What is Downbeat Nystagmus?
Downbeat nystagmus (DBN) is an eye condition that causes your eyes to drift downward and quickly snap back up. It can make things look like they’re moving or bouncing (called oscillopsia), especially when you look down or move your head. Many people with DBN also feel dizzy, off-balance, or unsteady when walking. DBN is often caused by problems in the lower part of the brain (called the cerebellum), but sometimes doctors don’t find a clear cause.
What is Ataxia?
Ataxia means poor coordination or balance. It can affect walking, hand movements, or speech. Some people with DBN also have ataxia, and both can happen from the same brain changes.
How is it treated?
There’s no cure for DBN or ataxia, but some medicines can help improve your symptoms. Not every medicine works for everyone, so treatment may take some trial and error.
Common Medicines for DBN and Ataxia
4-Aminopyridine (4-AP)
This medicine helps nerve signals work more effectively and may reduce eye jerking, as well as improve balance. It is often the first medicine doctors try. You may start on a low dose and slowly increase it. Side effects can include tingling, worsened dizziness, or, in high doses, seizures.
Acetazolamide
This drug is used for a rare type of balance disorder called episodic ataxia. It may help reduce dizziness and improve coordination. It can cause tingling, tiredness, or an upset stomach. Your doctor may check your blood tests while you take it.
Gabapentin
This medicine is often used to treat nerve pain, but it can also help alleviate dizziness or balance issues in some people. It’s usually well-tolerated but may cause sleepiness or dizziness in some individuals.
Baclofen
Baclofen is a muscle relaxer that may help with certain types of dizziness or stiffness. It’s not used as often, but it may help some patients.
Riluzole
Riluzole is used mainly for nerve diseases like ALS. Some doctors try it in patients with balance problems, but it’s still being studied and is not a common treatment.
Authors: Jake Sossamon, MD, and Kristen Steenerson, MD
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