Congenital nystagmus: Randomized, controlled, double‐masked trial of memantine/gabapentin

McLean, Rebecca J.; Proudlock, Frank A; Stiefmeier, Thomas; Degg, C.; Gottlob, Irène

doi:10.1002/ana.21065

Cited by 121 publications

(73 citation statements)

References 23 publications

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“…Because potassium channels are abundant on cerebellar Purkinje cells, the aminopyridines may increase their discharge. The Gabapentin (8,9,16,45,77) Memantine (8,9,33,47,77) 4-Aminopyridine (20,23) and 3,4-diaminopyridine (19,24,21) Baclofen (14,16,29,37) Clonazepam (12) Valproate (43) Trihexyphenidyl (17,18,58) Benztropine (17) Scopolamine ( (142) enhanced Purkinje cell activity could then restore normal levels of inhibition of vertical vestibular eye movements, leading to suppression of the nystagmus (22). However, 4-aminopyridine suppresses upbeat nystagmus in some patients (23), and it may occasionally cause downbeat nystagmus to convert to upbeat nystagmus (24).…”

Section: Downbeat Nystagmusmentioning

confidence: 98%

Therapy for Nystagmus

Thurtell

Leigh

2010

Journal of Neuro-Ophthalmology

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Pathological forms of nystagmus and their visual consequences can be treated using pharmacological, optical, and surgical approaches. Acquired periodic alternating nystagmus improves following treatment with baclofen, and downbeat nystagmus may improve following treatment with aminopyridines. Gabapentin and memantine are helpful in reducing acquired pendular nystagmus due to multiple sclerosis. Ocular oscillations in oculopalatal tremor may also improve following treatment with memantine or gabapentin. The infantile nystagmus syndrome (INS) may have only a minor impact on vision if "foveation periods" are well developed, but symptomatic patients may benefit from treatment with gabapentin, memantine, or base-out prisms to induce convergence. Several surgical therapies are also reported to improve INS, but selection of the optimal treatment depends on careful evaluation of visual acuity and nystagmus intensity in various gaze positions. Electro-optical devices are a promising and novel approach for treating the visual consequences of acquired forms of nystagmus.

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Section: Downbeat Nystagmusmentioning

confidence: 98%

Therapy for Nystagmus

Thurtell

Leigh

2010

Journal of Neuro-Ophthalmology

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“…It can be started at a lower dose (e.g., 300 mg daily for several days) and then gradually titrated upward according to beneficial response and side effects (e.g., to 300 mg two times daily for several days, 300 mg three times daily for several days, and then 300 mg four times daily). Patients with INS may require higher doses (e.g., up to 600 mg four times daily) to achieve a beneficial response [14,Class I].…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Treatment of Nystagmus

Thurtell

Leigh

2011

Curr Treat Options Neurol

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Patients with congenital and acquired forms of nystagmus are commonly encountered in clinical practice. Many report visual symptoms, such as oscillopsia and blurred vision, which can be alleviated if the nystagmus can be suppressed. Pharmacologic, optical, and surgical treatments are available, with the choice of treatment depending on the characteristics of the nystagmus and the severity of the associated visual symptoms. Downbeat nystagmus can be treated with 4-aminopyridine, 3,4-diaminopyridine, or clonazepam. Upbeat nystagmus can be reduced with memantine, 4-aminopyridine, or baclofen. Torsional nystagmus may respond to gabapentin. Acquired pendular nystagmus in patients with multiple sclerosis is often partially suppressed by gabapentin or memantine. Acquired pendular nystagmus in patients with oculopalatal tremor can respond to gabapentin, memantine, or trihexyphenidyl. Although acquired periodic alternating nystagmus is often completely suppressed by baclofen, memantine can be effective in refractory cases. Seesaw nystagmus can be reduced with alcohol, clonazepam, or memantine. Infantile nystagmus may not cause significant visual symptoms if "foveation periods" are well developed, but the nystagmus can be treated in symptomatic patients with gabapentin, memantine, acetazolamide, topical brinzolamide, contact lenses, or base-out prisms to induce convergence. Several surgical therapies have also been reported to improve infantile nystagmus syndrome (INS), but selection of the appropriate therapy requires preoperative evaluation of visual acuity and nystagmus intensity in different gaze positions. Other treatment options for nystagmus include botulinum toxin injections into the extraocular muscles or retrobulbar space. Electro-optical devices are currently being developed, in order to noninvasively negate the visual consequences of nystagmus.

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“…3 Medications such as gabapentin and memantine (glutamate antagonist) have been tried with some success. 4 Pediatricians and, more specifically, pediatric neurologists should be aware of the characteristics of congenital idiopathic nystagmus. Ruling out an underlying ocular or neurological condition is necessary.…”

Section: Discussionmentioning

confidence: 99%