Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 23;93(4):e398-e403.
doi: 10.1212/WNL.0000000000007825. Epub 2019 Jun 18.

Treatment effects and comorbid diseases in 58 patients with visual snow

Robin M van Dongen  1 , Lindy C Waaijer  1 , Gerrit L J Onderwater  1 , Michel D Ferrari  1 , Gisela M Terwindt  2
Affiliations

Treatment effects and comorbid diseases in 58 patients with visual snow

Robin M van Dongen et al. Neurology. .

Abstract

Objective: To evaluate pharmacologic treatment options for visual snow and to report prevalence of comorbid diseases.

Methods: Medical charts of patients with a diagnosis of visual snow at the neurology outpatient clinic were reviewed on prescribed medication, and comorbid migraine, tinnitus, and psychiatric conditions including depression and anxiety.

Results: From 2007 to 2018, 58 patients were diagnosed with visual snow. Comorbid migraine was present in 51.7% of patients, lifetime depression in 41.4%, and lifetime anxiety in 44.8%. Lamotrigine was prescribed most frequently (26/58) and resulted in partial remission of symptoms in 5/26 (19.2%). No patients reported complete remission. Adverse events occurred in 13/26 (50.0%) patients. None of the other prescribed drugs (valproate [n = 7], topiramate [n = 4], acetazolamide [n = 2], flunarizine [n = 1]) led to improvement except for topiramate in one patient, who discontinued, however, because of adverse events.

Conclusions: Of medication prescribed (lamotrigine, valproate, acetazolamide, flunarizine), only lamotrigine afforded some improvement in a small minority of patients. Migraine, depression, anxiety, and tinnitus were common comorbid diseases.

Classification of evidence: This study provides Class IV evidence that for some patients with visual snow, lamotrigine resulted in partial remission of symptoms.

PubMed Disclaimer

Figures

Figure
Figure. Flowchart of study participants
*Visual snow syndrome criteria as proposed by Schankin et al.
See this image and copyright information in PMC

Comment in

References

    1. Schankin CJ, Maniyar FH, Digre KB, et al. . “Visual snow”: a disorder distinct from persistent migraine aura. Brain 2014;137:1419–1428. - PubMed
    1. Puledda F, Schankin C, Digre K, Goadsby PJ. Visual snow syndrome: what we know so far. Curr Opin Neurol 2018;31:52–58. - PubMed
    1. Lauschke JL, Plant GT, Fraser CL. Visual snow: a thalamocortical dysrhythmia of the visual pathway? J Clin Neurosci 2016;28:123–127. - PubMed
    1. Unal-Cevik I, Yildiz FG. Visual snow in migraine with aura: further characterization by brain imaging, electrophysiology, and treatment: case report. Headache 2015;55:1436–1441. - PubMed
    1. Wang YF, Fuh JL, Chen WT, Wang SJ. The visual aura rating scale as an outcome predictor for persistent visual aura without infarction. Cephalalgia 2008;28:1298–1304. - PubMed