Crossover trial of gabapentin and memantine as treatment for acquired nystagmus

Thurtell, Matthew J.; Joshi, Anand C.; Leone, Alice C.; Tomsak, Robert L.; Kosmorsky, Gregory S.; Stahl, John S.; Leigh, R. John

doi:10.1002/ana.21991

Cited by 88 publications

(57 citation statements)

References 18 publications

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“…In a second trial showing that gabapentin was more successful than vigabatrin in improving APN, only patients with MS were tested. 31 In contrast to the results of a recent study in a small group of patients, 10 Shery et al 8 found that gabapentin and memantine were both effective in treating APN secondary to MS but not to other neurologic diseases, which is in accordance with our personal clinical experience. Finally, the studies from Starck 21,32 showing improvement of APN with gabapentin and memantine only tested patients with MS.…”

Section: Resultssupporting

confidence: 78%

Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor

Tilikete¹,

Jasse²,

Pélisson³

et al. 2011

Neurology

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Objective: Acquired pendular nystagmus occurs mainly in multiple sclerosis (MS) and focal brainstem lesions. In the later case, it is part of the syndrome of oculopalatal tremor. Even though pathophysiology of acquired pendular nystagmus has been clearly characterized experimentally in both etiologies, there is a persisting ambiguity in clinical literature, which leads one to consider both clinical conditions as a common entity. The objective of our work was to compare in a prospective study clinical features, eye movement recording, and functional consequences of acquired pendular nystagmus in 14 patients with oculopalatal tremor and 20 patients with MS. Methods:Besides complete neurologic evaluation, evaluation of visual function, 3-dimensional eye movement recording, and functional scores of the Visual Function Questionnaire were recorded. Results:One patient with oculopalatal tremor and 15 patients with MS disclosed signs of optic neuropathy. The nystagmus in the oculopalatal group showed significant larger mean amplitude (8 deg vs 1 deg), higher mean peak velocity (16 deg/s vs 6 deg/s), lower mean frequency (1-3 Hz vs 4-6 Hz), and larger asymmetry and irregularity of ocular oscillations compared to the MS group. The vision-specific health-related quality of life was more deteriorated in the oculopalatal tremor group than in the MS group. Conclusions:This study emphasizes the need to consider acquired pendular nystagmus in MS and oculopalatal tremor as 2 different clinical entities. This is of particular importance regarding the future evaluation of potential specific effects of pharmacologic agents. Pendular nystagmus corresponds to an enduring to and fro eye oscillation without resetting quick phases. The most common causes of acquired pendular nystagmus (APN) are multiple sclerosis (MS) and focal brainstem lesions. In the later case, APN arises as a feature of the oculopalatal tremor (OPT) syndrome. OPT develops weeks, months, or even years after a single brainstem or cerebellar lesion, 1-3 in most cases a hemorrhagic stroke. It results in synchronized low-frequency tremor of the eyes and palate or other orofacial motor territories and is associated with an hypertrophic degeneration of the inferior olivary nucleus (ION), 2 leading to T2 hypersignal on MRI.1 This condition is triggered by interruption of the GuillainMollaret triangle. 2,4Even though both etiology and clinical aspects appear different in APN associated with MS or OPT, 5 many neurologists are not familiar with the distinct pathogenesis and characteristics of nystagmus in these 2 syndromes. Furthermore, some pharmacologic studies and nystagmus treatment reviews did not differentiate their results according to the underlying etiology. 6 -10 In this study, we aimed to compare clinical features, eye movement recordings, and functional consequences of APN in patients with MS or OPT. The main objective was to emphaFrom the INSERM U1028,

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Section: Resultssupporting

confidence: 78%

Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor

Tilikete¹,

Jasse²,

Pélisson³

et al. 2011

Neurology

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“…Although it may produce pronounced visual symptoms during the acute period, upbeat nystagmus often resolves spontaneously or converts to downbeat nystagmus. There are few clinical trials evaluating pharmacological treatments for this form of nystagmus, although 1 recent study has shown that it may be suppressed with memantine (8). Treatments similar to those for downbeat nystagmus, such as the aminopyridines (23), are also worth considering in patients with persistent upbeat nystagmus.…”

Section: Upbeat Nystagmusmentioning

confidence: 98%

“…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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“…Medical therapy is worth trying and gabapentin and memantin have been proposed, with clinical improvement in some patients [37,38]. The dosage of gabapentin is usually 300 mg q.i.d., up to 600 mg q.i.d.…”

Section: Discussionmentioning

confidence: 99%

Oculopalatal Tremor: Variations on a Theme by Guillain and Mollaret

Jang

Borruat²

2014

Eur Neurol

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Background: Oculopalatal tremor (OPT) is a delayed complication of a brainstem lesion, characterized by involuntary contractions of the soft palate associated with a synchronized ocular pendular nystagmus. MRI reveals inferior olivary nucleus hypersignal/hypertrophy (IONH). Our objective was to refine the clinical profile of patients with OPT and to report a few oddities in both presentation and evolution. Methods: We performed a retrospective study of patients diagnosed with OPT and a literature search. Results: From our database, we retrieved 5 men and 3 women with a diagnosis of OPT. Eighty-two patients with OPT were retrieved from the literature and were compiled with our series. The average age was 54 years and there was a male predominance. Brainstem vascular lesion was the most common etiology (80%). Prominent vertical pendular nystagmus was found in 90%. Dissociated nystagmus was mostly associated to unilateral contralateral IONH on MRI, while bilateral symmetrical nystagmus was due to a bilateral IONH in the majority of cases. Three oddities were found amongst our 8 patients: prominent nystagmus ipsilateral to IONH; disappearance of IONH on MRI despite persisting nystagmus, and asymptomatic OPT. Conclusion: The clinical profile of OPT is rather stereotyped. Rarely do patients deviate from the classical description of OPT.

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Crossover trial of gabapentin and memantine as treatment for acquired nystagmus

Cited by 88 publications

References 18 publications

Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor

Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor

Therapy for Nystagmus

Oculopalatal Tremor: Variations on a Theme by Guillain and Mollaret

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