Purpose: To describe a combined pharmacological and surgical approach to treating acquired nystagmus in a patient with multiple sclerosis.
Design: 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.