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The ocular motor system consists of several subsystems, including the vestibular ocular nystagmus saccade system, the pursuit system, the fixation and gaze-holding system and the vergence system. All these subsystems aid the stabilization of the images on the retina during eye and head movements and any kind of disturbance of one of the systems can cause instability of the eyes (e.g. nystagmus) or an inadequate eye movement causing a mismatch between head and eye movement (e.g. bilateral vestibular failure). In both situations, the subjects experience a movement of the world (oscillopsia) which is quite disturbing. New insights into the patho-physiology of some of the ocular motor disorders have helped to establish new treatment options, in particular in downbeat nystagmus, upbeat nystagmus, periodic alternating nystagmus, acquired pendular nystagmus and paroxysmal vestibular episodes/attacks. The discussed patho-physiology of these disorders and the current literature on treatment options are discussed and practical treatment recommendations are given in the paper.
University of Munich, Munich, Germany Imperial College of Science, Technology and Medicine, London, UK University of Zurich, Zurich, Switzerland.
This article was published in the following journal.
Name: European journal of neurology : the official journal of the European Federation of Neurological Societies
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Involuntary rhythmical movements of the eyes in the normal person. These can be naturally occurring as in end-position (end-point, end-stage, or deviational) nystagmus or induced by the optokinetic drum (NYSTAGMUS, OPTOKINETIC), caloric test, or a rotating chair.
Elicitation of a rotatory nystagmus by stimulating the semicircular canals with water or air which is above or below body temperature. In warm caloric stimulation a rotatory nystagmus is developed toward the side of the stimulated ear; in cold, away from the stimulated side. Absence of nystagmus indicates the labyrinth is not functioning.
Normal nystagmus produced by looking at objects moving across the field of vision.
Involuntary movements of the eye that are divided into two types, jerk and pendular. Jerk nystagmus has a slow phase in one direction followed by a corrective fast phase in the opposite direction, and is usually caused by central or peripheral vestibular dysfunction. Pendular nystagmus features oscillations that are of equal velocity in both directions and this condition is often associated with visual loss early in life. (Adams et al., Principles of Neurology, 6th ed, p272)
Nystagmus present at birth or caused by lesions sustained in utero or at the time of birth. It is usually pendular, and is associated with ALBINISM and conditions characterized by early loss of central vision. Inheritance patterns may be X-linked, autosomal dominant, or recessive. (Adams et al., Principles of Neurology, 6th ed, p275)
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