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

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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.

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References

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

    Article  PubMed  Google Scholar 

  2. 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 41:818–825

    Article  CAS  PubMed  Google Scholar 

  3. 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 71:107–110

    Article  CAS  PubMed  Google Scholar 

  4. 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 35:319–325

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  6. 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 229:75–82

    Article  CAS  PubMed  Google Scholar 

  7. 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 12:4427–4436

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  9. 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 48:1130–1136

    Article  CAS  PubMed  Google Scholar 

  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 5:627–632

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  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 40:1012–1017

    CAS  PubMed  Google Scholar 

  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 2:93–98

    Article  CAS  PubMed  Google Scholar 

  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 134:780–782

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  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 41:1737–1741

    CAS  PubMed  Google Scholar 

  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 32:633–642

    Article  CAS  PubMed  Google Scholar 

  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 36:129–141

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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 13:227–231

    Article  CAS  PubMed  Google Scholar 

  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

    Google Scholar 

  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 90:839–843

    Article  CAS  PubMed  Google Scholar 

  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 41:313–324

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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 41:1084–1090

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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

    Google Scholar 

  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 11:83–89

    Article  CAS  PubMed  Google Scholar 

  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 40:492–494

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Ms. J. Benson for copy-editing the manuscript

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The authors report no conflict of interest.

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Correspondence to Michaela Starck.

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Starck, M., Albrecht, H., Pöllmann, W. et al. Acquired pendular nystagmus in multiple sclerosis: an examiner-blind cross-over treatment study of memantine and gabapentin. J Neurol 257, 322–327 (2010). https://doi.org/10.1007/s00415-009-5309-x

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  • DOI: https://doi.org/10.1007/s00415-009-5309-x

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