When Eyes Becomes The Window To The Brain

INTRODUCTION: Paroxysmal eye movements are presenting features of channelopathies, neurotransmitter disorder and epilepsy. They can serve as diagnostic handles. In this case series we tried to showcase the importance of eye movements which could be a tell-tale sign in various neurologic syndromes. METHODS: A retrospective analysis of 6 cases depicting various types of eye movements. Video-graphic analysis along with clinical history, examination and investigations are done. RESULTS: Case1: child with delayed development has head thrust movements with eye gaze saccades, diagnosed as GLUT1(video 1). Case 2: 3-month-old child, with tonic downgaze eye movements with some mid chaotic movements- normal history and workup-had benign paroxysmal tonic downgaze of infancy(video 2A,2B). Case 3: 2 children with different eye movements, one with tonic downgaze and oscillations, other with unilateral nystagmoid movements and developmental delay- diagnosed with ATP1A3 related alternating hemiplegia of childhood(video 3A,3B). Case 4: One had persistent tonic conjugate upward deviation lasting for 5mins with intact awareness- oculogyric crisis had neurotransmitter disorder, sepiapterin reductase deficiency(video 4). Case 5: One child presented with excessive irritability, multidirectional conjugate, chaotic eye movements, on investigation revealed neuroblastoma(video 5). Case 6: child presented with falls and episodic nystagmus- treated as seizures before, which after history and investigations revealed benign paroxysmal vertigo of childhood with nystagmus(video 6). CONCLUSION: Understanding these eye movements aids in early diagnosis by assisting in choosing the necessary investigations. This can help reduce financial burden and promote the initiation of early treatment. A preliminary approach of eye movements is formulated through literature review.