Medical Treatment of Nystagmus and Its Visual Consequences

Stahl, John S.; Plant, Gordon T.; Leigh, R. John

doi:10.1177/014107680209500505

Cited by 17 publications

(20 citation statements)

References 25 publications

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“…Baclofen at 5 to 10 mg three times a day dose completely abolishes the nystagmus in most patients [32,33]. Some patients with periodic alternating nystagmus might benefit from the addition of memantine [34].…”

Section: Treatment Of Nystagmusmentioning

confidence: 99%

Neuro-ophthalmology of type 1 Chiari malformation

Shaikh

Ghasia

2015

Expert Review of Ophthalmology

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Chiari malformation is a congenital deformity leading to herniation of cerebellar tonsils. Headache is a typical symptom of this condition, but patients with Chiari malformation often present with double vision and vertigo. Examination of eye movements in such patients often reveals nystagmus and strabismus. Eye movement deficits in the context of typical symptomatic presentation are critical clinical markers for the diagnosis of Chiari malformation. We will review eye movement deficits that seen in patients with type 1 Chiari malformation. We will then discuss the underlying pathophysiology and therapeutic options for such deficits.

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Section: Treatment Of Nystagmusmentioning

confidence: 99%

Neuro-ophthalmology of type 1 Chiari malformation

Shaikh

Ghasia

2015

Expert Review of Ophthalmology

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“…77 The treatment of choice is the GABA-ergic drug baclofen in a dosage of 5-10 mg three times daily, which abolishes periodic alternating nystagmus in most patients. 78 There have been no randomized, controlled trials so far.…”

Section: Periodic Alternating Nystagmusmentioning

confidence: 99%

Pharmacotherapy of Vestibular Disorders and Nystagmus

2013

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Vertigo and dizziness are with a life-time prevalence of ~30% among the most common symptoms and are often associated with nystagmus or other oculomotor disorders. The prerequisite for a successful treatment is a precise diagnosis of the underlying disorder. In this overview, the current pharmacological treatment options for peripheral and central vestibular, cerebellar, and oculomotor disorders including nystagmus are described. There are basically seven groups of drugs that can be used (the "7 As"): antiemetics; anti-inflammatory, anti-Menière's, and antimigraine medications; antidepressants, anticonvulsants, and aminopyridines. In acute vestibular neuritis, recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Menière's disease, a long-term high-dose treatment with betahistine-dihydrochloride (at least 48 mg three times daily) had a significant effect on the frequency of the attacks; the underlying mode of action is evidently an increase in inner-ear blood flow. The use of aminopyridines is a well-established therapeutic principle in the treatment of downbeat and upbeat nystagmus as well as episodic ataxia type 2 and cerebellar gait disorders. As was shown in animal experiments, these potassium channel blockers increase the activity and excitability and normalize irregular firing of cerebellar Purkinje cells. They evidently augment the inhibitory influence of these cells on vestibular and deep cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus; gabapentin and memantine improve pendular and infantile nystagmus. However, many other eye-movement disorders such as ocular flutter, opsoclonus, central positioning, and see-saw nystagmus are still difficult to treat. Although substantial progress has been made, further state-of-the-art trials must still be performed on many vestibular and oculomotor disorders, namely Menière's disease, vestibular paroxysmia, vestibular migraine, and many forms of central eye-movement disorders.

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“…These lesions alter the velocity-storage mechanism in the brainstem, as has been shown in animal studies, and the oscillations are, therefore, thought to arise from disinhibition of the optokinetic–vestibular system [106]. The treatment of choice for PAN is the GABAergic drug baclofen (5–10 mg tid), which completely abolishes the nystagmus in most patients [107, 108]. Memantine may be added, if necessary [109].…”

Section: Pathological Nystagmus and Saccadic Intrusionsmentioning

confidence: 99%

Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus

Strupp¹,

et al. 2011

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We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the “4 D’s”: correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the “7 A’s”) that can be used: antiemetics; anti-inflammatory, anti-Ménière’s, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière’s disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal “pacemaker” activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière’s disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine.

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Medical Treatment of Nystagmus and Its Visual Consequences

Cited by 17 publications

References 25 publications

Neuro-ophthalmology of type 1 Chiari malformation

Neuro-ophthalmology of type 1 Chiari malformation

Pharmacotherapy of Vestibular Disorders and Nystagmus

Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus

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