Treatment for Nystagmus
Seong-Hae Jeong
Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
Treatment for Nystagmus
Seong-Hae Jeong Chungnam National University Hospital
Goals of Treatment
Clear vision
Visual fixation
Eccentric
gaze-
holding
mechanism
VOR
Clin Neuroophthalmol 6(Suppl):S27-34, April 2016 S28 http://neuro-ophthalmology.co.kr
Physiologic movement eye
Nystagmus slow-phase
speed
Tenotomy or botulinum toxin
Not require specific Treatment
Infantile nystagmus
Peripheral vestibular nystagmus
Drug intoxication
General Approaches to Treatment
medical optical surgical
Acquired
Downbeat nystagmus
Upbeat nystagmus
Torsional nystagmus
Gaze-evoked nystagmus
Seesaw nystagmus
Periodic alternating nystagmus
Acquired pendular nystagmus in MS
Acquired pendular nystagmus in OPT
Congenial
Infantile nystagmus syndrome
Other congenital nystagmus
Acquired
Downbeat nystagmus
Upbeat nystagmus
Torsional nystagmus
Gaze-evoked nystagmus
Seesaw nystagmus
Periodic alternating nystagmus
Acquired pendular nystagmus in MS
Acquired pendular nystagmus in OPT
Congenial
Infantile nystagmus syndrome
Other congenital nystagmus
Downbeat nystagmus
Acquired cerebellar degenerations
Stroke
Hindbrain anomalies (e.g., Chiari malformation)
Multiple sclerosis
Medications(lithium, anticonvulsants, opoioids)
Idiopathic
HIRSCHBERG’S TEST: CORNEAL LIGHT REFLEX
Rough measure of deviation
Note location of corneal light reflex
1mm = 7°, or 15 ∆
Clin Neuroophthalmol 6(Suppl):S27-34, April 2016 S30 http://neuro-ophthalmology.co.kr
1. Involvement of excitatory burst neurons in the PPRF
: SCA2 (Horn AKE et al, Neuro-ophthalmology 1996;16:229-240) Experimental slow saccades by injecting lidocaine into the PPRF (Barton et al., 2003)
2. Lesions of the omnipuase neurons
: using experimental excitotoxins are also reported to cause slow horizontal and vertical saccades. (Kaneko CRS, J Neurophysiol 1996;75:2229-2242) 3. Both burst (PPRF) and omnipause cell populations may be affected : slow saccade after cardiac surgery (Hanson, et al. Ann Neurol 1986;20;209-217)
4. It is also possible that disturbance of other inputs to the posterior burst
neurons (i.e., LLBN) could lead to slow saccades. For example, acute
inactivation of the superior colliculus causes slow saccades in monkey.
Upbeat nystagmus
Baclofen
JNNP 1991burst neurons for vertical and torsional saccades
: vertical saccadic paresis
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Gaze-Evoked Nystagmus
Because gaze-evoked nystagmus does not usually produce visual symptoms, it does not need specific treatment.
Acquired pendular Nystagmus
Oculopalatal tremor
Mefloquine
Proc Natl Acad Sci USA 2004 Clonazepam
Neurology 2006 Gabapentin and Memantine
Ann Neurol 2010Ann Neurol 2010
and reduced visual acuity. During treatment with gabapentin 1,200 mg/day, there was substantial decrease in his nystagmus and his visual acuity improved (Video 11–18). (B) Axial T2-weighted magnetic resonance imaging (MRI) showed an old pontine tegmental infarction (left panel; arrowhead) and hypertrophy of the right inferior olivary nucleus (indicated by arrowhead).
Chapter: Acquired Pendular Nystagmus and its Relationship to Visual Pathways Author(s): R. John Leigh and David S. Zee
From: The Neurology of Eye Movements (5 ed.)
Downloaded from Oxford Medicine Online. © Oxford University Press, 2015
Seesaw and hemiseesaw nystagmus
Pendular seesaw nystagmus: alcohol or clonazepam
Rev Neurol 1995 Mematine
Ann Neurol 2010Treatment of nystagmus in EA2
Acetazolamide
Neurology 1978 4-aminopyridone Neurology 2011
Dalfampridine
Flunarizine
Eur Neurol 2006Treatment of Congenital nystagmus Treatment of Congenital nystagmus
Channelopathy
Semin Ophthalmol. 2006; 21:83–86 Oral acetazolamide
Open Ophthalmol J 2010 Topical brinzolamide
JNO 2011 Gene therapy – Leber’s congenital amaurosis
NEJM 2009http://bcove.me/53hssnmr
Clin Neuroophthalmol 6(Suppl):S27-34, April 2016 S34 http://neuro-ophthalmology.co.kr
Treatment of Saccadic Intrusions and Oscillations
Memantine
Benzodiazepines
Treatments for ocular flutter and opsoclonus
Propranolol
Clonazepam
Gabapentin
Topiramate
IVIG
Corticosteroids
ACTH
Rituximab
Ofatumumab
Optical treatments of abnormal eye movements
http://bcove.me/in111er2
Procedures to Weaken in EOM
Application of somatosensory or Auditory stimuli to suppress nystagmus
Figure 11–27 Effects of vibration at 100 Hz over the left mastoid process on monocular nystagmus in a patient with multiple sclerosis (Video 11–17). The nystagmus immediately decreases in amplitude after the stimulus is applied and continues to decrease during the stimulation period (gray area), increasing promptly when the stimulus is stopped.
Chapter: Treatments for Nystagmus and Saccadic Intrusions Author(s): R. John Leigh and David S. Zee From: The Neurology of Eye Movements (5 ed.) Downloaded from Oxford Medicine Online.
Reproduced with permission from Beh
SC, Tehrani AS, Kheradmand A, Zee DS.
Damping of monocular pendular nystagmus with vibration in a patient with multiple sclerosis.
Neurology. 2014; 821: 380–381.