neurological exam. LR = lateral rectus, SR = superior rectus, SO = superior oblique, MR = medial rectus, IR = inferior rectus. Because the growth didn't get any bigger over time, it is (thankfully) unlikely to be cancer. Early chemodenervation can also reduce the amount of surgery required to correct persistent sixth nerve palsies, although the evidence in the literature is not conclusive on this point. Figure 8. He is also a member of the USA Today Board of Contributors and a featured speaker for The Insight Bureau. Before your visit, write down questions you want answered. 0 Shop NowFind Eye Doctor Hypertropia in unilateral isolated abducens palsy. Your sixth cranial nerve sends signals from your brain to your lateral rectus muscle. My dad's sixth nerve had already been damaged and the muscle it controlled atrophied. All rights reserved. the There may also be a role for chemodenervation when no clinical signs of recovery emerge within the first month or two to prevent contracture in the medial rectus while awaiting recovery of lateral rectus function. But in cases of trauma, symptoms are less likely to go away We all know that as we get older, our bodies won't work as well as they once did. properly, your eye turns inward toward your nose. Figure 5. Your healthcare provider will probably want to order brain imaging tests because the nerve often becomes compressed as it leaves the brain. [7], The pathophysiological mechanism of sixth nerve palsy with increased intracranial pressure has traditionally been said to be stretching of the nerve in its long intracranial course, or compression against the petrous ligament or the ridge of the petrous temporal bone. A similar acquired syndrome in adults is ventral pontine syndrome from an infarct in the ventral pons that affects the nuclei of the sixth and seventh cranial nerves (Figure 1). The diplopia resolved spontaneously over a period of four Healthy volunteers may also participate to help others and to contribute to moving science forward. Also write down any new 2010: 51 (9), 4612-4617). Instead, they are more likely to develop lazy eye (amblyopia). What Is the Treatment for Sixth Nerve Palsy? A number of factors may help to predict prognosis in these patients. The disorder usually goes away once the cause is treated. Whilst this is a positive adaptation in the short term, in the long term it can lead to a lack of appropriate development of the visual cortex giving rise to permanent visual loss in the suppressed eye; a condition known as amblyopia or Lazy eye. These two muscles are synergists or "yoke muscles" as both attempt to move the eye over to the left or right. children, injury is a leading cause. WebThis may be particularly dangerous while driving. This causes problems with eye movement. The VIth nerve's course is short and lesions in the orbit rarely give rise to isolated VIth nerve palsies, but more typically involve one or more of the other extraocular muscle groups. Enroll in databases to allow researchers from participating institutions to find you. There are two main types of clinical studies: People participate in clinical trials for a variety of reasons. But sometimes, problems in other parts of the body are present, too. The most common symptom of sixth Unlike the other cranial nerves, its not supported by the dural wall of your sinuses. They may offer online and in-person resources to help people live well with their disease. Your childs healthcare provider may want to wait several months before starting additional treatment. In the 21st Century, nobody really expects to go blind, but it absolutely can and does happen. Small-vessel disease, especially if youre diabetic (, Temporary blurring of vision when you suddenly move your head. The American Council on Science and Health is a research and education organization operating under Section 501(c)(3) of the Internal Revenue Code. as This instrument lets them look into your eye and check for problems with your blood vessels and see whether theres increased pressure within your skull. Quasi-coronal magnetic resonance imaging of both orbits in central gaze showing profound symmetric atrophy of the paretic right lateral rectus muscle belly (red arrow) compared with the uninvolved left lateral rectus belly (blue arrow). Phamonvaechavan P, Anwar D, Guyton DL. As the VIth nerve passes through the subarachnoid space it lies adjacent to anterior inferior and posterior inferior cerebellar and basilar arteries and is therefore vulnerable to compression against the clivus. [8] Foville's syndrome can also arise as a result of brainstem lesions which affect Vth, VIth and VIIth cranial nerves. Affected people cannot turn the eye outwards toward the ear. Rosenbaum AL. [citation needed]. Many problems can disrupt the Of those who didnt recover, 40% had a serious underlying condition. COPYRIGHT 1978-2022 BY THE AMERICAN COUNCIL ON SCIENCE AND HEALTH, Email: [emailprotected] Partial lateral rectus function is associated with a smaller primary gaze esotropia and retained ability to abduct to the midline and beyond (Figure 7), but the preservation of some sixth nerve function raises the possibility of other confounding diagnoses (Table 3). Before your visit, write down questions you want answered. Know why a test or procedure is recommended and what the results could mean. Depending on the other structures affected, your child might have such symptoms as: Diagnosis begins with a thorough medical history and physical exam. If your condition is caused by viral illness or an unknown cause, its likely to completely disappear. Saccadic velocity tracing for a patient with a complete left lateral rectus palsy. A 12-year, prospective study of extraocular muscle imaging in complex strabismus. This means that prism spectacles cant get rid of double vision in every eye position. When your sixth nerve isn't working properly, it causes problems with the movement of your eye. Clark RA, Demer JL. Know why a new medicine or treatment For instance, many of us expect bad backs, achy joints, poor memory, and being hard of hearing. But it is often hard to do Prism spectacles can help realign images, but when you look in different directions, the misalignment of your eyes are different. Sixth nerve palsy results from dysfunction or damage of your sixth cranial nerve, also known as the abducens nerve. Shewakramani S, McCann DJ, Thomas SH, Nadel ES, Brown DF. it leaves the brain. Because the nerve emerges near the bottom of the brain, it is often the first nerve compressed when there is any rise in intracranial pressure. Accessing the nerve requires drilling through the skull, so my dad literally had a hole in his head. Force generation testing reveals the absence of lateral rectus force, formal saccadic testing demonstrates diminished saccadic velocity (Figure 9), and orbital imaging reveals profound, symmetric atrophy of the lateral rectus belly (Figure 6). palsy, additional symptoms may be present as well. Reference: Data from the Newborn Screening Codingand Terminology Guide is available here. The affected eye may not be able to move away from the midline normally. Finally, isolated sixth nerve palsies are often accompanied by small (< 5 prism diopter) hypertropias, possibly from asymmetric involvement of the lateral rectus compartments, but the presence of larger hypertropias should prompt consideration of concurrent fourth nerve palsies, skew deviations, or, in children, dissociated vertical deviations.The magnitude of the lateral rectus deficit provides important diagnostic, prognostic, and therapeutic information. probably want to order brain imaging tests because the nerve often becomes compressed Tylenol After Surgery? Sometimes, sixth nerve palsy is Non-neurologically isolated sixth nerve palsies typically are associated with more grave conditions. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Should You Worry About Artificial Flavors Or Colors? Find resources for patients and caregivers that address the challenges of living with a rare disease. The Next Plague and How Science Will Stop It. When this muscle contracts, your eye moves away from your nose. They will try to diagnose the root cause of the sixth nerve London: Churchill Livingstone, 2010).The sixth nerve itself contains a bifid, segregated structure of innervation to effectively create two vertically divided neuromuscular compartments within the lateral rectus (Figure 3). Symptoms following trauma may also improve Figure 2. What causes it, and can it be fixed? Long-term outcomes after surgical management of chronic sixth nerve palsy. Lateral rectus superior compartment palsy. When the deviation is too large for prismatic correction to be effective, permanent occlusion may be the only option for those unfit or unwilling to have surgery. The abducens nerve (cranial nerve 6), however, floats in the middle of the cavernous sinus adjacent to the internal carotid artery. alignmenta symptom called strabismus. Quasi-coronal magnetic resonance imaging of both orbits in central gaze showing marked asymmetric atrophy of the superior compartment of the left lateral rectus (red arrow) compared with the superior compartment of the uninvolved right lateral rectus (blue arrow). A variety of problems can disrupt the function of the sixth cranial nerve, causing sixth nerve palsy. In younger patients (< 50) and patients with other concurrent neurologic or systemic symptoms, however, a more aggressive workup is indicated at presentation.Neuro-imaging should be performed for younger patients and/or those with concurrent neurologic symptoms. its own cranial nerve. This is more common when looking far away or when looking in the direction of the affected eye. In a study of 213 people with this condition, 78.4% recovered without treatment. Pihlblad MS, Demer JL. This page was last edited on 17 September 2022, at 12:21. Know how you can contact your provider if you have questions. Secondly, by reducing the size of the deviation temporarily it might allow prismatic correction to be used where this was not previously possible, and, thirdly, by removing the pull of the medial rectus it may serve to reveal whether the palsy is partial or complete by allowing any residual movement capability of the lateral rectus to operate. Brain imaging is also important to make sure a brain tumor isnt Sometimes, sixth nerve palsy This is called nonisolated sixth nerve palsy. Partial rectus muscle-augmented transpositions in abduction deficiency. Ask if your condition can be treated in other ways. reaching the lateral rectus. In such cases it may be more appropriate simply to occlude one eye temporarily. Often, symptoms from sixth nerve palsy improve on their own. LR = lateral rectus, SR = superior rectus, SO = superior oblique, MR = medial rectus, IR = interior rectus. Always follow your healthcare professional's instructions. [11] The Cochrane review authors judged this to be low-certainty evidence; the study was not masked and the estimate of effect was imprecise. Many rare diseases have limited information. But problems in other parts of the body can occur, too. Possible causes Copyright 2002 BC Decker). completely. People who have sixth nerve palsy cannot turn the eye outwards toward the ear. Danbury, CT 06810 This causes problems with eye Limitations of eye movements are confined to abduction of the affected eye (or abduction of both eyes if bilateral) and the size of the resulting convergent squint or esotropia is always larger on distance fixation - where the lateral recti are more active - than on near fixation - where the medial recti are dominant. or so later, your healthcare provider might recommend further treatments. Holmes JM, Beck RW, Kip KE, Droste PJ, Leske DA, Pediatric Eye Disease Investigator Group. Treatment of sixth nerve palsy depends on its cause. nerve palsy. This causes problems with eye movement. Leuder GT, Archer SM, Hered RW, Karr DJ, Kodsi SR, Kraft SP, Paysse EA, and Nischal K. Basic and Clinical Science Course, Section 6: Merino P, Gmez de Liao P, Villalobo JMC, Franco G, Gmez de Liao R. Etiology and treatment of pediatric sixth nerve palsy. 2. of the worsens, the affected eye may drift toward the midline, even when looking straight [citation needed], Thereafter, a period of observation of around 6 months is appropriate before any further intervention, as some palsies will recover without the need for surgery. Because the lateral rectus muscle can no longer contract Vijayalakshmi P, Muralidhar R, Shetty S, Sane M. Resolution of anterior segment ischemia after the removal of lateral fixation sutures. Vallee et al. However, not everyone with sixth nerve palsy experiences this symptom. This may temporarily weaken the movement of your eye muscle. Your childs symptoms may be more likely to go away completely if he or she has isolated sixth nerve palsy. Sixth nerve palsy associated with obstruction in Dorello's canal, accompanied by nodular type muscular sarcoidosis. The procedure chosen will depend upon the degree to which any function remains in the affected lateral rectus. Green arrows point to linear, fast changes in gaze position, while the red arrow points to a slow, drifting saccade. Initial treatment outcomes in chronic sixth nerve palsy. Know the reason for your visit and what you want to happen. Gradenigo syndrome from severe bacterial infections of the middle ear and adjacent petrous portion of the temporal bone can create periorbital pain from involvement of the fifth cranial nerve, in addition to the sixth nerve palsy. Augmented vertical rectus transposition surgery with single posterior fixation suture: modification of Foster technique. The palsy may be secondary to nerve infarction, Wernicke encephalopathy, trauma, infection, or increased intracranial pressure, or it may be idiopathic. visit. Also write down any new instructions your provider gives you. Other times, sixth nerve palsy may come with other neurological or other symptoms. WebSixth nerve palsy is also known as lateral rectus palsy. Our Information Specialists are available to you by phone or by filling out our contact form. A sixth cranial nerve palsy most commonly arises from an acquired lesion occurring anywhere along its path between the sixth nucleus in the dorsal pons and the lateral rectus muscle within the orbit. Palsy is a type of full or partial paralysis. Dutton JJ, Fowler AM. The sixth cranial nerve sends signals to your lateral rectus muscle. WebDiagnosis: Sixth nerve palsy Etiology: The etiology of this presumed recurrent isolated left sixth nerve palsy was unclear. Know how you can contact your provider if you have questions. [citation needed]. Fax: 203-263-9938, Washington, DC Office Clinical studies are medical research involving people as participants. Each muscle moves the eye in one specific direction. Lateral view of the vertical extent of the lateral rectus (LR) insertion across the horizontal globe meridian (dashed black line). You may never fully recover, though, if your sixth nerve palsy is due to trauma. NPR Frets About 'Weight Stigma' As Doctors Fight Childhood Obesity, Ignore the News: Earth Is Getting Cleaner and Healthier, Another Lousy Anti-Vaping Study, Debunked, Insanity: Doctor Gives Teenage Son Cigarettes to Break Vaping Habit, Underwater Suicide? You may experience double vision when you look in the direction of your affected eye. We raise our funds each year primarily from individuals and foundations. American Association for Pediatric Ophthalmology & Strabismus: Sixth Nerve Palsy, Strabismus Surgery., Cabrera, A.F., Surez-Quintanilla, J.StatPearls, Anatomy, Head and Neck, Eye Lateral Rectus Muscle., Comprehensive Ophthalmology Update: Sixth Nerve Palsy., Emergency Medicine News: Right Abducens Nerve Palsy., Genetic and Rare Diseases Information Center: Sixth nerve palsy., Merck Manual: Neurologic Examination, Sixth Cranial Nerve (Abducens Nerve) Palsy.. Paralytic strabismus: third, fourth, and sixth nerve palsy. Enough Already! Iatrogenic injury. sixth cranial nerve is damaged or doesn't work right. GARD does not currently have information about the cause of this condition. The clinical manifestations, evaluation, and diagnosis of sixth nerve palsy are reviewed here. The disorder prevents some of the muscles that control eye movement from working Sometimes, only the sixth cranial nerve has problems. Some people may not need any treatment, while others may need surgery. This condition causes problems with eye movement. Podcast: Sweden's COVID Response; Eco-Doomsday is Cancelled, Why Do Books Smell? Where this process has fully developed, the preferred option is a simple recession, or weakening, of the medial rectus of the affected eye, combined with a resection, or strengthening, of the lateral rectus of the same eye. The resultant palsy is identified through loss of lateral gaze after application of the orthosis and is the most common cranial nerve injury associated with this device. It is relatively rare. [citation needed], The same approaches are adopted bilaterally where both eyes have been affected. Postoperative prisms may be required to provide single binocular vision in primary gaze, especially in patients with complete sixth nerve palsies. Bring someone with you to help you ask questions and remember what your provider tells Sixth nerve palsies in children. Unfortunately, the prism only correct for a fixed degree of misalignment and, because the affected individual's degree of misalignment will vary depending upon their direction of gaze, they may still experience diplopia when looking to the affected side. WebSixth nerve palsy is a nerve disorder that occurs when the sixth cranial nerve is damaged. Recurrent isolated sixth nerve palsy after consecutive annual influenza vaccinations in a child. Call the healthcare provider if your child experiences any sudden severe symptoms, like vision loss or difficulty moving an arm or a leg. In children, trauma is one of Your healthcare provider will 55 Kenosia Avenue [6] report that benign and rapidly recovering isolated VIth nerve palsy can occur in childhood, sometimes precipitated by ear, nose and throat infections. A 501(c)(3) non-profit organization. Coronal view of the cavernous sinus. However, this is the first study to evaluate the recovery of third, fourth, and sixth cranial nerve palsy with objective criteria based on deviation angle and to identify Figure 9. [citation needed]. Treatment usually depends on the cause of your sixth nerve palsy. Are "Low Dose" Health Effects of Chemicals Real? Partial right sixth nerve palsy and gaze-induced nystagmus in a young girl with an intracranial mass. In this situation, surgical intervention is indicated to establish or broaden the field of single binocular vision, with the surgical approach highly dependent on the presence of residual lateral rectus function.A complete sixth nerve palsy is characterized by a floating saccade toward central gaze from the resting esotropic, adducted eye position. sixth Sixth nerve palsy simply means paralysis of the sixth cranial nerve. Unusual cranial nerve palsy caused by cavernous sinus aneurysms. That leaves the last option: Something benign is pushing against the nerve. Temporary (Fresnel) prisms can be used to treat diplopia in patients with eyeglasses. Sixth nerve palsy following a viral illness often completely goes away within a few months. Contributions are fully tax-deductible. Basic and Clinical Science Course, Section 5: Foster RS. Sixth nerve palsy that happens without additional In addition to the standard ophthalmic examination, the following elements should be emphasized: Your browser does not support HTML5 video. In some cases, sixth nerve palsy is present at birth. affected, you might have symptoms such as: Diagnosis begins with a thorough For Adjustable suture technique for enhanced transposition surgery extraocular muscles. The eye on the affected side may drift toward the midline. Doctors may also recommend botulinum toxin (botox) injections. My dad is undergoing something like this, but nowhere nearly as dramatic and frightening as macular degeneration. Eye patches, glasses, corticosteroids, and/or botulinum toxin may be used to ease symptoms. The sixth cranial nerve has a long subarachnoid course. In MillardGubler syndrome, a unilateral softening of the brain tissue arising from obstruction of the blood vessels of the pons involving sixth and seventh cranial nerves and the corticospinal tract, the VIth nerve palsy and ipsilateral facial paresis occur with a contralateral hemiparesis. to wait several months before starting additional treatment. WebSixth nerve palsy occurs when the sixth cranial nerve is damaged or doesn't work right. The use of BT serves a number of purposes. On one end, it attaches to the brain stem; on the other, to a muscle near the eyeball. It's also known as the abducens have A Cochrane Review on interventions for eye movement disorders due to acquired brain injury,[10] last updated June 2017, identified one study of botulinum toxin for acute sixth nerve palsy. Some people may have permanent vision changes. The disorder prevents some of the muscles that control eye movement from working properly. function of the sixth cranial nerve, causing sixth nerve palsy. What causes the nerve to stop working? Partial right sixth nerve palsy and gaze-induced nystagmus in a young girl with an intracranial mass. Sixth nerve palsy occurs when the Meanwhile, as your sixth nerve palsy improves, the power of the prism can be decreased. Britt MT, Velez FG, Thacker N, Alcorn D, Foster RS, Rosenbaum AL. This is the most common isolated muscle palsy. Brain imaging is also important to make sure a brain tumor isnt causing symptoms. Sixth nerve palsy occurs when the Participants with a disease may participate to help others, but also to possibly receive the newest treatment and additional care from clinical study staff. Some available treatments are: Your childs provider may be most likely to recommend surgery if other treatment choices have not been effective. Only 16.4% failed to recover. (Reprinted with permission from Drake R, Vogl W, Mitchell A. Grays anatomy for students, 2nd edition. My Dad's Surgery for Sixth Nerve Palsy - American Council Tips to help you get the most from a visit to your healthcare provider: Cedars-Sinai has a range of comprehensive treatment options. However, in cases of trauma, symptoms are less likely to go away completely. Botulinum A toxin (Oculinum) in ophthalmology. Sixth nerve palsies in younger patients, however, have been associated with high rates of increased intracranial pressure, vascular anomalies, and neoplasms (Table 2). Looking for others who may be struggling with Sixth Nerve Palsy or similar eye movement disorders or issues that impair mobility/driving. Differential diagnosis is rarely difficult in adults. eliminate double vision (often an initial treatment), Special prism glasses to help align Treatment for sixth nerve palsy depends on its cause. [citation needed], Other management options at this initial stage include the use of botulinum toxin, which is injected into the ipsilateral medial rectus (botulinum toxin therapy of strabismus). NORD is a registered 501(c)(3) charity organization. Sometimes, the cause In a sixth nerve palsy one would expect that, over the 6 month observation period, most patients would show the following pattern of changes to their ocular muscle actions: firstly, an overaction of the medial rectus of the affected eye, then an overaction of the medial rectus of the contraletral eye and, finally, an underaction of the lateral rectus of the unaffected eye - something known as an inhibitional palsy. Know why a new medicine or treatment is prescribed, and how it will help you. Because his condition continued to deteriorate, a viral cause was unlikely. nerve palsy improve on their own. include: In congenital sixth nerve palsy, a problem with the sixth cranial nerve is present The eye may be slightly adducted when the patient looks straight ahead. Onset is typically sudden with symptoms of horizontal diplopia. Cranial Nerves in Health and Disease, 2nd ed. happens without any other symptoms. Orbital imaging can also aid the diagnosis of patients with high myopia to help determine if an abnormal location of the lateral rectus muscle within the orbit, not lateral rectus paresis, is the cause of the esotropia. It can also result The prisms create optical blur in direct proportion to the strength of the prism, so for large angles of esotropia they may reduce visual acuity 2-3 lines or more. The eye muscles work together to allow your eye to move in every direction. Masks Depart, 'Stomach Flu' Arrives. nervous system. 4. Over time, his eye began to drift inward toward his nose. Cranial nerve VI, also known as the abducens nerve, innervates the ipsilateral lateral rectus (LR), which functions to abduct the ipsilateral eye. To help aid the diagnosis, my dad got an MRI, depicted below: As shown, the doctor observed an unusual growth that was 0.37 cm by 0.83 cm located near the left sixth cranial nerve. Often, symptoms from Goodwin D. Differential diagnosis and management of acquired sixth cranial nerve palsy. Children with sixth nerve palsy usually dont have constant double vision. Damage at any point along its path can cause the nerve The sixth nerve has a relatively long course from its nucleus in the pons to the lateral rectus (Figure 1) and, depending on the location of the pathology, other important neurologic or anatomic structures might also be compromised (Figure 2). More than two million Americans suffer from age-related macular degeneration, which causes severe vision loss. Talk to a trusted doctor before choosing to participate in any clinical study. Know the reason for your visit and what you want to happen. This procedure is often most appropriate for those with total paralysis who, because of other health problems, are at increased risk of the anterior segment ischaemia associated with complex multi-muscle transposition procedures. Because the lateral rectus is incapable of generating abducting force to maintain eye alignment, lateral rectus resection or plication rarely produces any sustained clinical improvement. The efficacy of rectus muscle transposition surgery in esotropic Duane syndrome and VI Palsy. increased pressure inside your brain. The nerve runs in the sinus body adjacent to the internal carotid artery and oculo-sympathetic fibres responsible for pupil control, thus, lesions here might be associated with pupillary dysfunctions such as Horner's syndrome. SR = Superior Rectus; IR = Inferior Rectus. 2008; Wong A, Tweed D, Sharpe J. Vertical misalignment in unilateral sixth nerve palsy. In children, differential diagnosis is more difficult because of the problems inherent in getting infants to cooperate with a full eye movement investigation. This involves a loosening or tightening of your eye muscle to improve the alignment of your eyes. Each eye has its own lateral rectus muscle served by its own cranial nerve. What Are the Causes of Sixth Nerve Palsy? Mysterious Case of Diver Who Stabbed Himself. WebNeurologically isolated sixth nerve palsies are associated most commonly with vascular disease. It helps you move your eye sideways toward your temple. ahead. Anyone from the U.S. can register with this free program funded by NIH. So instead, he created some extra room for the tumor in order to relieve the pressure off the sixth nerve. paralyze the muscle on the other side of the eye and help eye alignment. However, many of the possible causes of sixth nerve palsy may have complications. Suite 310 Currently GARD aims to provide the following information for this disease: This section is currently in development. Quincy, MA 02169 Websixth (6th) nerve palsy. In some cases, the cause is unknown. Figure 10. Shioya A, Takuma H, Shiigai M, Ishii A, Tamaoka A. times, sixth nerve palsy may come with other symptoms. Augmentation of the full tendon transposition can be performed by placing permanent fixation sutures (red arrows) near the superior and inferior borders of the LR to pull the posterior vertical rectus bellies temporally, increasing the magnitude of abducting force. Copyright 2023 NORD National Organization for Rare Disorders, Inc. All rights reserved. Phone: 212.362.7044. recommend surgery if other treatment choices have not been effective. The affected eye may not be able to move away from the midline normally: Monday Friday, 7 a.m. 5 p.m. Leiba H, Wirth GM, Amstutz C, Landau K. Long-term results of vertical rectus muscle transposition and botulinum toxin for sixth nerve palsy. Thus, a nuclear lesion will give rise to an ipsilateral gaze palsy. If the condition is present at birth, it is usually caused by some type of trauma, neurological Your eye cant turn fully outward. Your healthcare provider may want Krzizok TH, Kaufmann H, Traupe H. New approach in strabismus surgery in high myopia. a risk for complications. Distances are scaled by 2mm slices posterior or anterior to the globe-optic nerve junction. suspected. Cinciripini GS, Donahue S, Borchert MS. Idiopathic intracranial hypertension in prepubertal pediatric patients: characteristics, treatment, and outcome. Patients must rely on the personal and individualized medical advice of their qualified health care professionals before seeking any information related to their particular diagnosis, cure or treatment of a condition or disorder.
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