’s likely that the starting cause is different from the cause of prolonged or worsening stuttering.
Emotional and psychological problems are no more likely in those who stutter than those who don’t, so they are not believed to be a cause.
Stuttering is treatable and gaining near-normal or normal fluency takes time. There is no cure. In general, results are better and appear faster the earlier treatment is begun. For very young children, this may even prevent developmental stuttering from becoming a lifelong issue.
Treatment can vary from person to person and between children, teens and adults. Speech therapists and pathologists are often the first and best option for treatment. They can tailor care and find the therapies that work best for each person.
There is no approved medication for stuttering, but some drugs, such as those for depression, epilepsy and anxiety, have been used; however, studies have concluded that they are largely ineffective. Clinical trials using other medications are currently being conducted.
There are several types of electronic devices; however, they do not work for everyone. Long-term effectiveness is not known, and real-world effectiveness is questionable.
A final option is self-help groups. Many sufferers have found that therapy and self-help/study help are the most beneficial. Self-help groups also act as a support system where people can come together and learn from each other, find new information, and develop mutual friendships with others who understand the daily stresses, difficulties and challenges of dealing with stuttering. Support groups in general can be extremely helpful to sufferers of any disorder, regardless of what it may be.
Readers interested in learning more can visit The Stuttering Foundation’s website or call for free informational brochures and a nationwide referral list of speech pathologists at (800) 992-9392. You can also visit the stuttering information page on the National Institute on Deafness and Other Communication Disorders (a part of the National Institutes of Health) website at www.nidcd.nih.gov/health/voice/stutter.html or by calling the NIDCD Information Clearinghouse at (800) 241-1044.

Dear Dr. Gott: I suffered vertigo misery for more than 20 years. I had brain scans and more that showed no pathology. Luckily, a referral from a local neurologist sent me to a physical therapist experienced in performing the Epley maneuvers. I had amazing results from the repositioning of debris in the inner ear. Between sessions, I wear a “Sea-band” elastic bracelet for any dizziness. Low-salt, low-alcohol, low-caffeine diets can also help tremendously.

Dear Reader: Vertigo is a common complaint among my readers and one of the most difficult to treat because it is often caused by benign or unknown conditions. The Epley maneuvers, as you have experienced, are designed to reposition debris to a location within the ear that does not cause the spinning, dizzy sensation of vertigo. These often have to be done on a regular basis to maintain results. Thank you for sharing your experience.
Readers who are interested in learning more about ear disorders can order my Health Report “Ear Infections and Disorders” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.


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