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Abstract Details

Improvement of Internuclear Ophthalmoparesis in a Multiple Sclerosis Patient Taking Dalfampridine
Neuro-ophthalmology/Neuro-otology
P06 - (-)
015
BACKGROUND: INO is frequently encountered in MS and is due to demyelination of the medial longitudinal fasciculus (MLF). INO causes significant disability as it results in visual confusion or double vision during daily activities such as reading and driving, but no medical treatment is available. Dalfampridine, a potassium channel blocker that improves neural conduction along demyelinated motor pathways, is FDA-approved for walking impairment in MS.
DESIGN/METHODS: A 50-year old man with relapsing remitting MS and chronic bilateral INO, taking dalfampridine (10 mg bid) for walking impairment, reported subjective improvement of vision since started on the medication. Repetitive horizontal saccades between two eccentric targets (卤10[deg]) were recorded using the EyeLink II system during a 10-minute saccadic fatigue test, before and 3 hours after taking a single dose of dalfampridine 10 mg. Horizontal saccadic conjugacy was maesured using the Phase-Plane technique. The Timed 25-Foot Walk test was performed before and 3 hours after therapy.
RESULTS: Baseline eye movements recording showed marked bilateral decrease in saccadic size and speed of the adducting eye compared to the abducting eye (saccadic dysconjugacy), which exhibited dissociated nystagmus, typical for bilateral INO. After dalfampridine, saccadic conjugacy was improved as demonstrated on Phase-Plane plots, and the patient required fewer adducting saccades to acquire the visual target; this effect was sustained during a 10-minute saccadic fatigue test. Dissociated nystagmus was also decreased. Walking speed also improved after treatment.
CONCLUSIONS: Dalfampridine improved horizontal eye movements performance in a MS patient with INO. The effect of dalfampridine on INO results from improved binocular conjugacy likely reflecting better neural conduction fidelity along the demyelinated MLF. Dalfampridine should be considered in treating MS patients with visual disability due to INO and might also improve saccadic fatigue.
Authors/Disclosures
Alessandro Serra, MD (University Hospitals Cleveland Medical Center)
PRESENTER 		Dr. Serra has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen Idec. Dr. Serra has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bristol Myers Squibb.
Deborah Downey, RN ANP No disclosure on file
No disclosure on file
Mark F. Walker, MD (Cleveland VAMC) The institution of Dr. Walker has received research support from US Department of Veterans Affairs. Dr. Walker has received publishing royalties from a publication relating to health care. Dr. Walker has received personal compensation in the range of $0-$499 for serving as a Grant Reviewer for Congressionally Directed Medical Research Program with General Dynamics Information Technology.
R. John Leigh, MD No disclosure on file
Alrabi Tawil, MD, FAAN (University of Rochester Medical Center) Dr. Tawil has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kate Therapeutics. Dr. Tawil has received personal compensation in the range of $500-$4,999 for serving as a Consultant for meRicule. The institution of Dr. Tawil has received research support from Friends of FSH Research. The institution of Dr. Tawil has received research support from FSH Society. The institution of Dr. Tawil has received research support from NIH. The institution of Dr. Tawil has received research support from Fulcrum. Dr. Tawil has received intellectual property interests from a discovery or technology relating to health care.