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NEUROLOGY 1991;41:1737
© 1991 American Academy of Neurology

Effect of anticholinergic agents upon acquired nystagmus

A double-blind study of trihexyphenidyl and tridihexethyl chloride

R. John Leigh, MD, Thomas H. Burnstine, MD, Robert L. Ruff, MD, PhD and Richard J. Kasmer, PharmD

Departments of Neurology (Drs. Leigh, Burnstine, and Ruff) and Pharmacology (Dr. Kasmer), University Hospitals, and Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH.

We conducted a randomized, double-blind, crossover trial of two anticholinergic agents—trihexyphenidyl and tridihexethyl chloride (a quaternary anticholinergic that does not cross the blood-brain barrier)—in patients with acquired nystagmus and measured visual acuity and nystagmus before and at the end of 1 month on each medication. Of the 10 patients admitted to the study, only five completed trials of both drugs due to intolerance of medication or intercurrent illness. Of six patients who completed the trial of trihexyphenidyl, only one showed improvement. Of six patients who completed a trial of tridihexethyl chloride, four showed improvement. We conclude that (1) trihexyphenidyl is not a reliable treatment for acquired nystagmus, although occasional patients may benefit; (2) anticholinergic agents may suppress nystagmus by peripheral rather than central mechanisms; and (3) the side effects of anticholinergic agents limit their effectiveness in the treatment of nystagmus.

Address correspondence and reprint requests to Dr. R. John Leigh, Department of Neurology, University Hospitals of Cleveland, 2074 Abington Road, Cleveland, OH 44106.

Supported by USPHS grant EY06717 (to Dr. Leigh), the Department of Veterans Affairs, and the Evenor Armington Fund.

Received March 8, 1991. Accepted for publication in final form May 6, 1991.




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