Mirtazapine for treatment of visual snow syndrome: A case series with insights into pathophysiology and therapy
Ozan Eren, Christoph J Schankin
First Published May 20, 2020 Research Article
Results:Mirtazapine has no effect on VSS, neither positive nor negative. This is in line with the reports from the literature suggested only some beneficial effects from lamotrigine.
Conclusions:Since the pathophysiology of VSS is not fully understood, we still rely on the reports of individual cases or patient series. This includes not only the positive, but also the negative results to avoid unnecessary treatment trials. Looking into the literature, antidepressants do not seem to be a solution for the visual symptoms. So far, best data exists for the anticonvulsant lamotrigine.
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Ozan E Eren, Ruth Ruscheweyh, Andreas Straube, Christoph J Schankin
First Published December 22, 2019 Brief Report Find in PubMed
Patients with VSS had an increased L-VISS-score compared to matched controls [(22.2 ± 5.9 vs. 4.4 ± 4.8; ANOVA, factors VSS and comorbid migraine: Main effect for VSS (F = 100.70; p < 0.001), but not for migraine (F < 0.01; p = 1.00) or the interaction (F = 1.93; p = 0.16)]. An L-VISS-score of 14 identified VSS with a sensitivity and specificity of 95% (Receiver Operating Characteristic analysis, 0.986 ± 0.014, p ≤ 0.001).
Patients with VSS suffer continuously from photophobia at a level similar to chronic migraineurs during attacks. Although migraine and VSS share dysfunctional visual processing, patients with VSS might be more severely affected.
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Christoph J Schankin, Farooq H Maniyar, Denise E Chou, Michael Eller, Till Sprenger, Peter J Goadsby
Brain, Volume 143, Issue 4, April 2020, Pages 1106–1113, https://doi.org/10.1093/brain/awaa053
Published: 24 March 2020
AbstractPatients with visual snow syndrome suffer from a continuous pan-field visual disturbance, additional visual symptoms, tinnitus, and non-perceptional symptoms. The pathophysiology of visual symptoms might involve dysfunctional visual cortex. So far, the extra-visual system has not been investigated. We aimed at identifying structural and functional correlates for visual and non-visual symptoms in visual snow syndrome. Patients were compared to age- and sex-matched controls using 18F-2-fluoro-2-deoxy-D-glucose PET (n = 20 per group) and voxel-based morphometry (n = 17 per group). Guided by the PET results, region of interest analysis was done in voxel-based morphometry to identify structural-functional correspondence. Grey matter volume was assessed globally. Patients had corresponding hypermetabolism and cortical volume increase in the extrastriate visual cortex at the junction of the right lingual and fusiform gyrus. There was hypometabolism in the right superior temporal gyrus and the left inferior parietal lobule. Patients had grey matter volume increases in the temporal and limbic lobes and decrease in the superior temporal gyrus. The corresponding structural and functional alterations emphasize the relevance of the visual association cortex for visual snow syndrome. The broad structural and functional footprint, however, confirms the clinical impression that the disorder extends beyond the visual system.
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Authors: Puledda, Francesca; Schankin, Christoph; Digre, Kathleen; Goadsby, Peter J.;
Source: Current Opinion in Neurology, Volume 31, Number 1, February 2018, pp. 52-58(7)
Publisher: Wolters Kluwer
Purpose of review
We provide an overview of the neurological condition known as visual snow syndrome. Patients affected by this chronic disorder suffer with a pan-field visual disturbance described as tiny flickering dots, which resemble the static noise of an untuned television.
The term ‘visual snow’ has only appeared in the medical literature very recently. The clinical features of the syndrome have now been reasonably described and the pathophysiology has begun to be explored. This review focuses on what is currently known about visual snow.
Recent evidence suggests visual snow is a complex neurological syndrome characterized by debilitating visual symptoms. It is becoming better understood as it is systematically studied. Perhaps the most important unmet need for the condition is a sufficient understanding of it to generate and test hypotheses about treatment.
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Francesca Puledda, Christoph Schankin, Peter J. Goadsby
First published January 15, 2020, DOI: https://doi.org/10.1212/WNL.000000000000890
Results The visual snow population had an average age of 29 years and had no sex prevalence. The disorder usually started in early life, and ≈40% of patients had symptoms for as long as they could remember. The most commonly experienced static was black and white. Floaters, afterimages, and photophobia were the most reported additional visual symptoms. A latent class analysis showed that visual snow does not present with specific clinical endophenotypes. Severity can be classified by the amount of visual symptoms experienced. Migraine and tinnitus had a very high prevalence and were independently associated with a more severe presentation of the syndrome.
Conclusions Clinical characteristics of visual snow did not differ from the previous cohort in the literature, supporting validity of the current criteria. Visual snow likely represents a clinical continuum, with different degrees of severity. On the severe end of the spectrum, it is more likely to present with its common comorbid conditions, migraine and tinnitus. Visual snow does not depend on the effect of psychotropic substances on the brain.
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