Thank you for your interest in our case report. We appreciate your contribution of information about the genetics underlying chronic progressive external ophthalmoplegia (CPEO). Readers will benefit from these additional details, including that mitochondrial disorders may frequently be accompanied by headaches. We agree with your comments about the diagnosis of CPEO and that there are other treatments for patients mitochondrial disorders that may help their symptoms.
The intent of this case report was to describe “treatment aimed at maintaining the best functioning as possible in patients who cannot become free of disease or symptoms”.1 As stated in the limitations section of our paper “no determination of cause and effect can be made.” The patient had no known changes involving neuropathy, myopathy, carotid stenosis, cardiac disease, or autonomic disturbances during the course of his care. We are aware that these can be complicating factors.
Thank you for your contribution and your communication.
References
- 1.Russell BS, Hosek RS, Hoiriis KT, Drake ED. Chronic Progressive External Ophthalmoplegia and Bilateral Vestibular Hypofunction: balance, gait, and eye movement before and after multimodal chiropractic care: a case study. J Chiropr Med. 2019 Jun;18(2):144–154. doi: 10.1016/j.jcm.2018.11.004. [DOI] [PMC free article] [PubMed] [Google Scholar]