TY - JOUR
T1 - Downbeat Nystagmus Is Abolished by Alcohol in Nonalcoholic Wernicke Encephalopathy
AU - Helmchen, Christoph
AU - Machner, Björn
AU - Gablentz, Janina Von Der
AU - Sprenger, Andreas
AU - Zee, David S.
N1 - Publisher Copyright:
© American Academy of Neurology.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Background and ObjectivesLesions of the cerebellar flocculus cause enduring downbeat nystagmus (DBN) with unrelenting oscillopsia. Unlike most patients with DBN, the flocculus is structurally spared in nonalcoholic Wernicke encephalopathy (nWE) with chronic DBN. The objective was to study the effects of alcohol in nWE.MethodsWe recorded eye movements of a unique patient with nWE under controlled alcohol consumption who said his oscillopsia disappeared with a few drinks of alcohol.ResultsHis DBN was markedly diminished by alcohol (by 77.4%), although he remained alert with normal saccades.DiscussionThis striking observation may be caused by the differential effect of alcohol on the perihypoglossal complex and the paramedian tract neurons, which control the level of activity in the flocculus, with opposite (inhibition and excitation, respectively) effects. The finding suggests new ideas about the treatment and pathophysiology of DBN with a structurally intact cerebellum.
AB - Background and ObjectivesLesions of the cerebellar flocculus cause enduring downbeat nystagmus (DBN) with unrelenting oscillopsia. Unlike most patients with DBN, the flocculus is structurally spared in nonalcoholic Wernicke encephalopathy (nWE) with chronic DBN. The objective was to study the effects of alcohol in nWE.MethodsWe recorded eye movements of a unique patient with nWE under controlled alcohol consumption who said his oscillopsia disappeared with a few drinks of alcohol.ResultsHis DBN was markedly diminished by alcohol (by 77.4%), although he remained alert with normal saccades.DiscussionThis striking observation may be caused by the differential effect of alcohol on the perihypoglossal complex and the paramedian tract neurons, which control the level of activity in the flocculus, with opposite (inhibition and excitation, respectively) effects. The finding suggests new ideas about the treatment and pathophysiology of DBN with a structurally intact cerebellum.
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U2 - 10.1212/CPJ.0000000000001138
DO - 10.1212/CPJ.0000000000001138
M3 - Article
C2 - 36380886
AN - SCOPUS:85120865704
SN - 2163-0402
VL - 12
SP - E129-E132
JO - Neurology: Clinical Practice
JF - Neurology: Clinical Practice
IS - 5
ER -