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Meo M, Del Punta JA, Sánchez I, de Luis García R, Gasaneo G, Martin R. A dynamical method to objectively assess infantile nystagmus based on eye tracking. A pilot study. JOURNAL OF OPTOMETRY 2023:S1888-4296(23)00002-X. [PMID: 36697270 DOI: 10.1016/j.optom.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this research is to propose a new method for the easy, inexpensive and objective quantification of nystagmus using eye-tracking records collected during a simple reading task that could be implantable in clinical practice to assess patients with nystagmus. METHODS This is a prospective, observational pilot study. Eye movements of 4 nystagmus patients and 9 healthy children during a reading task (a paragraph with 82 words) on a 15'' monitor were collected and compared. Data are time series indicating the gaze position on the screen. Two quantifiers were proposed: IndS (based on the speed of movements) and IndF (based on the variation of the gaze trajectory). RESULTS The indices proposed reflect differences in the behavior of eye movements between the two groups. Nystagmus patients present higher values of IndS - indicating smaller number of slow movements (16% of movements with speeds <0.33 1/s for nystagmus and 85% for the control group, with p = 0.01) - and higher values of IndF - indicating higher gaze fluctuation (p = 0.01). Differences were not related with reading speed as show the mean and standard deviation: the nystagmus group required 115±45 s to complete the task and the control group 151±85 s; p = 0.73. CONCLUSIONS The proposed indices provide a new method that allows an objective assessment of nystagmus, with potential use in clinical and research practice to improve the follow-up of patients by monitoring the nystagmus over time or treatment.
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Affiliation(s)
- Marcos Meo
- Instituto de Física del Sur, Departamento de Física, Universidad Nacional del Sur (UNS) - CONICET, 8000 Bahía Blanca, Argentina
| | - Jessica Adriana Del Punta
- Instituto de Física del Sur, Departamento de Física, Universidad Nacional del Sur (UNS) - CONICET, 8000 Bahía Blanca, Argentina; Departamento de Matemática, Universidad Nacional del Sur (UNS), 8000 Bahía Blanca, Argentina
| | - Irene Sánchez
- Optometry Research Group, IOBA Eye Institute. School of Optometry, University of Valladolid. 47011 Valladolid, Spain; Departamento de Física Teórica Atómica y Óptica. Universidad de Valladolid, 47011 Valladolid, Spain.
| | - Rodrigo de Luis García
- Laboratorio de Procesado de Imagen (LPI). Universidad de Valladolid, 47011 Valladolid, Spain
| | - Gustavo Gasaneo
- Instituto de Física del Sur, Departamento de Física, Universidad Nacional del Sur (UNS) - CONICET, 8000 Bahía Blanca, Argentina; Centro Integral de Neurociencias Aplicadas, 8000 Bahía Blanca, Argentina
| | - Raúl Martin
- Optometry Research Group, IOBA Eye Institute. School of Optometry, University of Valladolid. 47011 Valladolid, Spain; Departamento de Física Teórica Atómica y Óptica. Universidad de Valladolid, 47011 Valladolid, Spain
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Badjate DM, Kovela RK, Harjpal P, Morghade SV. Vestibular Rehabilitation Thinking Beyond Benign Paroxysmal Positional Vertigo: Inference in a Rare Case of Oculocutaneous Albinism. Cureus 2022; 14:e30452. [DOI: 10.7759/cureus.30452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
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Sharma P. Calming the Visual Storm: Management of Childhood Nystagmus. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1757889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AbstractChildhood nystagmus creates a visual storm both for the affected child and the treating doctor. This problem occurring in the development phase of the child affects not only the vision but also the general development, if not diagnosed and managed in time. Moreover, some forms may even harbor a neurological tumor needing timely management. First, a brief introduction of nystagmus classification, a simplified approach to diagnose the common childhood nystagmus, and the value of electrophysiology will be presented. Next, the approach to treatment, using a thorough clinical examination, illustrated by patient examples of different types of nystagmus will be presented. The different forms of childhood nystagmus are described: idiopathic infantile nystagmus syndrome (IINS), sensory nystagmus (SN), fusion maldevelopment nystagmus (FMDN), spasmus nutans syndrome (SNS), nystagmus blockage syndrome, periodic alternating nystagmus, and others as well as their specific management. The role of electronystagmography and that of neuroimaging in specific conditions is life saving and is described. The role of auditory biofeedback, acupuncture, medical treatment, and surgical procedures like Augmented Anderson procedure, Hertle-Dell'Osso procedure, supra maximal retro-equatorial recession, and posterior fixation have been elucidated. Newer techniques have simplified the management options and improved the functional outcomes in childhood nystagmus. To conclude, children with nystagmus of types IINS, FMDN, SNS, or SN need to be managed differently. It is thus possible to timely manage these children, not only to save their life and improve their vision but also to improve their living quotient.
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Affiliation(s)
- Pradeep Sharma
- Pediatric and Neuro-Ophthalmology, Centre for Sight, New Delhi, India
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Tran TM, Lee MS, McClelland CM. Downbeat nystagmus: a clinical review of diagnosis and management. Curr Opin Ophthalmol 2021; 32:504-514. [PMID: 34456290 DOI: 10.1097/icu.0000000000000802] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review will extensively cover the clinical manifestations, causes, diagnostic evaluation, and management strategies of downbeat nystagmus (DBN). RECENT FINDINGS Historically, MRI to assess for structural lesions at the cervicomedullary junction has been the primary diagnostic test in the evaluation of DBN since the 1980s. In recent years, there is increasing awareness of nonstructural causes of DBN including gluten ataxia, nutritional deficiencies, and paraneoplastic syndromes, among others. Medical management with aminopyridines has become first-line therapy in addition to disease-specific therapies. SUMMARY DBN is a common form of acquired nystagmus and the differential diagnosis remains broad, including both benign and potentially fatal causes. For practical purposes, the causes can be categorized as structural vs. nonstructural with MRI as the ideal, initial diagnostic study to differentiate the two. General therapeutic options include pharmacotherapy to enhance Purkinje cell function, strabismus surgery or prisms to shift null points, and behavioural changes. Disease-specific treatment is necessarily broad, though a significant proportion of patients will be idiopathic.
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Affiliation(s)
- Tu M Tran
- Department of Ophthalmology and Visual Neurosciences
| | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences
- Department of Neurology
- Department of Neurosurgery, University of Minnesota, Minneapolis, USA
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Self JE, Dunn MJ, Erichsen JT, Gottlob I, Griffiths HJ, Harris C, Lee H, Owen J, Sanders J, Shawkat F, Theodorou M, Whittle JP. Management of nystagmus in children: a review of the literature and current practice in UK specialist services. Eye (Lond) 2020; 34:1515-1534. [PMID: 31919431 PMCID: PMC7608566 DOI: 10.1038/s41433-019-0741-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/24/2019] [Indexed: 11/09/2022] Open
Abstract
Nystagmus is an eye movement disorder characterised by abnormal, involuntary rhythmic oscillations of one or both eyes, initiated by a slow phase. It is not uncommon in the UK and regularly seen in paediatric ophthalmology and adult general/strabismus clinics. In some cases, it occurs in isolation, and in others, it occurs as part of a multisystem disorder, severe visual impairment or neurological disorder. Similarly, in some cases, visual acuity can be normal and in others can be severely degraded. Furthermore, the impact on vision goes well beyond static acuity alone, is rarely measured and may vary on a minute-to-minute, day-to-day or month-to-month basis. For these reasons, management of children with nystagmus in the UK is varied, and patients report hugely different experiences and investigations. In this review, we hope to shine a light on the current management of children with nystagmus across five specialist centres in the UK in order to present, for the first time, a consensus on investigation and clinical management.
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Affiliation(s)
- J E Self
- University Hospital Southampton, Southampton, UK.
- Clinical and Experimental Sciences, School of Medicine, University of Southampton, Southampton, UK.
| | - M J Dunn
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - J T Erichsen
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - I Gottlob
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - H J Griffiths
- Division of Ophthalmology and Orthoptics, Health Sciences School, University of Sheffield, Sheffield, UK
| | - C Harris
- Royal Eye Infirmary, Derriford Hospital, Plymouth, UK
| | - H Lee
- University Hospital Southampton, Southampton, UK
- Clinical and Experimental Sciences, School of Medicine, University of Southampton, Southampton, UK
| | - J Owen
- Royal Eye Infirmary, Derriford Hospital, Plymouth, UK
| | - J Sanders
- Patient Representative, Plymouth, UK
| | - F Shawkat
- University Hospital Southampton, Southampton, UK
| | - M Theodorou
- Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, London, UK
| | - J P Whittle
- Eye Department, Sheffield Children's Hospital, Sheffield, UK
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Nistagmo. Neurologia 2019. [DOI: 10.1016/s1634-7072(18)41585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yang HK, Jung JH. Diagnosis and treatment of childhood strabismus. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.6.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Rowe FJ, Hanna K, Evans JR, Noonan CP, Garcia‐Finana M, Dodridge CS, Howard C, Jarvis KA, MacDiarmid SL, Maan T, North L, Rodgers H. Interventions for eye movement disorders due to acquired brain injury. Cochrane Database Syst Rev 2018; 3:CD011290. [PMID: 29505103 PMCID: PMC6494416 DOI: 10.1002/14651858.cd011290.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acquired brain injury can cause eye movement disorders which may include: strabismus, gaze deficits and nystagmus, causing visual symptoms of double, blurred or 'juddery' vision and reading difficulties. A wide range of interventions exist that have potential to alleviate or ameliorate these symptoms. There is a need to evaluate the effectiveness of these interventions and the timing of their implementation. OBJECTIVES We aimed to assess the effectiveness of any intervention and determine the effect of timing of intervention in the treatment of strabismus, gaze deficits and nystagmus due to acquired brain injury. We considered restitutive, substitutive, compensatory or pharmacological interventions separately and compared them to control, placebo, alternative treatment or no treatment for improving ocular alignment or motility (or both). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (containing the Cochrane Eyes and Vision Trials Register) (2017, Issue 5), MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, AMED Ovid, PsycINFO Ovid, Dissertations & Theses (PQDT) database, PsycBITE (Psychological Database for Brain Impairment Treatment Efficacy), ISRCTN registry, ClinicalTrials.gov, Health Services Research Projects in Progress (HSRProj), National Eye Institute Clinical Studies Database and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The databases were last searched on 26 June 2017. No date or language restrictions were used in the electronic searches for trials. We manually searched the Australian Orthoptic Journal, British and Irish Orthoptic Journal, and ESA, ISA and IOA conference proceedings. We contacted researchers active in this field for information about further published or unpublished studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of any intervention for ocular alignment or motility deficits (or both) due to acquired brain injury. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data. We used standard methods expected by Cochrane. We employed the GRADE approach to interpret findings and assess the quality of the evidence. MAIN RESULTS We found five RCTs (116 participants) that were eligible for inclusion. These trials included conditions of acquired nystagmus, sixth cranial nerve palsy and traumatic brain injury-induced ocular motility defects. We did not identify any relevant studies of restitutive interventions.We identified one UK-based trial of a substitutive intervention, in which botulinum toxin was compared with observation in 47 people with acute sixth nerve palsy. At four months after entry into the trial, people given botulinum toxin were more likely to make a full recovery (reduction in angle of deviation within 10 prism dioptres), compared with observation (risk ratio 1.19, 95% CI 0.96 to 1.48; low-certainty evidence). These same participants also achieved binocular single vision. In the injection group only, there were 2 cases of transient ptosis out of 22 participants (9%), and 4 participants out of 22 (18%) with transient vertical deviation; a total complication rate of 24% per injection and 27% per participant. All adverse events recovered. We judged the certainty of evidence as low, downgrading for risk of bias and imprecision. It was not possible to mask investigators or participants to allocation, and the follow-up between groups varied.We identified one USA-based cross-over trial of a compensatory intervention. Oculomotor rehabilitation was compared with sham training in 12 people with mild traumatic brain injury, at least one year after the injury. We judged the evidence from this study to be very low-certainty. The study was small, data for the sham training group were not fully reported, and it was unclear if a cross-over study design was appropriate as this is an intervention with potential to have a permanent effect.We identified three cross-over studies of pharmacological interventions for acquired nystagmus, which took place in Germany and the USA. These studies investigated two classes of pharmacological interventions: GABAergic drugs (gabapentin, baclofen) and aminopyridines (4-aminopyridines (AP), 3,4-diaminopyridine (DAP)). We judged the evidence from all three studies as very low-certainty because of small numbers of participants (which led to imprecision) and risk of bias (they were cross-over studies which did not report data in a way that permitted estimation of effect size).One study compared gabapentin (up to 900 mg/day) with baclofen (up to 30 mg/day) in 21 people with pendular and jerk nystagmus. The follow-up period was two weeks. This study provides very low-certainty evidence that gabapentin may work better than baclofen in improving ocular motility and reducing participant-reported symptoms (oscillopsia). These effects may be different in pendular and jerk nystagmus, but without formal subgroup analysis it is unclear if the difference between the two types of nystagmus was chance finding. Quality of life was not reported. Ten participants with pendular nystagmus chose to continue treatment with gabapentin, and one with baclofen. Two participants with jerk nystagmus chose to continue treatment with gabapentin, and one with baclofen. Drug intolerance was reported in one person receiving gabapentin and in four participants receiving baclofen. Increased ataxia was reported in three participants receiving gabapentin and two participants receiving baclofen.One study compared a single dose of 3,4-DAP (20 mg) with placebo in 17 people with downbeat nystagmus. Assessments were made 30 minutes after taking the drug. This study provides very low-certainty evidence that 3,4-DAP may reduce the mean peak slow-phase velocity, with less oscillopsia, in people with downbeat nystagmus. Three participants reported transient side effects of minor perioral/distal paraesthesia.One study compared a single dose of 4-AP with a single dose of 3,4-DAP (both 10 mg doses) in eight people with downbeat nystagmus. Assessments were made 45 and 90 minutes after drug administration. This study provides very low-certainty evidence that both 3,4-DAP and 4-AP may reduce the mean slow-phase velocity in people with downbeat nystagmus. This effect may be stronger with 4-AP. AUTHORS' CONCLUSIONS The included studies provide insufficient evidence to inform decisions about treatments specifically for eye movement disorders that occur following acquired brain injury. No information was obtained on the cost of treatment or measures of participant satisfaction relating to treatment options and effectiveness. It was possible to describe the outcome of treatment in each trial and ascertain the occurrence of adverse events.
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Affiliation(s)
- Fiona J Rowe
- University of LiverpoolDepartment of Health Services ResearchWaterhouse Building (B211)1‐3 Brownlow StreetLiverpoolUKL69 3GL
| | - Kerry Hanna
- University of LiverpoolDepartment of Health Services ResearchWaterhouse Building (B211)1‐3 Brownlow StreetLiverpoolUKL69 3GL
| | - Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Carmel P Noonan
- Aintree University Hospitals NHS Foundation TrustDepartment of OphthalmologyLower LaneLiverpoolUKL9 7AL
| | - Marta Garcia‐Finana
- University of LiverpoolBiostatisticsBlock F, Waterhouse Bld1‐5 Brownlow StreetLiverpoolUKL69 3GL
| | - Caroline S Dodridge
- Oxford University Hospitals NHS TrustOrthopticsOxford Eye Hospital, John Radcliffe Hospital, Headley WayOxfordUKOX3 9DU
| | - Claire Howard
- Salford Royal NHS Foundation TrustOrthopticsStott LaneSalfordManchesterUKM6 8HD
| | - Kathryn A Jarvis
- University of LiverpoolOccupational TherapyBrownlow HillLiverpoolUKL69 3GB
| | - Sonia L MacDiarmid
- Warrington and Halton Hospitals NHS Foundation TrustDepartment of OrthopticsLovely LaneWarringtonUKWA5 2QQ
| | - Tallat Maan
- Pennine Care NHS Foundation TrustCommunity Eye Service225 Old StreetAshton‐under‐LyneUKOL6 7SR
| | - Lorraine North
- Frimley Park NHS Foundation TrustOrthopticsPortsmouth RoadFrimleySurreyUKGU16 7UJ
| | - Helen Rodgers
- Newcastle UniversityInstitute of NeuroscienceNewcastleUKNE2 4HH
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Balzer BWR, Catt CJ, Bou-Abdou M, Martin FJ. Visual Acuity Improves in Children and Adolescents With Idiopathic Infantile Nystagmus. Asia Pac J Ophthalmol (Phila) 2018; 7:99-101. [PMID: 28971630 DOI: 10.22608/apo.201795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Idiopathic infantile nystagmus is associated with reduced visual acuity. Recent work has linked extraocular muscle surgery to improvements in visual acuity through childhood but no work has reported long-term secular trends in visual acuity in infantile nystagmus. Our aim is to describe visual acuity changes for children and adolescents with idiopathic infantile nystagmus to allow comparison for future interventional studies. DESIGN Retrospective chart review. METHODS Review of patients attending our center up to the age of 18 with a diagnosis of idiopathic infantile nystagmus and visual acuity measured using Snellen visual acuity. Patients provided informed consent. RESULTS We observed improvements in best corrected visual acuity in 43 children and adolescents with idiopathic infantile nystagmus. Binocular best corrected visual acuity improved at a rate of -0.16 logarithm of the minimum angle of resolution (logMAR)/log year of age (P < 0.001), an improvement of 0.05 logMAR (half a Snellen line) as the age doubles. Intraclass correlation was 0.95 and interindividual correlation between visual acuity and age was significant (r = -0.24, P < 0.001). CONCLUSIONS We describe a natural history of gradual improvement in binocular visual acuity in infantile nystagmus and provide a baseline against which future interventional work can be compared.
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Affiliation(s)
- Ben W R Balzer
- South-Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Caroline J Catt
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Ophthalmic Specialists, Sydney, New South Wales, Australia
| | - Milia Bou-Abdou
- Sydney Ophthalmic Specialists, Sydney, New South Wales, Australia
| | - Frank J Martin
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Ophthalmic Specialists, Sydney, New South Wales, Australia
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[Rare tremor syndromes]. DER NERVENARZT 2018; 89:386-393. [PMID: 29327098 DOI: 10.1007/s00115-017-0477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is a group of uncommon sporadic tremor syndromes, which are only partially taken into account in the current classification of tremor. Their knowledge is of diagnostic and therapeutic relevance and they should be considered in the differential diagnosis of frequent tremor syndromes. OBJECTIVE Differential diagnostics and treatment of uncommon tremor syndromes. METHOD Literature search (PubMed, Google Scholar). RESULTS Holmes tremor, myorhythmia, palatal tremor, limb-shaking transient ischemic attack (TIA), tardive tremor, neuropathic tremor, tremor induced by peripheral trauma and orthostatic tremor syndrome are described. CONCLUSION Uncommon sporadic tremor syndromes are mainly symptomatic with various underlying neurological or systemic pathologies. Their recognition accelerates the diagnostic process and has therapeutic relevance.
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Rowe FJ. Vision In Stroke cohort: Profile overview of visual impairment. Brain Behav 2017; 7:e00771. [PMID: 29201538 PMCID: PMC5698855 DOI: 10.1002/brb3.771] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/06/2017] [Accepted: 06/14/2017] [Indexed: 12/19/2022] Open
Abstract
AIM To profile the full range of visual disorders from a large prospective observation study of stroke survivors referred by stroke multidisciplinary teams to orthoptic services with suspected visual problems. METHODS Multicenter prospective study undertaken in 20 acute Trust hospitals. Standardized screening/referral forms and investigation forms documented data on referral signs and symptoms plus type and extent of visual impairment. RESULTS Of 1,345 patients referred with suspected visual impairment, 915 were recruited (59% men; mean age at stroke onset 69 years [SD 14]). Initial visual assessment was at median 22 days post stroke onset. Eight percent had normal visual assessment. Of 92% with confirmed visual impairment, 24% had reduced central visual acuity <0.3 logMAR and 13.5% <0.5 logMAR. Acquired strabismus was noted in 16% and acquired ocular motility disorders in 68%. Peripheral visual field loss was present in 52%, most commonly homonymous hemianopia. Fifteen percent had visual inattention and 4.6% had other visual perceptual disorders. Overall 84% were visually symptomatic with visual field loss the most common complaint followed by blurred vision, reading difficulty, and diplopia. Treatment options were provided to all with confirmed visual impairment. Targeted advice was most commonly provided along with refraction, prisms, and occlusion. CONCLUSIONS There are a wide range of visual disorders that occur following stroke and, frequently, with visual symptoms. There are equally a wide variety of treatment options available for these individuals. All stroke survivors require screening for visual impairment and warrant referral for specialist assessment and targeted treatment specific to the type of visual impairment.
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12
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Hanna KL, Hepworth LR, Rowe FJ. The treatment methods for post-stroke visual impairment: A systematic review. Brain Behav 2017; 7:e00682. [PMID: 28523224 PMCID: PMC5434187 DOI: 10.1002/brb3.682] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 12/23/2022] Open
Abstract
AIM To provide a systematic overview of interventions for stroke related visual impairments. METHOD A systematic review of the literature was conducted including randomized controlled trials, controlled trials, cohort studies, observational studies, systematic reviews, and retrospective medical note reviews. All languages were included and translation obtained. This review covers adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke and were discussed separately. We searched scholarly online resources and hand searched articles and registers of published, unpublished, and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Article selection was performed by two authors independently. Data were extracted by one author and verified by a second. The quality of the evidence and risk of bias was assessed using appropriate tools dependant on the type of article. RESULTS Forty-nine articles (4142 subjects) were included in the review, including an overview of four Cochrane systematic reviews. Interventions appraised included those for visual field loss, ocular motility deficits, reduced central vision, and visual perceptual deficits. CONCLUSION Further high quality randomized controlled trials are required to determine the effectiveness of interventions for treating post-stroke visual impairments. For interventions which are used in practice but do not yet have an evidence base in the literature, it is imperative that these treatments be addressed and evaluated in future studies.
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Affiliation(s)
- Kerry Louise Hanna
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
| | | | - Fiona J. Rowe
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
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McLoon LK, Willoughby CL, Anderson JS, Bothun ED, Stager D, Felius J, Lee H, Gottlob I. Abnormally Small Neuromuscular Junctions in the Extraocular Muscles From Subjects With Idiopathic Nystagmus and Nystagmus Associated With Albinism. Invest Ophthalmol Vis Sci 2016; 57:1912-20. [PMID: 27092717 PMCID: PMC4849883 DOI: 10.1167/iovs.16-19129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Infantile nystagmus syndrome (INS) is often associated with abnormalities of axonal outgrowth and connectivity. To determine if this manifests in extraocular muscle innervation, specimens from children with idiopathic INS or INS and albinism were examined and compared to normal age-matched control extraocular muscles. Methods Extraocular muscles removed during normal surgery on children with idiopathic INS or INS and albinism were immunostained for neuromuscular junctions, myofiber type, the immature form of the acetylcholine receptor, and brain-derived neurotrophic factor (BDNF) and compared to age-matched controls. Results Muscles from both the idiopathic INS and INS and albinism groups had neuromuscular junctions that were 35% to 71% smaller based on myofiber area and myofiber perimeter than found in age-matched controls, and this was seen on both fast and slow myosin heavy chain isoform–expressing myofibers (all P < 0.015). Muscles from subjects with INS and albinism showed a 7-fold increase in neuromuscular junction numbers on fast myofibers expressing the immature gamma subunit of the acetylcholine receptor. The extraocular muscles from both INS subgroups showed a significant increase in the number and size of slow myofibers compared to age-matched controls. Brain-derived neurotrophic factor was expressed in control muscle but was virtually absent in the INS muscles. Conclusions These studies suggest that, relative to the final common pathway, INS is not the same between different patient etiologies. It should be possible to modulate these final common pathway abnormalities, via exogenous application of appropriate drugs, with the hope that this type of treatment may reduce the involuntary oscillatory movements in these children.
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Affiliation(s)
- Linda K McLoon
- Department of Ophthalmology and Visual Neurosciences University of Minnesota, Minneapolis, Minnesota, United States 2Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota, United States
| | - Christy L Willoughby
- Department of Ophthalmology and Visual Neurosciences University of Minnesota, Minneapolis, Minnesota, United States 2Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jill S Anderson
- Department of Ophthalmology and Visual Neurosciences University of Minnesota, Minneapolis, Minnesota, United States
| | - Erick D Bothun
- Department of Ophthalmology and Visual Neurosciences University of Minnesota, Minneapolis, Minnesota, United States 3Department of Pediatrics, Minneapolis, Minnesota, United States
| | - David Stager
- Pediatric Ophthalmology and Adult Strabismus, Plano, Texas, United States
| | - Joost Felius
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Helena Lee
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Irene Gottlob
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, Leicester, United Kingdom
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Thurtell MJ. Diagnostic approach to abnormal spontaneous eye movements. Continuum (Minneap Minn) 2014; 20:993-1007. [PMID: 25099105 PMCID: PMC10564019 DOI: 10.1212/01.con.0000453307.50604.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Abnormal spontaneous eye movements, including nystagmus and saccadic intrusions, are often encountered in neurologic practice and can cause disabling visual symptoms, such as oscillopsia and blurred vision. This article reviews the spectrum of abnormal spontaneous eye movements and describes their characteristics, etiology, and management. RECENT FINDINGS The number of prospective, controlled, and masked clinical trials evaluating candidate treatments for abnormal spontaneous eye movements has increased significantly over the past decade. The findings of recent clinical trials are highlighted, and the dosing and potential side effects of proposed medical treatments are summarized. SUMMARY Abnormal spontaneous eye movements are often encountered in neurologic practice. Recent clinical trials provide an evidence base to guide treatment decisions for these disorders.
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Thurtell MJ, Rucker JC, Tomsak RL, Leigh RJ. Medical treatment of acquired nystagmus. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.11.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Multiple sclerosis (MS) is a disease marked by focal demyelinating inflammatory plaques throughout the CNS. Neuro-ophthalmologic sequelae are common in MS and may arise from the disease itself or from treatment of the disease. Both afferent and efferent functions may be affected. Despite much progress, our understanding of the pathophysiology of MS, and the efficacy of our available treatments, remain inadequate. Here, we review the chief neuro-ophthalmologic abnormalities associated with MS and discuss the emerging diagnostic and therapeutic advances that are likely to further our understanding of MS and its treatment.
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Affiliation(s)
- Ryan D Walsh
- Departments of Neurology & Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 3 W Gates Building, Philadelphia, PA 19104, USA
| | - Collin M McClelland
- Departments of Neurology & Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 3 W Gates Building, Philadelphia, PA 19104, USA
| | - Steven L Galetta
- Departments of Neurology & Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 3 W Gates Building, Philadelphia, PA 19104, USA
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Ehrt O. Infantile and acquired nystagmus in childhood. Eur J Paediatr Neurol 2012; 16:567-72. [PMID: 22459007 DOI: 10.1016/j.ejpn.2012.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 02/22/2012] [Accepted: 02/24/2012] [Indexed: 11/15/2022]
Abstract
Nystagmus is an involuntary, periodic eye movement caused by a slow drift of fixation which is followed by a fast refixation saccade (jerk nystagmus) or a slow movement back to fixation (pendular nystagmus). In childhood most cases are benign forms of nystagmus: idiopathic infantile, ocular or latent nystagmus. They arise at the age of 3 months, without oscillopsia and show the absence of the physiologic opto-kinetic nystagmus. A full ophthalmologic evaluation is all that is needed in most cases: albinism, macular or optic nerve hypoplasia and congenital retinal dystrophies are the most common forms of ocular nystagmus. Idiopathic infantile nystagmus can be hereditary, the most common and best analyzed form being a mutation of the FRMD7 gene on chromosome Xq26.2. The mutation shows a mild genotype-phenotype correlation. In all female carriers the opto-kinetic nystagmus is absent and half had mild nystagmus. Latent nystagmus is part of the infantile esotropia syndrome and shows the unique feature of change of direction when the fixing eye changes: it is always beating to the side of the fixing eye. There is no cure for infantile nystagmus but therapeutic options include magnifying visual aids or eye muscle surgery at the age of 6-8 y in patients with head turn. Less than 20% of childhood nystagmus are acquired and need further neurological and imaging work-up. Alarming signs and symptoms are: onset after the age of 4 months, oscillopsia, dissociated (asymmetric) nystagmus, preserved opto-kinetic nystagmus, afferent pupillary defect, papilloedema and neurological symptoms like vertigo and nausea. The most common cause is due to pathology of the anterior optic pathway (e.g. optic nerve gliomas). It shows the same clinical feature of dissociated nystagmus as spasmus nutans but has a higher frequency as in INO. Other forms of acquired nystagmus are due to brainstem, cerebellar or metabolic diseases.
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Affiliation(s)
- Oliver Ehrt
- Department of Ophthalmology, Ludwig-Maximilian University, Mathildenstr. 8, D-80336 Muenchen, Germany.
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Abstract
OPINION STATEMENT 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.
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Affiliation(s)
- Matthew J Thurtell
- Department of Ophthalmology & Visual Sciences, University of Iowa, 200 Hawkins Dr PFP, Iowa City, IA, 52242, USA,
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Galvez-Ruiz A, Roig C, Muñoz S, Arruga J. Convergent-Divergent Nystagmus as a Manifestation of Oculopalatal Tremor. Neuroophthalmology 2011. [DOI: 10.3109/01658107.2011.609606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Strupp M, Thurtell MJ, Shaikh AG, Brandt T, Zee DS, Leigh RJ. Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. J Neurol 2011; 258:1207-22. [PMID: 21461686 PMCID: PMC3132281 DOI: 10.1007/s00415-011-5999-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/01/2011] [Accepted: 03/04/2011] [Indexed: 01/28/2023]
Abstract
We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière's disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal "pacemaker" activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière's disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine.
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Affiliation(s)
- Michael Strupp
- Department of Neurology, University of Munich, Munich, Germany
| | - Matthew J. Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA USA
| | - Aasef G. Shaikh
- Neurology Service, Veterans Affairs Medical Center and Case Medical Center, Cleveland, OH USA
| | - Thomas Brandt
- Department of Neurology, University of Munich, Munich, Germany
| | - David S. Zee
- Department of Neurology, John Hopkins Medical Center, Baltimore, MD USA
| | - R. John Leigh
- Neurology Service, Veterans Affairs Medical Center and Case Medical Center, Cleveland, OH USA
- Department of Neurology, University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106-5040 USA
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Abstract
We review current concepts of nystagmus and saccadic oscillations, applying a pathophysiological approach. We begin by discussing how nystagmus may arise when the mechanisms that normally hold gaze steady are impaired. We then describe the clinical and laboratory evaluation of patients with ocular oscillations. Next, we systematically review the features of nystagmus arising from peripheral and central vestibular disorders, nystagmus due to an abnormal gaze-holding mechanism (neural integrator), and nystagmus occurring when vision is compromised. We then discuss forms of nystagmus for which the pathogenesis is not well understood, including acquired pendular nystagmus and congenital forms of nystagmus. We then summarize the spectrum of saccadic disorders that disrupt steady gaze, from intrusions to flutter and opsoclonus. Finally, we review current treatment options for nystagmus and saccadic oscillations, including drugs, surgery, and optical methods. Examples of each type of nystagmus are provided in the form of figures.
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Affiliation(s)
- Matthew J Thurtell
- Departments of Neurology and Daroff-Dell'Osso Laboratory, Veterans Affairs Medical Center and University Hospitals, Case Western Reserve University, Cleveland, OH 44106, USA
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Thurtell MJ, Joshi AC, Leone AC, Tomsak RL, Kosmorsky GS, Stahl JS, Leigh RJ. Crossover trial of gabapentin and memantine as treatment for acquired nystagmus. Ann Neurol 2010; 67:676-80. [PMID: 20437565 PMCID: PMC3064518 DOI: 10.1002/ana.21991] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We conducted a masked, crossover, therapeutic trial of gabapentin (1,200mg/day) versus memantine (40 mg/day) for acquired nystagmus in 10 patients (aged 28-61 years; 7 female; 3 multiple sclerosis [MS]; 6 post-stroke; 1 post-traumatic). Nystagmus was pendular in 6 patients (4 oculopalatal tremor; 2 MS) and jerk upbeat, hemi-seesaw, torsional, or upbeat-diagonal in each of the others. For the group, both drugs reduced median eye speed (p < 0.001), gabapentin by 32.8% and memantine by 27.8%, and improved visual acuity (p < 0.05). Each patient improved with 1 or both drugs. Side effects included unsteadiness with gabapentin and lethargy with memantine. Both drugs should be considered as treatment for acquired forms of nystagmus.
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