Journal of Neurology

, Volume 259, Issue 4, pp 773–774 | Cite as

Upbeat nystagmus as a clinical sign of physostigmine-induced right occipital non-convulsive status epilepticus

  • H. NeugebauerEmail author
  • T. Winkler
  • B. Feddersen
  • H. W. Pfister
  • S. Noachtar
  • A. Straube
  • T. Pfefferkorn
Letter to the Editors

Dear Sirs,

The main indication for use of physostigmine is treatment of anticholinergic coma after anaesthesia and intoxication. Generalized epileptic seizures are known complications of physostigmine, whereas focal seizures and non-convulsive status epilepticus (NCSE) have not been described as complications in this setting [1]. Epileptic nystagmus (EN) is a rare clinical sign of seizures defined as repetitive jerking of the eyes secondary to epileptic activity. EN usually occurs as horizontal nystagmus with its fast phase beating away from the epileptogenic hemisphere [2]. Purely vertical beating EN on the contrary is unusual and has been described only a few times in the setting of bilateral epileptic activity [3]. We present a patient in whom cholinergic treatment with physostigmine resulted in right occipital NCSE presenting with upbeat nystagmus and prolonged impairment of consciousness documented on video electroencephalogram (EEG).

A 66-year-old woman with history of drug abuse...


Occipital Lobe Physostigmine Glasgow Coma Score Perfusion Compute Tomography Epileptic Activity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest


Supplementary material

Supplementary material 1 (WMV 1857 kb)

Supplementary material 2 (WMV 1352 kb)


  1. 1.
    Houghton A (1977) Adverse effects of physostigmine. Can Anaesth Soc J 24:525–526PubMedCrossRefGoogle Scholar
  2. 2.
    Leigh RJ, Zee DS (2006) Eye movements during epileptic seizure. In: Leigh RJ, Zee DS (eds) The neurology of eye movements, 4th edn. Oxford University Press, New York, pp 669–670Google Scholar
  3. 3.
    Kaplan PW, Lesser RP (1989) Vertical and horizontal epileptic gaze deviation and nystagmus. Neurology 39:1391–1393PubMedGoogle Scholar
  4. 4.
    Rona S, Rosenow F, Arnold S et al (2005) A semiological classification of status epilepticus. Epileptic Disord 7:5–12PubMedGoogle Scholar
  5. 5.
    Meierkord H, Holtkamp M (2007) Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 6(4):329–339PubMedCrossRefGoogle Scholar
  6. 6.
    Penfield W, Erickson TC (1941) Epilepsy and Cerebral Localization. Carles C. Thomas, Oxford, EnglandGoogle Scholar
  7. 7.
    Gastaut H (1982) A new type of epilepsy: benign partial epilepsy of childhood with occipital spike-waves. Clin Elektroencephalogr 13:13–22Google Scholar
  8. 8.
    Bender MB (1980) Brain control of conjugate horizontal and vertical eye movements: a survey of the structural and functional correlates. Brain 103:23–69PubMedCrossRefGoogle Scholar
  9. 9.
    Rasmussen T, Penfield W (1948) Movement of head and eyes from stimulation of human frontal cortex. Res Publ Assoc Res Nerv Ment Dis 27:346–361PubMedGoogle Scholar
  10. 10.
    Dieterich M, Straube A, Brandt T et al (1991) The effects of baclofen and cholinergic drugs on upbeat and downbeat nystagmus. J Neurol Neurosurg Psychiatry 54:627–632PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • H. Neugebauer
    • 1
    Email author
  • T. Winkler
    • 1
  • B. Feddersen
    • 1
  • H. W. Pfister
    • 1
  • S. Noachtar
    • 1
  • A. Straube
    • 1
  • T. Pfefferkorn
    • 1
  1. 1.Department of NeurologyLudwig-Maximilians UniversityMunichGermany

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