Can repetitive transcranial magnetic stimulation of the visual cortex ameliorate the state of patients with visual snow?

Grey, V; Klobušiaková, Patrícia; Minks, Eduard

doi:10.4149/bll_2020_064

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…Grey et al applied TMS at 10 and 10 + 1 Hz over occipital brain areas during 20 sessions in nine patients. They found an improvement of VS intensities after the 10 + 1 Hz application, but no significant difference of the comparison to Sham or 10 Hz ( 64 ).…”

Section: Resultsmentioning

confidence: 95%

Visual Snow Syndrome as a Network Disorder: A Systematic Review

Schankin

2021

Front. Neurol.

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Aim: By reviewing the existing clinical studies about visual snow (VS) as a symptom or as part of visual snow syndrome (VSS), we aim at improving our understanding of VSS being a network disorder.Background: Patients with VSS suffer from a continuous visual disturbance resembling the view of a badly tuned analog television (i.e., VS) and other visual, as well as non-visual symptoms. These symptoms can persist over years and often strongly impact the quality of life. The exact prevalence is still unknown, but up to 2.2% of the population could be affected. Presently, there is no established treatment, and the underlying pathophysiology is unknown. In recent years, there have been several approaches to identify the brain areas involved and their interplay to explain the complex presentation.Methods: We collected the clinical and paraclinical evidence from the currently published original studies on VS and its syndrome by searching PubMed and Google Scholar for the term visual snow. We included original studies in English or German and excluded all reviews, case reports that did not add new information to the topic of this review, and articles that were not retrievable in PubMed or Google Scholar. We grouped the studies according to the methods that were used.Results: Fifty-three studies were found for this review. In VSS, the clinical spectrum includes additional visual disturbances such as excessive floaters, palinopsia, nyctalopia, photophobia, and entoptic phenomena. There is also an association with other perceptual and affective disorders as well as cognitive symptoms. The studies that have been included in this review demonstrate structural, functional, and metabolic alterations in the primary and/or secondary visual areas of the brain. Beyond that, results indicate a disruption in the pre-cortical visual pathways and large-scale networks including the default mode network and the salience network.Discussion: The combination of the clinical picture and widespread functional and structural alterations in visual and extra-visual areas indicates that the VSS is a network disorder. The involvement of pre-cortical visual structures and attentional networks might result in an impairment of “filtering” and prioritizing stimuli as top-down process with subsequent excessive activation of the visual cortices when exposed to irrelevant external and internal stimuli. Limitations of the existing literature are that not all authors used the ICHD-3 definition of the VSS. Some were referring to the symptom VS, and in many cases, the control groups were not matched for migraine or migraine aura.

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Section: Resultsmentioning

confidence: 95%

Visual Snow Syndrome as a Network Disorder: A Systematic Review

Schankin

2021

Front. Neurol.

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“…Patients also report wearing sunglasses to reduce light sensitivity, improvement with healthy sleep and diet habits, and learning how to ignore symptoms [50]. Repetitive transcranial magnetic stimulation (rTMS) as a potential treatment for VSS is in the pipeline; a preliminary study in nine patients showed a potential improvement [80] and an open-label treatment trial is ongoing [81]. A clinical trial using neurofeedback is also currently ongoing, with the idea of teaching patients to downregulate activity in different regions of the visual cortex (NeurofeebackSnow, NCT04902365).…”

Section: Treatmentmentioning

confidence: 99%

Differential Diagnosis of Visual Phenomena Associated with Migraine: Spotlight on Aura and Visual Snow Syndrome

et al. 2023

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Migraine is a severe and common primary headache disorder, characterized by pain as well as a plethora of non-painful symptoms. Among these, visual phenomena have long been known to be associated with migraine, to the point where they can constitute a hallmark of the disease itself. In this review we focus on two key visual disorders that are directly or indirectly connected to migraine: visual aura and visual snow syndrome (VSS). Visual aura is characterized by the transient presence of positive and negative visual symptoms, before, during or outside of a migraine attack. VSS is a novel stand-alone phenomenon which has been shown to be comorbid with migraine. We discuss key clinical features of the two disorders, including pathophysiological mechanisms, their differential diagnoses and best treatment practices. Our aim is to provide an aid for clinicians and researchers in recognizing these common visual phenomena, which can even appear simultaneously in patients with an underlying migraine biology.

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“…18 In some neurodegenerative and ocular diseases, VS was refractory to any treatment. 18 Color filters of the yellowblue color spectrum 41 and repetitive transcranial magnetic stimulation of the visual cortex 42 are also helpful in some patients with VSS. These strategies can be used to treat secondary VS in refractory cases.…”

Section: Discussionmentioning

confidence: 99%