MS – Acquired Pendular Nystagmus Treatment — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Acquired Pendular Nystagmus TreatmentSCE Neurology

A 45-year-old woman with MS presents with bilateral oscillopsia (sensation of visual world bouncing) and persistent nystagmus. It is significantly impairing her reading and daily activities. What pharmacological treatment may help reduce her nystagmus?

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Correct answer: A — Gabapentin or memantine

Acquired pendular nystagmus in MS (which causes oscillopsia) can be treated with gabapentin or memantine. Both have been shown in randomised trials to reduce nystagmus amplitude and improve oscillopsia. Gabapentin acts via calcium channel modulation; memantine acts via NMDA receptor antagonism. This is one of the few pharmacological treatments for nystagmus with evidence of efficacy. A: Carbamazepine has limited evidence for nystagmus. C: Baclofen is used for periodic alternating nystagmus but not pendular nystagmus. D: Amitriptyline does not treat nystagmus. E: Propranolol has no role.

Reference: NICE NG100 MS (2022); Starck et al. Gabapentin for Nystagmus; Thurtell & Leigh Nystagmus Review