EFNS task force – therapy of nystagmus and oscillopsia

Straube, Andreas; Leigh, R. John; Bronstein, Adolfo M.; Heide, Wolfgang; Riordan-Eva, Paul; Tijssen, Cees; Dehaene, I.; Straumann, Dominik

doi:10.1046/j.1468-1331.2003.00754.x

Cited by 68 publications

(29 citation statements)

References 71 publications

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“…It is difficult to establish an evidence-based therapy for symptoms as rare as APN [43]. One treatment option is the use of prisms or adaptive filters [37][38][39] to improve image Most studies have focused on various drugs, especially antiepileptic drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with acquired fixational pendular nystagmus (APN), a very distressing oculomotor finding in multiple sclerosis (MS), often experience oscillopsia and blurred vision, all of which interfere with their ability to read, watch television, or even to visually stabilize their posture [23,26,43]. The pathophysiology and exact site of the causal lesions are not yet known [1,11,26,40].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Starck¹,

Albrecht²,

Pöllmann³

et al. 2009

J Neurol

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A prospective examiner-blind, cross-over study was conducted to compare the efficacy of memantine (40 or 60 mg/day) and gabapentin (1,200 mg/day) as therapy for acquired fixational pendular nystagmus (APN) in 11 patients with multiple sclerosis. APN was documented in 20 eyes by electrooculography (EOG). The primary objective of the study was an at least 50% reduction in amplitude and/or frequency of APN compared with baseline values in EOG. This aim was reached for 17 of 20 APN-affected eyes with memantine 40-60 mg and for 11 eyes with gabapentin up to 1,200 mg. A complete cessation of APN was achieved in eight eyes (four patients) with memantine 40 mg and in a further four eyes (two patients) with memantine 60 mg. One patient achieved the same benefit with memantine 40 mg and gabapentin. In two other eyes APN completely subsided with gabapentin 1,200 mg only, but not with memantine. Near visual acuity, a secondary outcome parameter, improved by at least 0.1 in 11 of 17 eyes treated with memantine and in 8 out of 16 eyes treated with gabapentin. In summary, memantine and gabapentin are safe and effective treatment options for APN.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Starck¹,

Albrecht²,

Pöllmann³

et al. 2009

J Neurol

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show abstract

“…Downbeat nystagmus has been reported to respond to 3.4 diaminopiridine and to 4 aminopiridine [45] and this important observation awaits further clinical confirmation. A recent review on the treatment of nystagmus and oscillopsia has just been published but, admittedly, all treatment recommendations are classified as evidence based type "C", since no double blind trials are available [44].…”

Section: ■ Treatment Of Oscillopsiamentioning

confidence: 99%

Vision and vertigo

Bronstein

2004

Journal of Neurology

150

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This review deals with two syndromes, oscillopsia and visual vertigo. Oscillopsia is the illusion of oscillation of the visual surroundings. For diagnosis purposes one should ask, when does the oscillopsia occur? If oscillopsia is only present during head (or whole body) movements, the likely underlying cause is a bilateral defect in the vestibulo-ocular reflex (VOR). The more common causes are post meningitic vestibular damage, gentamicin ototoxicity or bilateral idiopathic vestibular failure. When oscillopsia develops after specific head positions, it is usually due to a positional nystagmus, usually the result of brainstem-cerebellar disease. When the oscillopsia is largely unrelated to head movements, one should ask, is it fairly constant or is it in attacks (paroxysmal)? If the oscillopsia is constant it is usually due to the presence of a clinically observable nystagmus; the most common is downbeat nystagmus but the most visually disabling is pendular nystagmus. If the oscillopsia comes in brief attacks it is usually due to a paroxysmal nystagmus as observed in irritative VIII nerve and brainstem lesions. However, the most common cause of paroxysmal oscillopsia is a non organic condition called voluntary nystagmus. Treatment of oscillopsia is often pharmacological but disappointing; the best chance of success is carbamazepine for paroxysmal disorders secondary to structural vestibular nerve/nuclear lesions.Visual vertigo should not be confused with oscillopsia. It can be defined as dizziness provoked by visual environments with large size (full field) repetitive or moving visual patterns. Patients with visual vertigo report discomfort in supermarkets and when viewing movement of large visual objects, eg crowds, traffic, clouds or foliage. Visual vertigo is present in many patients with a history of a peripheral vestibular disorder, particularly those who are visually dependent (ie subjects who use vision preferentially for postural and space orientation control). Patients with visual vertigo benefit from the addition to their standard vestibular rehabilitation of optic flow (optokinetic) stimuli and exercises involving visuo-vestibular conflict.

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“…Complete withdrawal was possible after 1 year in the first patient, the second patient is still on clonazepam, even after 5 years. In the literature clonazepam was shown to be either useful or ineffective [7][8][9] . The dose was, however, not noted or low in some of these patients.…”

Section: Discussionmentioning

confidence: 99%

Effective High-Dose Clonazepam Treatment in Two Patients with Opsoclonus and Myoclonus: GABAergic Hypothesis

Bartoš¹

2006

Eur Neurol

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EFNS task force – therapy of nystagmus and oscillopsia

Cited by 68 publications

References 71 publications

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

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

Vision and vertigo

Effective High-Dose Clonazepam Treatment in Two Patients with Opsoclonus and Myoclonus: GABAergic Hypothesis

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