Dr. Friedman is saying that magnesium only needs to have peripheral action in order to have an effect for migraine, and this is presumably through a vascular effect. For migraine management typically magnesium sulfate IV or or magnesium oxide or magnesium citrate are given.
I am not sure of what the role magnesium has for prolonged visual aura. The original question is what anti-epileptics might work similarly to lamotrigine. Lacosamide as another sodium channel blocker seems reasonable though I would be cautious about going after persistent visual phenomena with anti-epileptics. There is some limited evidence lacosamide might help with migraine through reduction of CGRP levels.
Robert
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Original Message:
Sent: 12/22/2025 8:19:00 AM
From: Scott Forman
Subject: RE: persistent visual aura
Mg Oxide, deb does not cross the blood brain barrier in sufficient quantities hence too high doses are needed. Mg Threonate is the only one that does.
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Scott Forman, MD
Senior Fellow North American Neuro-ophthalmology Society
Adult and Pediatric Neuro-ophthalmology
Comprehensive Ophthalmology
Functional Medicine
Original Message:
Sent: 12/21/2025 6:43:00 PM
From: Deborah Friedman
Subject: RE: persistent visual aura
The form that was studied in a clinical trial and shown to be beneficial was mag oxide. A lot of medications for migraine work peripherally (such as triptans); crossing the BBB is not necessary.
Deb
Original Message:
Sent: 12/19/2025 8:47:00 PM
From: Scott Forman
Subject: RE: persistent visual aura
Great cocktail except for mag citrate, which does not cross the bbb. Only Mg threonate does and that's why this is the only Mg form that helps migraine.
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Scott Forman, MD
Senior Fellow North American Neuro-ophthalmology Society
Adult and Pediatric Neuro-ophthalmology
Comprehensive Ophthalmology
Functional Medicine
Original Message:
Sent: 12/19/2025 7:05:00 PM
From: Andrew Berman
Subject: RE: persistent visual aura
You might try the cocktail of riboflavin, Co-Q 10 and mag citrate.
Original Message:
Sent: 12/11/2025 9:46:00 AM
From: Nathan Kung
Subject: persistent visual aura
Hi all,
I have an 18 yo pt who for the last 1-2 yrs has been experiencing visual disturbances almost like things are "moving in slow motion, or fish-eye like in a concave/convex mirror, sometimes in association with light sensitivity".
I have characterized it generally as possible persistent visual aura related to alice-in-wonderland syndrome. She did not respond to any CGRP or typical migrainous therapies such as topamax/propranolol, but then had a marked response to lamictal w/near complete resolution for the last several months, but has been having significant tolerance issues w/the med and wants to try something different. She does appear to have dose-responsiveness to the lamictal.
Does anyone have any suggestions for another similar med that might treat 'persistent visual aura' in this way similar to lamictal? I'm wondering about possible oxcarbazepine or vimpat?
thanks,
Nathan