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01-03-2010 | Original Communication

Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin

Authors: Michaela Starck, Holger Albrecht, Walter Pöllmann, Marianne Dieterich, Andreas Straube

Published in: Journal of Neurology | Issue 3/2010

Abstract

A prospective examiner-blind, cross-over study was conducted to compare the efficacy of memantine (40 or 60 mg/day) and gabapentin (1,200 mg/day) as therapy for acquired fixational pendular nystagmus (APN) in 11 patients with multiple sclerosis. APN was documented in 20 eyes by electrooculography (EOG). The primary objective of the study was an at least 50% reduction in amplitude and/or frequency of APN compared with baseline values in EOG. This aim was reached for 17 of 20 APN-affected eyes with memantine 40–60 mg and for 11 eyes with gabapentin up to 1,200 mg. A complete cessation of APN was achieved in eight eyes (four patients) with memantine 40 mg and in a further four eyes (two patients) with memantine 60 mg. One patient achieved the same benefit with memantine 40 mg and gabapentin. In two other eyes APN completely subsided with gabapentin 1,200 mg only, but not with memantine. Near visual acuity, a secondary outcome parameter, improved by at least 0.1 in 11 of 17 eyes treated with memantine and in 8 out of 16 eyes treated with gabapentin. In summary, memantine and gabapentin are safe and effective treatment options for APN.

Averbuch-Heller l, Zivotofsky AZ, Das VE, DiScenna AO, Leigh RJ (1995) Investigations of the pathogenesis of acquired pendular nystagmus. Brain 118:369–378CrossRefPubMed

Averbuch-Heller L, Tusa RJ, Fuhry L, Rottach KG, Ganser GL, Heide W, Büttner U, Leigh RJ (1997) A double-blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus. Ann Neurol 41:818–825CrossRefPubMed

Bandini F, Castello E, Mazzella L, Mancardi GL, Solaro C (2001) Gabapentin but not vigabatrin is effective in the treatment of acquired nystagmus in multiple sclerosis: how valid is the GABAergic hypothesis? J Neurol Neurosurg Psychiatry 71:107–110CrossRefPubMed

Barton JJS, Huaman AG, Sharpe JA (1994) Muscarinic antagonists in the treatment of acquired pendular and downbeat nystagmus: a double-blind, randomized trial of three intravenous drugs. Ann Neurol 35:319–325CrossRefPubMed

Bormann J (1989) Memantine is a potent blocker of N-methyl-d-aspartate (NMDA) receptor channels. Eur J Pharmacol 166:591–592CrossRefPubMed

Bubser M, Keseberg U, Notz PK, Schmidt WJ (1992) Differential behavioural and neurochemical effects of competitive and non-competitive NMDA receptor antagonists in rats. Eur J Pharmacol 229:75–82CrossRefPubMed

Chen HS, Pellegrini JW, Aggarwal SK, Lei SZ, Warrach S, Jensen FE, Lipton SA (1992) Open-channel block of N-methyl-d-aspartate (NMDA) responses by memantine: therapeutic advantage against NMDA receptor-mediated neurotoxicity. J Neurosci 12:4427–4436PubMed

Currie J, Matsuo V (1986) The use of clonazepam in the treatment of nystagmus induced oscillopsia. Ophthalmology 93:924–932PubMed

Dahl JB, Mathiesen O, Moiniche S (2004) ‘Protective premedication’: an option with gabapentin and related drugs? A review of gabapentin and pregabalin in in the treatment of post-operative pain. Acta Anaesthesiol Scand 48:1130–1136CrossRefPubMed

10.

Dieterich M, Straube A, Brandt Th, Paulus W, Büttner U (1991) The effects of baclofen and anticholinergic drugs on upbeat and downbeat nystagmus. J Neurol Neurosurg Psychiatry 5:627–632CrossRef

11.

Dieterich M (2002) The topographic diagnosis of acquired nystagmus in brainstem disorders. Strabismus 10:137–145CrossRefPubMed

12.

Ell JJ, Gresty MA, Chambers BR, Findley LJ (1982) Acquired pendular nystagmus: characteristics, pathophysiology and pharmacological modification. In: Roucoux A, Crommelinck M (eds) Physiological and pathological aspects of eye movements. Dr Junk Publishers, The Hague, pp 89–98

13.

Gresty MA, Ell JJ, Findley LJ (1982) Acquired pendular nystagmus: its characteristics, localizing value and pathophysiology. J Neurol Neurosurg Psychiatry 45:431–439CrossRefPubMed

14.

Helveston EM, Pogrebniak AE (1988) Treatment of acquired nystagmus with botulinum toxin A. Am J Ophthalmol 106:584–586CrossRefPubMed

15.

Helveston EM, Ellis FD, Plager DA (1991) Large recession of the horizontal recti for treatment of nystagmus. Ophthalmology 98:1302–1305PubMed

16.

Herishanu Y, Louzoun Z (1986) Trihexyphenidyl treatment of vertical pendular nystagmus. Neurology 3:82–84

17.

Inobe J, Arakawa T, Mori T, Kumamoto T, Tsuda T (2000) Acquired pendular nystagmus associated with the lesion of tegmentum mesencephali in a patient with probable multiple sclerosis. Rinsho Shinkeigaku 40:1012–1017PubMed

18.

Jabbari B, Rosenberg M, Scherokman B, Gunderson C, McBurney JW, McClintock W (1987) Effectiveness of trihexyphenidyl against pendular nystagmus and palatal myoclonus: evidence of cholinergic dysfunction. Mov Disord 2:93–98CrossRefPubMed

19.

Jain S, Proudlock F, Constantinescu CS, Gottlob I (2002) Combined pharmacologic and surgical approach to acquired nystagmus due to multiple sclerosis. Am J Ophthalmol 134:780–782CrossRefPubMed

20.

Kim JI, Averbuch-Heller L, Leigh RJ (2001) Evaluation of transdermal scopolamine as treatment for acquired nystagmus. J Neuroophthalmol 21:188–192PubMed

21.

Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452PubMed

22.

Leigh RJ, Zee DS (1991) The neurology of eye movements, 2nd edn. FA Davis, Philadelphia

23.

Leigh RJ, Burnstine TH, Ruff RL, Kasmer RJ (1991) The effect of anticholinergic agents upon acquired nystagmus: a double-blind study of trihexyphenidyl and tridihexethyl chloride. Neurology 41:1737–1741PubMed

24.

Leigh RJ, Tomsak RL, Grant MP, Remler BF, Yaniglos SS, Lystad L, Dell’Osso LF (1992) Effectiveness of botulinum toxin administered to abolish acquired nystagmus. Ann Neurol 32:633–642CrossRefPubMed

25.

Leigh J, Averbuch-Heller L, Tomsak RL, Remler BF, Yaniglos SS, Dell’Osso LF (1994) Treatment of abnormal eye movements that impair vision: strategies based on current concepts of physiology and pharmacology. Ann Neurol 36:129–141CrossRefPubMed

26.

Leigh RJ, Das VE, Seidman SH (2002) A neurobiological approach to acquired nystagmus. Ann N Y Acad Sci 956:380–390CrossRefPubMed

27.

Lefkowitz D, Harpold G (1985) Treatment of ocular myoclonus with valproic acid. Ann Neurol 17:103–104CrossRefPubMed

28.

Lopez LI, Bronstein AM, Gresty MA, DuBoulay EP, Rudge P (1996) Clinical and MRI correlates in 27 patients with acquired pendular nystagmus. Brain 119:465–472CrossRefPubMed

29.

Lossignol DA, Plehiers B, Body JJ (2004) Gabapentin (Neurontin) and cancer pain: a pilot study. Rev Med Brux 25:429–435PubMed

30.

Menon GJ, Thaller VT (2002) Therapeutic external ophthalmoplegia with bilateral retrobulbar botulinum toxin—an effective treatment for acquired nystagmus with oscillopsia. Eye 16:804–806CrossRefPubMed

31.

Mettes P, Godaux E, Cheron G, Galiana HL (1994) Effect of muscimol microinjections into the prepositus hypoglossi and the medial vestibular nuclei on cat eye movements. J Neurophysiol 72:785–802

32.

Mossman SS, Bronstein AM, Rudge P, Gresty MA (1985) Acquired pendular nystagmus suppressed by alcohol. Neuroophthalmology 13:99–106CrossRef

33.

Pellegrini JW, Lipton SA (1993) Delayed administration of memantine prevents N-methyl-D-aspartate receptor-mediated neurotoxicity. Ann Neurol 33:403–407CrossRefPubMed

34.

Poser CM, Paty DW, Scheinberg LC, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231CrossRefPubMed

35.

Schon F, Hart P, Hodgson T, Pambakian A, Kennard C (1999) Suppression of pendular nystagmus by smoking cannabis in a patient with multiple sclerosis. Neurology 54:2190–2191

36.

Shery T, Proudlock FA, Sarvananthan N, McLean RJ, Gottlob I (2006) The effects of gabapentin and memantine in acquired and congenital nystagmus—a retrospective study. Br J Ophthalmol 90:839–843CrossRefPubMed

37.

Smith RM, Oommen BS, Stahl JS (2004) Application of adaptive filters to visual testing and treatment in acquired pendular nystagmus. J Rehabil Res Dev 41:313–324CrossRefPubMed

38.

Smith RM, Oommen BS, Stahl JS (2004) Image-shifting optics for a nystagmus treatment device. J Rehabil Res Dev 41:325–336CrossRefPubMed

39.

Stahl JS, Lehmkuhle M, Wu K, Burke B, Saghafi D, Pesh-Imam S (2000) Prospects for treating acquired pendular nystagmus with servo-controlled optics. Invest Ophthalmol Vis Sci 41:1084–1090PubMed

40.

Stahl JS, Leigh RJ (2001) Nystagmus. Curr Neurol Neurosci Rep 1:471–477CrossRefPubMed

41.

Starck M, Albrecht H, Pöllmann W, Straube A, Dieterich M (1997) Drug therapy for acquired pendular nystagmus in multiple sclerosis. J Neurol 244:9–16CrossRefPubMed

42.

Straube A, Paulus W, Quintern J, Brandt Th (1989) Visual ataxia induced by eye movements: posturographic measurements in normals and patients with ocular motor disorders. Clin Sci 4:107–113

43.

Straube A, Leigh RJ, Bronstein A, Heide W, Riordan-Eva P, Tijssen CC, Dehaene I (2004) EFNS task force–therapy of nystagmus and oscillopsia. Eur J Neurol 11:83–89CrossRefPubMed

44.

Traccis S, Rosati G, Monaco M, Aiello I, Agnetti V (1990) Successful treatment of acquired pendular elliptical nystagmus in multiple sclerosis with isoniazid and base-out prisms. Neurology 40:492–494PubMed

45.

Yokota J, Kosaka K, Yoshimoto Y, Amakusa T (1999) Acquired pendular nystagmus after pontine hemorrhage. No To Shinkei 51:1055–1060PubMed

Title: Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin
Authors: Michaela Starck
Holger Albrecht
Walter Pöllmann
Marianne Dieterich
Andreas Straube
Publication date: 01-03-2010
Publisher: Springer-Verlag
Published in: Journal of Neurology / Issue 3/2010
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-009-5309-x

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Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin

Abstract

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