Abstract
Objective: The aim is to report a case of visual snow syndrome amenable to treatment with lamotrigine and review relevant case series.
Background: Visual snow is a rare phenomenon of seeing “spots” or “television static” when in the entire visual field, with otherwise normal clinical examination. While initially reported as a persistent visual migraine phenomenon, there is increasing recognition of visual snow as a distinct syndrome. Visual snow occurs bilaterally unlike unilateral visual phenomena in migraine with aura.
Design/Methods: Pubmed was searched using keyword “visual snow” from 1/1/2013 to 10/1/2017.
Results: Proposed diagnostic criteria for visual snow syndrome by Schankin et al. (2014) were reviewed. Opinion statement by Bou and Pelak and case report by Unal-Cevik and Yildiz detailing lamotrigine treatment were retrieved. Simpson (2013) and Schankin (2016) report lack of response to treatment including no response in 6 other case series, resolution with naproxen in one case and partial improvement on sertraline in one case.
Case report: The patient is a 22 year old right handed male, who presented with seeing static like visual changes since age 18. Initially, these occurred intermittently and 1.5 years ago became continuous. There is associated photopsia and palinopsia. His mother had post herpetic neuralgia but family history was negative for migraine. He had a normal 3T MRI brain, brainstem and auditory evoked potentials, as well as ophthalmological evaluation including funduscopic and visual field examination and normal neurological examination. He received lamotrigine dose escalation to 75 mg BID with complete resolution of symptoms.
Conclusions: Visual snow syndrome is a benign disorder which may be amenable to treatment with lamotrigine, which has so far been reported in only one case report and one opinion statement.
Disclosure: Dr. Fekete has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Teva Neuroscience, Neurocrine, Inc., Acadia Pharmaceutical, Inc., Lundbeck, LLC. Dr. Fekete has received research support from Lundbeck, LLC.
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