Superior Oblique Myokymia - Three Patients with Recorded Attacks Using VOG and Frenzel Goggles

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Patients with superior oblique myokymia (SOM) commonly present with complaints of monocular oscillopsia and/or vertical diplopia, which are related to the primary and secondary actions of the SO (incycloduction and depression, respectively). In many cases, SOM represents a neurovascular compression syndrome involving the 4th cranial nerve, although irritation by a compressive mass lesion is also possible. Additionally, the clinician should consider SOM in any patient complaining of transient visual symptoms or blurriness that last for <5 seconds and occur many times throughout the day. Monocular blurriness can result from alternating contraction and relaxation of the affected SO. Binocular blurriness can result from subtle vertical-torsional ocular misalignment during attacks. In each case, the SOM was subtle and could only be appreciated with the slit lamp, ophthalmoscope, video-oculography (VOG), or with the magnification of Frenzel goggles. Each of the three patients here responded well to gabapentin, although a variety of other anti-seizure medications may be beneficial. Unfortunately, there is no robust evidence for one particular therapy over another, and randomized controlled trials are lacking for SOM. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: Patients with superior oblique myokymia (SOM) commonly present with complaints of monocular oscillopsia and/or vertical diplopia, which are related to the primary and secondary actions of the SO (incycloduction and depression, respectively). In many cases, SOM represents a neurovascular compression syndrome involving the 4th cranial nerve, although irritation by a compressive mass lesion is also possible. Additionally, the clinician should consider SOM in any patient complaining of transient visual symptoms or blurriness that last for <5 seconds and occur many times throughout the day. Monocular blurriness can result from alternating contraction and relaxation of the affected SO. Binocular blurriness can result from subtle vertical-torsional ocular misalignment during attacks. In each case, the SOM was subtle and could only be appreciated with the slit lamp, ophthalmoscope, video-oculography (VOG), or with the magnification of Frenzel goggles. Each of the three patients here responded well to gabapentin, although a variety of other anti-seizure medications may be beneficial. Unfortunately, there is no robust evidence for one particular therapy over another, and randomized controlled trials are lacking for SOM. https://collections.lib.utah.edu/ark:/87278/s6993k7q