Recovery from cortical blindness with mepivacaïne

Abstract

We report the case of a patient suffering from cortical blindness following bilateral occipital stroke, who recovered normal vision in his right visual field following injection of the local anesthetic mepivacaïne. The effect was transient but reproducible, allowing the patient to lead a normal life. Effect duration increased after adjunction of paroxetine. We provide anatomical and functional brain imaging correlates of this improvement, showing particularly how functional connectivity is restored between intact perilesional cortex and distant brain regions. This serendipitous finding may potentially benefit patients suffering from visual but also nonvisual handicap following brain lesions.

Paroxetine can improve primary visual cortex activity in a high-risk mouse model of schizophrenia

“…Because risperidone alone cannot improve neural activity, but risperidone and paroxetine can improve neural activity, perhaps paroxetine antagonizes risperidone in the HRMMS visual cortex. This idea is consistent with the suggestion that the 5-HT serotonin system interacts reciprocally with the dopamine system in the human visual cortex to improve visual cortex activity [10][11][12].…”

“…However, the strategies to improve visual disturbances in schizophrenia patients remain limited [7,8]. By exploring methods to protect from visual disturbances in individuals at high risk of schizophrenia, the downstream disease symptoms may be prevented [9,10].…”

“…Thus, we designed a pilot animal study to investigate the functional changes in the primary visual cortex induced by pharmacological agents. Previous MRI analyses showed that paroxetine, an antidepressant, can improve visual cortex activity [10][11][12], but it is unknown whether antipsychotic agents can improve visual cortex activity [9]. Using our novel high-risk mouse model of schizophrenia (HRMMS), we aimed (1) to determine whether the offspring of high-risk mice had primary visual cortex functional impairments when compared to healthy control offspring and (2) to determine whether early treatment with pharmacological agents can improve the primary visual cortex functional activity.…”

Visual stimulation rehabilitation for cortical blindness after vertebral artery interventional surgery: A case report and literature review

“…We searched the PubMed database for clinical studies conducted in patients with complete cortical blindness due to various causes over the past 10 years and summarized in Table 1 . We focused on the type of neurophysiological examination performed, treatment modality, and outcomes [ 7 , 8 , 15 , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ]. The search strategy was “Blindness, cortical/rehabilitation”[Mesh] OR “Blindness, Cortical/therapy”[Mesh].…”

“…Physical therapists should consider the use of medications such as valproic acid, carbamazepine, and antipsychotics to improve recovery engagement. Furthermore, in terms of medicine for cortical blindness, injection of the local anesthetic mepivacaine [ 32 ] and treatment with cortisol [ 33 , 36 ] and plasma exchange [ 31 ] have been shown in case studies to bring about visual recovery. However, due to the variable pathogenic factors of cortical blindness, the effectiveness of such drugs needs to be verified in large clinical samples and multi-etiological populations.…”