Treatment effects and comorbid diseases in 58 patients with visual snow

Abstract

ObjectiveTo evaluate pharmacologic treatment options for visual snow and to report prevalence of comorbid diseases.MethodsMedical charts of patients with a diagnosis of visual snow at the neurology outpatient clinic were reviewed on prescribed medication, and comorbid migraine, tinnitus, and psychiatric conditions including depression and anxiety.ResultsFrom 2007 to 2018, 58 patients were diagnosed with visual snow. Comorbid migraine was present in 51.7% of patients, lifetime depression in 41.4%, and lifetime anxiety in 44.8%. Lamotrigine was prescribed most frequently (26/58) and resulted in partial remission of symptoms in 5/26 (19.2%). No patients reported complete remission. Adverse events occurred in 13/26 (50.0%) patients. None of the other prescribed drugs (valproate [n = 7], topiramate [n = 4], acetazolamide [n = 2], flunarizine [n = 1]) led to improvement except for topiramate in one patient, who discontinued, however, because of adverse events.ConclusionsOf medication prescribed (lamotrigine, valproate, acetazolamide, flunarizine), only lamotrigine afforded some improvement in a small minority of patients. Migraine, depression, anxiety, and tinnitus were common comorbid diseases.Classification of evidenceThis study provides Class IV evidence that for some patients with visual snow, lamotrigine resulted in partial remission of symptoms.

Prevalence of visual snow syndrome in the UK

“…Except for age, we were able to substantiate earlier epidemiological estimations, including figures on comorbidities and the female-to-male ratio. Thus, our results regarding the co-occurrence of headache (54.5%) and tinnitus (59.1%), as well as the femaleto-male ratio (1.6:1), are very similar to those reported previously (headache, 59.0%; tinnitus, 52.0%; femaleto-male ratio 1.1:1 [1,5,9,13]). Slightly higher numbers in our study concerning mood impairment (72.7%), compared with previous figures for anxiety (23.0% and 44.8%) and depression (21.0% and 41.4%) [1,5], might be because we inquired about mood symptoms in very general terms.…”

“…Minor physiological alterations in visual association pathways appear compatible with this notion [6,7]. Although speculative, this may perhaps also explain the poor response to various attempts at medical treatment [5].…”

“…Nevertheless, a large number of publications about visual snow and visual snow syndrome have occurred in PubMed within the last 5 years (e.g. [5,6,[8][9][10][11][12][13][14]). This and extensive media coverage, as well as responses on social platforms (e.g.…”

Neuro-ophthalmologic Findings in Visual Snow Syndrome

“…Complete remission was defined as the disappearance of visual snow, while partial remission was defined as an improvement in the self-assessed symptom severity. 11…”

“…7 Lamotrigine down-regulates glutamate, which is known to propagate cortical spreading depression in migraine. 31 van Dongen et al 11 prescribed lamotrigine to 26 of 58 patients with visual snow syndrome, which led to partial remission in 5/26 (19.2%). However, their results provide little information since the proportion of comorbidities was not matched among treatments.…”