Long-Term Follow-Up of Spasmus Nutans
John W. Simon, MD; Rupin N. Parikh; Gerard P. Barry, MD; Jitka L. Zobal-Ratner, MD
Albany Medical College Department of Ophthalmology/Lions Eye Institute
Introduction: Spasmus nutans is an acquired form of fine and rapid nystagmus that is classically associated with torticollis and titubations of the head, often presenting in the first year of life and spontaneously resolving within the next two years. The purpose of our study was to record and characterize the long-term prognosis of spasmus nutans.
Methods: All patients under the age of 21 years with a diagnosis of spasmus nutans were included. Parameters of age, nystagmus symmetry and quality, presence of titubations, torticollis, and strabismus, and findings on CT or MRI were recorded.
Results: Our 22 patients had an average age of onset of 9.8 and a follow-up of 62.6 months. Nystagmus was unilateral in 5 children, asymmetric in 5, symmetric in 10, and inapparent in 2. Titubations were identified in 10 and torticollis in 7. Nystagmus persisted in 16 of 20 children, titubations in 3, and torticollis in 6. Neuroimaging, performed on 17 of the 22 children, was negative for any space-occupying lesions.
Discussion: Parents can be advised that many children do well, assuming normal imaging, but that nystagmus, torticollis, and even titubations may persist. Follow-up, especially for strabismus and amblyopia, should be continued throughout childhood.
Conclusion: We are reluctant to assure parents of children who have even the most typical spasmus nutans that their child will be normal after a predictable interval.
References: 1. King RA, Nelson LB, Wagner RS. Spasmus nutans: a benign clinical entity? Arch Ophthalmol..1986; 104:1501-1504.
2. Arnoldi, KA, Tychsen, L. Prevalence of intracranial lesions in children initially diagnosed with disconjugate nystagmus (spasmus nutans). J Pediatr Ophthalmol Strabismus, 1995;32:296-301.