Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin

Starck, Michaela; Albrecht, H.; Pöllmann, W.; Dieterich, Marianne; Straube, Andreas

doi:10.1007/s00415-009-5309-x

Cited by 70 publications

(36 citation statements)

References 39 publications

(35 reference statements)

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“…31 In contrast to the results of a recent study in a small group of patients, 10 Shery et al 8 found that gabapentin and memantine were both effective in treating APN secondary to MS but not to other neurologic diseases, which is in accordance with our personal clinical experience. Finally, the studies from Starck 21,32 showing improvement of APN with gabapentin and memantine only tested patients with MS.…”

Section: Resultsmentioning

confidence: 99%

Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor

Tilikete¹,

Jasse²,

Pélisson³

et al. 2011

Neurology

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Objective: Acquired pendular nystagmus occurs mainly in multiple sclerosis (MS) and focal brainstem lesions. In the later case, it is part of the syndrome of oculopalatal tremor. Even though pathophysiology of acquired pendular nystagmus has been clearly characterized experimentally in both etiologies, there is a persisting ambiguity in clinical literature, which leads one to consider both clinical conditions as a common entity. The objective of our work was to compare in a prospective study clinical features, eye movement recording, and functional consequences of acquired pendular nystagmus in 14 patients with oculopalatal tremor and 20 patients with MS. Methods:Besides complete neurologic evaluation, evaluation of visual function, 3-dimensional eye movement recording, and functional scores of the Visual Function Questionnaire were recorded. Results:One patient with oculopalatal tremor and 15 patients with MS disclosed signs of optic neuropathy. The nystagmus in the oculopalatal group showed significant larger mean amplitude (8 deg vs 1 deg), higher mean peak velocity (16 deg/s vs 6 deg/s), lower mean frequency (1-3 Hz vs 4-6 Hz), and larger asymmetry and irregularity of ocular oscillations compared to the MS group. The vision-specific health-related quality of life was more deteriorated in the oculopalatal tremor group than in the MS group. Conclusions:This study emphasizes the need to consider acquired pendular nystagmus in MS and oculopalatal tremor as 2 different clinical entities. This is of particular importance regarding the future evaluation of potential specific effects of pharmacologic agents. Pendular nystagmus corresponds to an enduring to and fro eye oscillation without resetting quick phases. The most common causes of acquired pendular nystagmus (APN) are multiple sclerosis (MS) and focal brainstem lesions. In the later case, APN arises as a feature of the oculopalatal tremor (OPT) syndrome. OPT develops weeks, months, or even years after a single brainstem or cerebellar lesion, 1-3 in most cases a hemorrhagic stroke. It results in synchronized low-frequency tremor of the eyes and palate or other orofacial motor territories and is associated with an hypertrophic degeneration of the inferior olivary nucleus (ION), 2 leading to T2 hypersignal on MRI.1 This condition is triggered by interruption of the GuillainMollaret triangle. 2,4Even though both etiology and clinical aspects appear different in APN associated with MS or OPT, 5 many neurologists are not familiar with the distinct pathogenesis and characteristics of nystagmus in these 2 syndromes. Furthermore, some pharmacologic studies and nystagmus treatment reviews did not differentiate their results according to the underlying etiology. 6 -10 In this study, we aimed to compare clinical features, eye movement recordings, and functional consequences of APN in patients with MS or OPT. The main objective was to emphaFrom the INSERM U1028,

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Section: Resultsmentioning

confidence: 99%

Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor

Tilikete¹,

Jasse²,

Pélisson³

et al. 2011

Neurology

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“…Because potassium channels are abundant on cerebellar Purkinje cells, the aminopyridines may increase their discharge. The Gabapentin (8,9,16,45,77) Memantine (8,9,33,47,77) 4-Aminopyridine (20,23) and 3,4-diaminopyridine (19,24,21) Baclofen (14,16,29,37) Clonazepam (12) Valproate (43) Trihexyphenidyl (17,18,58) Benztropine (17) Scopolamine ( (142) enhanced Purkinje cell activity could then restore normal levels of inhibition of vertical vestibular eye movements, leading to suppression of the nystagmus (22). However, 4-aminopyridine suppresses upbeat nystagmus in some patients (23), and it may occasionally cause downbeat nystagmus to convert to upbeat nystagmus (24).…”

Section: Downbeat Nystagmusmentioning

confidence: 98%

Therapy for Nystagmus

Thurtell

Leigh

2010

Journal of Neuro-Ophthalmology

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Pathological forms of nystagmus and their visual consequences can be treated using pharmacological, optical, and surgical approaches. Acquired periodic alternating nystagmus improves following treatment with baclofen, and downbeat nystagmus may improve following treatment with aminopyridines. Gabapentin and memantine are helpful in reducing acquired pendular nystagmus due to multiple sclerosis. Ocular oscillations in oculopalatal tremor may also improve following treatment with memantine or gabapentin. The infantile nystagmus syndrome (INS) may have only a minor impact on vision if "foveation periods" are well developed, but symptomatic patients may benefit from treatment with gabapentin, memantine, or base-out prisms to induce convergence. Several surgical therapies are also reported to improve INS, but selection of the optimal treatment depends on careful evaluation of visual acuity and nystagmus intensity in various gaze positions. Electro-optical devices are a promising and novel approach for treating the visual consequences of acquired forms of nystagmus.

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“…Standard dosage Memantine is often effective for APN and OPT at a dose of 10 mg four times daily [12•,13•,15,Class II]. In some patients with APN, complete suppression is possible with a total dose of 60 mg per day, but side effects are frequent [15,Class II].…”

Section: Memantinementioning

confidence: 99%

Treatment of Nystagmus

Thurtell

Leigh

2011

Curr Treat Options Neurol

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Patients with congenital and acquired forms of nystagmus are commonly encountered in clinical practice. Many report visual symptoms, such as oscillopsia and blurred vision, which can be alleviated if the nystagmus can be suppressed. Pharmacologic, optical, and surgical treatments are available, with the choice of treatment depending on the characteristics of the nystagmus and the severity of the associated visual symptoms. Downbeat nystagmus can be treated with 4-aminopyridine, 3,4-diaminopyridine, or clonazepam. Upbeat nystagmus can be reduced with memantine, 4-aminopyridine, or baclofen. Torsional nystagmus may respond to gabapentin. Acquired pendular nystagmus in patients with multiple sclerosis is often partially suppressed by gabapentin or memantine. Acquired pendular nystagmus in patients with oculopalatal tremor can respond to gabapentin, memantine, or trihexyphenidyl. Although acquired periodic alternating nystagmus is often completely suppressed by baclofen, memantine can be effective in refractory cases. Seesaw nystagmus can be reduced with alcohol, clonazepam, or memantine. Infantile nystagmus may not cause significant visual symptoms if "foveation periods" are well developed, but the nystagmus can be treated in symptomatic patients with gabapentin, memantine, acetazolamide, topical brinzolamide, contact lenses, or base-out prisms to induce convergence. Several surgical therapies have also been reported to improve infantile nystagmus syndrome (INS), but selection of the appropriate therapy requires preoperative evaluation of visual acuity and nystagmus intensity in different gaze positions. Other treatment options for nystagmus include botulinum toxin injections into the extraocular muscles or retrobulbar space. Electro-optical devices are currently being developed, in order to noninvasively negate the visual consequences of nystagmus.

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Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin

Cited by 70 publications

References 39 publications

Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor

Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor

Therapy for Nystagmus

Treatment of Nystagmus

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