Swedish News Blog

Pharmacologic Treatment of Nystagmus in Multiple Sclerosis

Eugene F. May, MD

At least half of all people with multiple sclerosis (MS) are expected to have nystagmus at some point during the course of their illness. Nystagmus results from demyelination that involves the brainstem or cerebellar eye movement pathways. While it may be asymptomatic, it often causes blurred vision or oscillopsia. The extent of the visual disturbance is directly related to the velocity of the slow phase of the nystagmus.

In MS patients with chronic nystagmus, the most common form is an acquired pendular nystagmus (APN), which is almost always accompanied by optic atrophy, and often by internuclear ophthalmoplegia (INO).

Numerous treatment trials have demonstrated the efficacy of pharmacologic treatment of chronic symptomatic nystagmus. Treatment should be considered in individuals in whom blurred vision or oscillopsia is severe enough to warrant the potential risk of medication side effects. As a general rule, drugs used to treat nystagmus are titrated slowly upwards from a low dose to either efficacy or tolerance.

The two most effective medications for APN in MS are....

Emerging therapies in multiple sclerosis

Lily K. Jung Henson, MD

Multiple sclerosis is unique among neurological diseases in that there are currently eight treatments for this one condition that have received approval by the U.S. Food and Drug Administration (FDA). Five of these drugs require subcutaneous or intramuscular injection, two are administered intravenously, and fingolimod, the newest agent on the block, is given orally. None are considered curative, but these disease-modifying therapies (DMT) have led to a reduction in relapse rates and the progression of disability.

Despite this progress, each of the drugs comes with side effects, including flu-like symptoms with the interferons, lipoatrophy with glatiramer, progressive multifocal leukodystrophy (PML) with natalizumab, and congestive heart failure or leukemia with mitoxantrone. As the first oral agent for MS, fingolimod created great expectations prior to FDA approval. Its popularity, however, has been surprisingly limited, presumably due to the potential for unknown long-term risks. The occur rence of PML with natalizumab demonstrated to MS neurologists and patients the potential risks associated with new drugs.

Additional DMTs in the pipeline may increase MS-management effectiveness in coming years, although safety will continue to be a major consideration in the use of these drugs. For instance, oral cladribine was on the verge of FDA approval in early March when the agency referred the drug back for more safety studies. This drug is already used in intravenous form for the management of hairy cell leukemia, but it is being studied for use with remitting relapsing MS because of its apoptotic effects on lymphocytes. If cladribine is ultimately approved for use, the risk of infection and neoplasms may limit its use.

Other oral agents being studied include:

Results 99-100 of 100

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