Abstract
Evidence-Based Answer There is no single best treatment for superior oblique myokymia (SOM), but all of the following therapies were reported to be a least somewhat effective: carbamazepine, phenytoin, propranolol, topical timolol, memantine, gabapentin, prism lenses, and microvascular decompression of the trochlear nerve (SOR: C, case series and case reports). Mirtazapine, onabotulinumtoxinA, and baclofen were ineffective long-term; mild symptoms may self-resolve (SOR: C, case studies).
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