Current treatment of nystagmus

Abstract

Acquired and congenital nystagmus often causes decreased visual acuity as a direct result of the inability to maintain stable foveal vision. In addition, acquired nystagmus causes a disabling subjective sensation of movement of the visual world called oscillopsia. The eye movements themselves do not require treatment if the patient is asymptomatic. However, therapy is necessary if visual disability is present. Treatments based in pharmacologic mechanisms are preferred. There are few controlled treatment trials and therapeutic efficacy generally is sought in a trial and error approach, depending on the type of nystagmus present. Treatment with 3,4-diaminopyridine and 4-aminopyridine recently have been shown to be effective for downbeat nystagmus. Gabapentin, baclofen, and clonazepam also are useful in some patients with downbeat nystagmus. Baclofen is the therapy of choice for periodic alternating nystagmus. Gabapentin often is effective for acquired pendular nystagmus. Clonazepam and valproate also may be effective for acquired pendular nystagmus. Memantine now is available in the United States and is promising in the treatment of pendular nystagmus. Optical devices that negate the negative effects of nystagmus continue to undergo development research. These and other medical, surgical, and optical devices are potentially useful alone or in combination with other therapies.

Psychotropic Drugs and Ocular Side Effects

“…[72][73][74] In the year of 2001, Young et. al 75 have shown that clonazepam is 100% effective in treatment of 5 patients with idiopathic downbeat nystagmus.…”

The Effect of Horizontal Extraocular Muscle Surgery on the Heimann-Bielschowsky Phenomenon

“…2 Hertle et al 3 reported that horizontal rectus tenotomy could result in improvement of subjective visual function and nystagmus amplitude in patients with congenital nystagmus. The authors postulated that the clinical and electrophysiological effects of extraocular muscle tenotomy in patients with congenital nystagmus have been attributed to an interruption of the afferent proprioceptive loop, resulting in a damped peripheral ocular motor response to the nystagmus signal.…”

Memantine/gabapentin for the treatment of congenital nystagmus

“…The authors have brought both memantine and gabapentin squarely into the growing armamentarium of pharmacologic approaches to the treatment of CIN and, to a lesser extent, acquired nystagmus [1,2]. Most of the recommendations for drug treatment of nystagmus are made on the basis of "by-guess-and by-golly" utilization of drugs based on individual case reports and small patient series.…”

“…Such reports provide the stimulus for randomized, prospective, double-masked studies such as this one. Other drugs, including 3, 4 diaminopyridine, 4-aminopyridine, clonazepam, valproate, and baclofen, have been studied and need larger trials to determine their firm place in treating nystagmus [1]. In the meantime, other techniques, including surgical approaches, contact lenses, and the use of prisms, are alternatives to medication [3,4].…”