Acquired Nystagmus Medication

  • Author: Christopher M Bardorf, MD, MS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 15, 2012
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Next

Muscle relaxants, GABA agonists

Class Summary

Use for periodic alternating nystagmus, downbeat and upbeat nystagmus, and seesaw nystagmus.[15]

View full drug information

Baclofen (Lioresal)

 

Periodic alternating oscillopsia may be a major complaint in patients with periodic alternating nystagmus and may be cured by the use of baclofen.

Previous
Next

Anticonvulsants

Class Summary

Increases GABA synthesis and release and decreases GABA degradation. Used for acquired pendular nystagmus.

View full drug information

Gabapentin (Neurontin)

 

May reduce nystagmus, improve visual acuity, and reduce oscillopsia in patients with acquired pendular nystagmus.

View full drug information

Clonazepam (Klonopin)

 

Used for downbeat nystagmus. Suppresses muscle contractions by facilitating inhibitory GABA neurotransmission and other inhibitory transmitters.

Previous
Next

Neuromuscular blocker agents

Class Summary

Blocks neuromuscular transmission at cholinergic junctions by preventing release of acetylcholine from nerve terminals. Decreases nystagmus and improves visual acuity.[16]

View full drug information

OnabotulinumtoxinA (BOTOX®)

 

Treats excessive, abnormal contractions associated with blepharospasm. Binds to receptor sites on motor nerve terminals and inhibits release of acetylcholine, which, in turn, inhibits transmission of impulses in neuromuscular tissue.

Reexamine patients 7-14 d after initial dose to assess for response. Increase doses 2-fold over previous one for patients experiencing incomplete paralysis of target muscle. Do not exceed 25 U when giving it as single injection or 200 U as cumulative dose in 30-day period.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Christopher M Bardorf, MD, MS  Ophthalmologist, Children's Eye Physicians

Christopher M Bardorf, MD, MS is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory Van Stavern, MD  Attending Physician, Department of Ophthalmology and Neurology, Washington University School of Medicine

Gregory Van Stavern, MD is a member of the following medical societies: American Academy of Neurology and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Enrique Garcia-Valenzuela, MD, PhD  Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center

Enrique Garcia-Valenzuela, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Retina Society, and Society for Neuroscience

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Bartiss, OD, MD  Medical Director, Ophthalmology, Family Eye Care of the Carolinas

Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and North Carolina Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Brian R Younge, MD  Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Rucker JC. An update on acquired nystagmus. Semin Ophthalmol. Mar-Apr 2008;23(2):91-7. [Medline].

  2. Shaikh AG, Thurtell MJ, Optican LM, Leigh RJ. Pharmacological tests of hypotheses for acquired pendular nystagmus. Ann N Y Acad Sci. Sep 2011;1233:320-6. [Medline]. [Full Text].

  3. Sarvananthan N, Surendran M, Roberts E, et al. The prevalence of nystagmus: The Leicestershire nystagmus survey. Invest Ophthalmol Vis Sci. May 20 2009;[Medline].

  4. Wagner JN, Glaser M, Brandt T, Strupp M. Downbeat nystagmus: aetiology and comorbidity in 117 patients. J Neurol Neurosurg Psychiatry. Jun 2008;79(6):672-7. [Medline].

  5. Thurtell MJ, Leigh RJ. Nystagmus and saccadic intrusions. Handb Clin Neurol. 2011;102:333-78. [Medline].

  6. Daroff RB, Troost BT. Upbeat nystagmus. JAMA. Jul 16 1973;225(3):312. [Medline].

  7. Gonzalez C, Seth RK, Ramos-Esteban JC. Change in head posture and character of nystagmus in a patient with neurological upbeat nystagmus. Binocul Vis Strabismus Q. 2007;22(3):179-84. [Medline].

  8. Spielmann AC. Large recession of the four vertical rectus muscles for acquired pendular vertical nystagmus and oscillopsia without a null zone. J AAPOS. Feb 2009;13(1):102-4. [Medline].

  9. Thurtell MJ, Weber KP, Halmagyi GM. Teaching video NeuroImage: acquired or congenital gaze-evoked nystagmus?. Neurology. Jun 3 2008;70(23):e96. [Medline].

  10. Murofushi T, Chihara Y, Ushio M, Iwasaki S. Periodic alternating nystagmus in Meniere's disease: the peripheral type?. Acta Otolaryngol. Jul 2008;128(7):824-7. [Medline].

  11. Tilikete C, Jasse L, Pelisson D, Vukusic S, Durand-Dubief F, Urquizar C, et al. Acquired pendular nystagmus in multiple sclerosis and oculopalatal tremor. Neurology. May 10 2011;76(19):1650-7. [Medline].

  12. Thurtell MJ, Leigh RJ. Treatment of nystagmus. Curr Treat Options Neurol. Feb 2012;14(1):60-72. [Medline].

  13. Menon GJ, Thaller VT. Therapeutic external ophthalmoplegia with bilateral retrobulbar botulinum toxin- an effective treatment for acquired nystagmus with oscillopsia. Eye. Nov 2002;16(6):804-6. [Medline].

  14. Castillo IG, Reinecke RD, Sergott RC, Wizov S. Surgical treatment of trauma-induced periodic alternating nystagmus. Ophthalmology. Jan 2004;111(1):180-3. [Medline].

  15. Kumar A, Thomas S, McLean R, et al. Treatment of acquired periodic alternating nystagmus with memantine: a case report. Clin Neuropharmacol. Mar-Apr 2009;32(2):109-10. [Medline].

  16. Cestari DM, Chan K, Tajouri N, Rizzo JF 3rd. The use of onabotulinum toxin a in the treatment of see-saw nystagmus. J Pediatr Ophthalmol Strabismus. Jul 22 2010;47 Online:e1-3. [Medline].

  17. American Academy of Ophthalmology. Basic and Clinical Science Course. In: Neuro-ophthalmology. 5. 1999-2000:139-41.

  18. American Academy of Ophthalmology. Basic and Clinical Science Course. In: Pediatric. 69(3). 1999-2000:129-35.

  19. American Medical Association. Drug Evaluations. 1995.

  20. Arnoldi KA, Tychsen L. Prevalence of intracranial lesions in children initially diagnosed with disconjugate nystagmus (spasmus nutans). J Pediatr Ophthalmol Strabismus. Sep-Oct 1995;32(5):296-301. [Medline].

  21. Averbuch-Heller L, Tusa RJ, Fuhry L, et al. A double-blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus. Ann Neurol. Jun 1997;41(6):818-25. [Medline].

  22. Baloh RW, Spooner JW. Downbeat nystagmus: a type of central vestibular nystagmus. Neurology. Mar 1981;31(3):304-10. [Medline].

  23. Breen LA. Nystagmus and related ocular oscillations. In: Neuroophthalmology: Clinical Signs and Symptoms. Vol 4. 1997:504-20.

  24. Cross SA, Smith JL, Norton EW. Periodic alternating nystagmus clearing after vitrectomy. J Clin Neuroophthalmol. Mar 1982;2(1):5-11. [Medline].

  25. Donin JF. Acquired monocular nystagmus in children. Can J Ophthalmol. Jul 1967;2(3):212-5. [Medline].

  26. Glaser JS. Neuro-Ophthalmology. 1990.

  27. Leigh RJ, Robinson DA, Zee DS. A hypothetical explanation for periodic alternating nystagmus: instability in the optokinetic-vestibular system. Ann N Y Acad Sci. 1981;374:619-35. [Medline].

  28. Martin JH. Neuroanatomy Atlas. 2nd ed. McGraw-Hill Co; 1996:155-61.

  29. May EF, Truxal AR. Loss of vision alone may result in seesaw nystagmus. J Neuroophthalmol. Jun 1997;17(2):84-5. [Medline].

  30. Neely DE, Sprunger DT. Nystagmus. Curr Opin Ophthalmol. Oct 1999;10(5):320-6. [Medline].

  31. Nolte J. The Human Brain. 1993:218-23.

  32. Norton EW, Cogan DG. Spasmus nutans; a clinical study of twenty cases followed two years or more since onset. AMA Arch Ophthalmol. Sep 1954;52(3):442-6. [Medline].

  33. Pratt-Johnson JA, Tillson G. Management of Strabismus and Amblyopia: A Practical Guide. 1994.

  34. Ruben ST, Lee JP, O'Neil D, Dunlop I, Elston JS. The use of botulinum toxin for treatment of acquired nystagmus and oscillopsia. Ophthalmology. Apr 1994;101(4):783-7. [Medline].

  35. Sharpe JA, Lo AW, Rabinovitch HE. Control of the saccadic and smooth pursuit systems after cerebral hemidecortication. Brain. Jun 1979;102(2):387-403. [Medline].

  36. Stahl JS, Averbuch-Heller L, Leigh RJ. Acquired nystagmus. Arch Ophthalmol. Apr 2000;118(4):544-9. [Medline].

  37. Troost BT. Nystagmus and Related Ocular Oscillations. Available at http://www.waduicenter.com/?page_id=1341.

  38. Tusa RJ. Nystagmus: diagnostic and therapeutic strategies. Semin Ophthalmol. Jun 1999;14(2):65-73. [Medline].

  39. Tychsen L. Pediatric Ocular Motility Disorders of Neuro-ophthalmic Significance. Vol. 4. 1991:615-43.

  40. Van Stavern GP, Biousse V, Newman NJ, Leingang JC. Downbeat nystagmus from heat stroke. J Neurol Neurosurg Psychiatry. Sep 2000;69(3):403-4. [Medline]. [Full Text].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.