Treatment for Nystagmus

Transcription

1 ISSN: Treatment for Nystagmus Seong-Hae Jeong Department of Neurology, Chungnam National University Hospital, Daejeon, Korea Treatment for Nystagmus Seong-Hae Jeong Chungnam National University Hospital Goals of Treatment Visual fixation VOR Clear vision Eccentric gazeholding mechanism Copyright 2016 The Korean Society of Neuro-Ophthalmology S27

2 Jeong SH Treatment for Nystagmus Not require specific Treatment Physiologic eye movement Infantile Peripheral vestibular Drug intoxication Nystagmus slow-phase speed Tenotomy or botulinum toxin General Approaches to Treatment medical optical surgical Acquired Downbeat Upbeat Torsional Gaze-evoked Seesaw Periodic alternating Acquired pendular in MS Acquired pendular in OPT Congenial Infantile syndrome Other congenital Downbeat Acquired Downbeat Upbeat Torsional Gaze-evoked Seesaw Periodic alternating Acquired pendular in MS Acquired pendular in OPT Congenial Infantile syndrome Other congenital Acquired cerebellar degenerations Stroke Hindbrain anomalies (e.g., Chiari malformation) Multiple sclerosis Medications(lithium, anticonvulsants, opoioids) Idiopathic S28

3 Treatment for Nystagmus Jeong SH HIRSCHBERG S TEST: CORNEAL LIGHT REFLEX Rough measure of deviation Note location of corneal light reflex 1mm = 7, or 15 S29

4 Jeong SH Treatment for Nystagmus 1. Involvement of excitatory burst neurons in the PPRF (Horn AKE et al, Neuro-ophthalmology 1996;16: ) : SCA2 Experimental slow saccades by injecting lidocaine into the PPRF (Barton et al., 2003) 2. Lesions of the omnipuase neurons : using experimental excitotoxins are also reported to cause slow (Kaneko CRS, J Neurophysiol 1996;75: ) horizontal and vertical saccades. 3. Both burst (PPRF) and omnipause cell populations may be affected : slow saccade after cardiac surgery (Hanson, et al. Ann Neurol 1986;20; ) 4. It is also possible that disturbance of other inputs to the posterior burst neurons (i.e., LLBN) could lead to slow saccades. For example, acute inactivation of the superior colliculus causes slow saccades in monkey. S30

5 Treatment for Nystagmus Jeong SH Upbeat Baclofen JNNP 1991 burst neurons for vertical and torsional saccades : vertical saccadic paresis S31

6 Jeong SH Treatment for Nystagmus Gaze-Evoked Nystagmus Because gaze-evoked does not usually produce visual symptoms, it does not need specific treatment. Acquired pendular Nystagmus Oculopalatal tremor Mefloquine Proc Natl Acad Sci USA 2004 Clonazepam Neurology 2006 Gabapentin and Memantine Ann Neurol 2010 S32

7 Treatment for Nystagmus Jeong SH Figure Acquired pendular in the syndrome of oculopalatal tremor, which developed in a 37-year-old man in the months following pontine hemorrhage.887 (A) Before treatment, he showed a predominantly vertical-torsional that caused oscillopsia and reduced visual acuity. During treatment with gabapentin 1,200 mg/day, there was substantial decrease in his and his visual acuity improved (Video 11 18). (B) Axial T2-weighted magnetic resonance imaging (MRI) showed an old pontine tegmental infarction (left panel; arrowhead) and hypertrophy of the right inferior olivary nucleus (indicated by arrowhead). Chapter: Acquired Pendular Nystagmus and its Relationship to Visual Pathways Author(s): R. John Leigh and David S. Zee From: The Neurology of Eye Movements (5 ed.) Ann Neurol 2010 Downloaded from Oxford Medicine Online. Oxford University Press, 2015 Seesaw and hemiseesaw Treatment of in EA2 Pendular seesaw : alcohol or clonazepam Rev Neurol 1995 Mematine Ann Neurol 2010 Acetazolamide Neurology aminopyridone Neurology 2011 Dalfampridine Flunarizine Eur Neurol 2006 Treatment of Congenital Treatment of Congenital Channelopathy Semin Ophthalmol. 2006; 21:83 86 Oral acetazolamide Open Ophthalmol J 2010 Topical brinzolamide JNO 2011 Gene therapy Leber s congenital amaurosis NEJM S33

8 Jeong SH Treatment for Nystagmus Treatment of Saccadic Intrusions and Oscillations Treatments for ocular flutter and opsoclonus Memantine Propranolol Benzodiazepines Clonazepam Gabapentin Topiramate IVIG Corticosteroids ACTH Rituximab Ofatumumab Optical treatments of abnormal eye movements Procedures to Weaken in EOM Application of somatosensory or Auditory stimuli to suppress Figure Effects of vibration at 100 Hz over the left mastoid process on monocular in a patient with multiple sclerosis (Video 11 17). The immediately decreases in amplitude after the stimulus is applied and continues to decrease during the stimulation period (gray area), increasing promptly when the stimulus is stopped. Chapter: Treatments for Nystagmus and Saccadic Intrusions Author(s): R. John Leigh and David S. Zee From: The Neurology of Eye Movements (5 ed.) Downloaded from Oxford Medicine Online. Reproduced with permission from Beh SC, Tehrani AS, Kheradmand A, Zee DS. Damping of monocular pendular with vibration in a patient with multiple sclerosis. Neurology. 2014; 821: S34