Treatment of Nystagmus

Abstract

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.

Influence of head posture on the visual acuity of children with nystagmus

“…Visual acuity is a quantitative assessment of the ability of the human sensory system to discriminate detail in objects (4) . The close association between visual acuity and nystagmus has been reported in the literature (5)(6)(7)(8)(9) . Nystagmus comprises involuntary ocular oscillations that prevent the adequate projection of the image on the retina (5) .…”

Visual rehabilitation of patients with oculocutaneous albinism Type I (OCA1): Results in 85 patents

“…Over the last 20 years the safe use of oral and intrathecal baclofen has been employed to treat spasticity in patients with cerebral palsy. Several case reports of IAPAN describe a positive effect of baclofen and suggest its effectiveness in patients with IAPAN [46][47][48][49][50]. These reports plus the author's experience with baclofen's use in treating IAPAN was the reason for employing it as part of this treatment protocol.…”

“…IAPAN is more common in patients with OCA and, in that clinical setting, is usually not associated with serious central nervous system pathology. Pharmacologically useful agents for patients with nystagmus are primarily GABA agonists or inhibitors of the excitatory neurotransmitter system, including drugs such as gabapentin, memantine and baclofen [46][47][48][49][50]. Over the last 20 years the safe use of oral and intrathecal baclofen has been employed to treat spasticity in patients with cerebral palsy.…”

Dizziness in stroke

“…Инсульт с повреждением области варолиева моста и продолговатого мозга может приводить к формированию приобретенного маятникообразного нистагма. В таких слу-чаях применяют мемантин по 10 мг 4 раза в сутки или габа-пентин по 300 мг 4 раза в сутки [24].…”