Combined pharmacologic and surgical approach to acquired nystagmus due to multiple sclerosis.
OBJECTIVE
To describe a combined pharmacological and surgical approach to treating acquired nystagmus in a patient with multiple sclerosis.


METHODS
Interventional case report.


METHODS
A 40-year-old patient with acquired horizontal and vertical nystagmus and severe oscillopsia secondary to multiple sclerosis had combined treatment with gabapentin and a vertical Kestenbaum-type procedure.


RESULTS
After gabapentin treatment (3,000 mg orally daily) the horizontal nystagmus was significantly reduced, and the patient developed a marked chin-up position. The vertical nystagmus remained unchanged, dampening on downgaze. A recession of both inferior rectus muscles reduced the nystagmus significantly in primary position, the abnormal head position disappeared, and oscillopsia completely resolved. Treatment increased visual acuity from 6/24 in the right eye and 6/60 in the left eye to 6/9 in both eyes.


CONCLUSIONS
Acquired nystagmus in multiple sclerosis can be significantly improved by using a combined pharmacological and surgical approach.
Jain
Sunila
S
Department of Ophthalmology, Leicester Royal Infirmary, Leicester, United Kingdom.
Proudlock
Frank
F
Constantinescu
Cris S
CS
Gottlob
Irene
I
D000085:Acetates / Q000627:therapeutic use*; D000328:Adult; D000588:Amines; D003131:Combined Modality Therapy; D003509:Cyclohexanecarboxylic Acids; D004172:Diplopia / Q000209:etiology / Q000628:therapy*; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D000077206:Gabapentin; D019416:Head Movements; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications*; D009759:Nystagmus, Pathologic / Q000209:etiology / Q000628:therapy*; D009801:Oculomotor Muscles / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D011187:Posture; D014792:Visual Acuity; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D018691:Excitatory Amino Acid Antagonists; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin