Downbeat nystagmus with a pseudocycloid waveform: Improvement with base‐out prisms

Lavin, P. J. M.; Traccis, S.; Dell’Osso, Louis F.; Abel, Larry A; Ellenberger, Christoph

doi:10.1002/ana.410130607

Cited by 31 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With baseout prisms, some individuals with INS experience an improvement of vision that is sufficient to qualify them for a driving license. Occasional patients with acquired nystagmus may benefit from prisms (90). Those whose nystagmus is worse during near viewing may respond to base-in prisms, which reduce convergence effort (91).…”

Section: Optical Treatmentsmentioning

confidence: 99%

Therapy for Nystagmus

Thurtell

Leigh

2010

Journal of Neuro-Ophthalmology

View full text Add to dashboard Cite

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.

show abstract

Section: Optical Treatmentsmentioning

confidence: 99%

Therapy for Nystagmus

Thurtell

Leigh

2010

Journal of Neuro-Ophthalmology

View full text Add to dashboard Cite

show abstract

“…In addition, 2 previously reported patients with chronic DBN probably had a prior episode of thiamine deficiency. 11,12 The frequent association with WE in our patients and the literature suggests that thiamine deficiency affects neurons involved in the control of vertical eye movements.…”

mentioning

confidence: 62%

Conversion of upbeat to downbeat nystagmus in Wernicke encephalopathy

Kattah

Tehrani

et al. 2018

Neurology

View full text Add to dashboard Cite

ObjectiveTo explain (1) why an initial upbeat nystagmus (UBN) converts to a permanent downbeat nystagmus (DBN) in Wernicke encephalopathy (WE) and (2) why convergence and certain vestibular provocative maneuvers may transiently switch UBN to DBN.MethodsFollowing a literature review and study of our 2 patients, we develop hypotheses for the unusual patterns of vertical nystagmus in WE.ResultsOur overarching hypothesis is that there is a selective vulnerability and a selective recovery from thiamine deficiency of neurons within brainstem gaze-holding networks. Furthermore, since the circuits affected in WE are commonly paraventricular, especially medially, just under the floor of the fourth ventricle where lie structures important for control of vertical gaze, we suggest the patterns of involvement in WE also reflect a breakdown in vulnerable areas of the blood–brain barrier. Many of the initial deficits of our patients improved over time, but their DBN did not. Irreversible changes in paramedian tract neurons, which project to the cerebellar flocculus, may be the cause. Here we suggest that conversion of UBN to permanent DBN points to thiamine deficiency and may argue for a chronic, nonprogressive DBN/truncal ataxia syndrome. Finally, we posit that the transient switch of UBN to DBN reflects abnormal processing of otolith information about linear acceleration, and often points to a diagnosis of WE.ConclusionRecognizing the unusual patterns of transient switching and then permanent conversion of UBN to DBN in WE is vital since long-term disability from WE may be prevented by timely, parenteral high-dose thiamine.

show abstract

“…An unexpected finding of this study was that baclofen actually made downbeat iiystagrnus worse in some patients, especially during mar viewing. Downbeat nystagmus is known to be influenced by the viewing distance of the target [32]; this might be related to physiological changes in the gain of the VOR that occur when subjects view a near object during head rotations [33]. Although VOR gain was not measured in the jerk nystagrnus patients, in Patients 1 through 10 with APN no change in VOR gain occurred after treatment with baclofen that might support this mechanism.…”

Section: D41mentioning

confidence: 97%

A double‐blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus

Averbuch‐Heller

Tusa²,

Fuhry

et al. 1997

Annals of Neurology

183

View full text Add to dashboard Cite

We conducted a double-blind crossover trial comparing gabapentin (up to 900 mg/day) to baclofen (up to 30 mg/day) as therapy for acquired nystagmus in 21 patients. We measured visual acuity and the nystagmus before, and at the end of, 2 weeks on each medication. For a group of 15 patients with acquired pendular nystagmus (APN), visual acuity improved significantly with gabapentin, but not with baclofen. Gabapentin significantly reduced APN median eye speed in all three planes, but baclofen did so only in the vertical plane. In 10 patients with APN, the reduction of nystagmus with gabapentin was substantial and 8 of these elected to continue taking the drug. In 6 patients with downbeat or torsional downbeat nystagmus, changes in median slow-phase eye speed were less consistent with both drugs, either increasing or decreasing, and being dependent on viewing conditions. Only 1 patient showed consistent reduction of median eye speed, and this was achieved by either drug. Our findings suggest that gabapentin may be an effective treatment for many patients with APN and that occasional patients with downbeat nystagmus will respond to gabapentin or baclofen.

show abstract

Downbeat nystagmus with a pseudocycloid waveform: Improvement with base‐out prisms

Cited by 31 publications

References 19 publications

Therapy for Nystagmus

Therapy for Nystagmus

Conversion of upbeat to downbeat nystagmus in Wernicke encephalopathy

A double‐blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus

Contact Info

Product

Resources

About