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  • 1.  Superior oblique myokymia?

    Posted yesterday
    Good morning – question to the hive!
    Any ideas on how to further treat superior oblique myokymia? Patient is already taking carbamazepine 200 mg TID and has been intolerant to topical timolol all in the past.
    Also, I have not been able to observe or elicit the myokymia in clinic – I only saw him once so far-- patient wants to go up on the dose of Carbamazepine to 400 mg TID on his own.

    Best regards,

    Rashmi Verma MD
    Adult and pediatric Neuro Ophthalmologist
    Fellow of the North American Neuro-Ophthalmology Society


  • 2.  RE: Superior oblique myokymia?

    Posted yesterday
    Try low dose gabapentin.  (Tomsak et al. Gabapentin attenuates superior oblique myokymia. AJO 2002; 133: 721-723)

    Bob Tomsak



    Original Message


  • 3.  RE: Superior oblique myokymia?

    Posted yesterday
    Thanks, Bob. He tried that in the past as well. I can consider doing it again, but the issue is that I have never seen the myokymia by myself despite trying very hard on the slit lamp.
    Is there something that I can do to elicit the myokymia? I would feel better treating him if I could see it.

    Best regards,

    Rashmi Verma MD
    Adult and pediatric Neuro Ophthalmologist
    Fellow of the North American Neuro-Ophthalmology Society





    Original Message


  • 4.  RE: Superior oblique myokymia?

    Posted yesterday
    Are his symptoms monocular episodic oscillopsia?  If so, I doubt that it could be anything else.

    Bob



    Original Message


  • 5.  RE: Superior oblique myokymia?

    Posted yesterday
    In the office, he did complain of oscillopsia and diplopia, but when we examined him at that exact point of time under the slitlamp, no myokymia was detected

    Best regards,

    Rashmi Verma MD
    Adult and pediatric Neuro Ophthalmologist
    Fellow of the North American Neuro-Ophthalmology Society





    Original Message


  • 6.  RE: Superior oblique myokymia?

    Posted yesterday
    I have very nice selfie videos from patients with SOM - I tell them it is their homework.

    Karl Golnik, MD, MEd
    Professor, Barrow Neurological Institute
    Ophthalmology Foundation Chair for Education





    Original Message


  • 7.  RE: Superior oblique myokymia?

    Posted yesterday
    Hi Karl 
    Yes, I did ask him to do that – I am seeing him later today. We will see if he remembered his homework! Thanks.

    Best regards,

    Rashmi Verma MD
    Adult and pediatric Neuro Ophthalmologist
    Fellow of the North American Neuro-Ophthalmology Society



    Original Message


  • 8.  RE: Superior oblique myokymia?

    Posted 14 hours ago
    Try topical betablocker. It’s in the literature and I’ve had good response most of the time.

    Charles Rheeman


    Original Message


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