Treatment of superior oblique myokymia with pregabalin. Review of a clinical case

Abstract

Superior oblique myokymia is a rare idiopathic disease, characterized by sudden, spontaneous, unilateral, rhythmic contractions of the superior oblique muscle and typically presents with monocular oscillopsia and diplopia. This pathological condition most often affects middle‑aged patients without concomitant systemic diseases. The aim of the article was to study the features of the clinical course, diagnosis and methods of treatment of superior oblique myokymia based on a clinical case. A review of a clinical case of superior oblique myokymia in a patient born in 1983 is presented. The diagnosis was established on the basis of clinical manifestations in the form of sudden episodes of vertical oscillopsia and diplopia in the field of vision of the right eye, which occurred both spontaneously during prolonged work at the computer, driving a vehicle, and in response to light stimulation. A 38‑year‑old patient described the disease as the presence of periodic attacks, during which blurred vision, doubling and movement of objects in the field of vision of the right eye occurred for 2 — 3 seconds, after which the vision returned to normal. The number of attacks was up to 100 per day and significantly worsened the patient’s quality of life. During the neurological examination, an episode of vertical oscillopsia with diplopia was revealed when light was directed at the right eye. No other pathological changes were observed in the nervous system, eyes and other systems and organs, which was confirmed by laboratory and instrumental examination methods, examinations and consultations of different specialists. The patient had a positive therapeutic effect in the treatment of superior oblique myokymia with pregabalin at a dose of 150 mg per day. Recommendations to reduce the time spent working at the computer and to adopt a healthy lifestyle were important. Thus, superior oblique myokymia is a rare pathological condition manifested by sudden episodes of monocular vertical oscillopsia and diplopia. Pregabalin can be considered as the medication of choice in the treatment of this disease. Further research is needed to establish unified treatment guideline.