Treatment of superior oblique myokymia with oxcarbazepine

Abstract

A 33-year-old male patient with ipsilateral intermittent oscillopsia and blurry vision for 18 months was found to have intorsional nystagmus of the right eye, especially when gazing at the nasal lower field. The oscillations improved with exercise and were aggravated by rest. An abnormal head posture, with a tilt towards the left, and mild right superior oblique muscle paresis were noted by the prism cover test and motility examination. Neurovascular compression was not confirmed by 0.9-mm thick, high-resolution magnetic resonance imaging with fast imaging employing steady state acquisition sequence. After treatment with oxcarbazepine (600 mg/day), the oscillations resolved and there have been no complications during the 1-year follow-up period. Superior oblique myokymia is a rare form of nystagmus that may cause oscillopsia and blurry vision. Oxcarbazepine, a structural derivative of carbamazepine, can be used to successfully eliminate oscillopsia without serious adverse reaction.