From the Guidelines
Nystagmus is an involuntary, rhythmic eye movement disorder that can be diagnosed and managed based on its underlying cause, with treatment options including medications, surgical procedures, and vestibular rehabilitation, as recommended by recent guidelines 1.
Definition and Classification
Nystagmus can be classified as congenital or acquired, with the latter being further divided into different types based on the underlying cause, such as vestibular nystagmus, which may result from peripheral or central vestibular pathway dysfunction 1.
Diagnosis and Management
The diagnosis of nystagmus involves a thorough clinical examination, including a review of the patient's medical history and a physical examination, as well as imaging studies such as MRI, which may be necessary to exclude underlying structural lesions or other conditions that may be causing the nystagmus 1.
Treatment Options
Treatment options for nystagmus depend on the underlying cause and may include medications such as baclofen, memantine, or gabapentin, as well as vestibular suppressants like meclizine or diazepam, which can help reduce symptoms in some cases 1.
Recent Guidelines
Recent guidelines recommend that patients with benign paroxysmal positional vertigo (BPPV) be treated with canalith repositioning procedures, and that vestibular rehabilitation may be offered as an additional treatment option 1.
Key Considerations
Key considerations in the management of nystagmus include the need to exclude underlying structural lesions or other conditions that may be causing the nystagmus, as well as the importance of providing patients with accommodations and support to help them manage their symptoms and improve their quality of life 1. Some key points to consider when managing nystagmus include:
- The importance of a thorough clinical examination and imaging studies to determine the underlying cause of the nystagmus
- The need to exclude underlying structural lesions or other conditions that may be causing the nystagmus
- The use of medications and other treatment options to reduce symptoms and improve quality of life
- The importance of providing patients with accommodations and support to help them manage their symptoms and improve their quality of life
- The role of vestibular rehabilitation in the management of nystagmus, as recommended by recent guidelines 1.
From the Research
Definition and Characteristics of Nystagmus
- Nystagmus is defined as rhythmic, most often involuntary eye movements, consisting of a slow drift of the eyes followed by a fast central compensatory movement back to the primary position (refixation saccade) 2.
- The direction of nystagmus is reported according to the fast phase.
- Cardinal symptoms of nystagmus include blurred vision, jumping images (oscillopsia), reduced visual acuity, and sometimes double vision, which depend on the eye position 2.
Types and Classification of Nystagmus
- There are two major categories of nystagmus: spontaneous nystagmus (e.g., upbeat or downbeat nystagmus) and nystagmus induced or modified by certain factors (e.g., gaze-evoked nystagmus, head-shaking nystagmus, positional nystagmus) 2.
- Downbeat nystagmus is most often caused by a bilateral floccular lesion or dysfunction, while upbeat nystagmus is caused by a lesion in the midbrain or medulla 2.
- Benign paroxysmal positional vertigo (BPPV) is characterized by brief attacks of rotatory vertigo associated with positional and/or positioning nystagmus, which are elicited by specific head positions or changes in head position relative to gravity 3.
Diagnosis and Management of Nystagmus
- The observation of positional and/or positioning nystagmus is essential for the diagnosis of BPPV 3.
- BPPV is treated with the canalith repositioning procedure (CRP), which moves otoconial debris from the affected semicircular canal to the utricle 3.
- Downbeat nystagmus can be managed with medical treatment, such as aminopyridines, and disease-specific therapies 4.
- Persistent spontaneous nystagmus can occur following a canalith repositioning procedure in horizontal semicircular canal BPPV, possibly due to a canalith jam 5.