[Characterization of A German Cohort with Visual Snow Syndrome]

Overview

Journal Nervenarzt

Specialty Neurology

Date 2024 Nov 12

PMID 39532711

Authors

Felix Fay

Andreas Straube

Ruth Ruscheweyh

Ozan Emre Eren

Affiliations

Soon will be listed here.

Abstract

Background: Visual snow is a disorder of visual perception that is manifested as a constant flickering or "TV-like" noise in the entire visual field. Visual snow syndrome (VSS) describes a combination with other additional visual symptoms, such as sensitivity to light, afterimages, night blindness and entoptic phenomena. Cases of VS have been described in the literature using a wide variety of terms, often misunderstood as persistent migraine aura. Established diagnostic criteria have existed for more than 10 years now; however, the pathophysiology is still incompletely understood. The exact prevalence also remains unknown and high numbers of unreported cases are suspected. This is the first detailed description of a cohort of VSS patients from Germany.

Methods: Patients with VSS from several studies conducted at our center were pooled and retrospectively evaluated with respect to demographic, epidemiological and clinical data.

Results: In this study 66 patients with VSS were included (age 31.3 ± 8.3 years, 30 women). The most commonly associated visual symptoms were photophobia (67%) and afterimages (65%). Of the patients 36 (54%) had comorbid migraine of whom 25 (70%) had migraine with aura, 26 (39%) reported depressive symptoms and 32 (48%) symptoms of an anxiety disorder. Tinnitus was reported by 32 (48%) patients.

Conclusion: The characteristics of the German cohort described here are similar to other international descriptions. Due to the frequent psychological comorbidity there is still a risk of psychosomatic stigmatization.

References

Aldusary N, Traber G, Freund P, Fierz F, Weber K, Baeshen A . Abnormal Connectivity and Brain Structure in Patients With Visual Snow. Front Hum Neurosci. 2020; 14:582031. PMC: 7710971. DOI: 10.3389/fnhum.2020.582031. View

Eren O, Rauschel V, Ruscheweyh R, Straube A, Schankin C . Evidence of dysfunction in the visual association cortex in visual snow syndrome. Ann Neurol. 2018; 84(6):946-949. DOI: 10.1002/ana.25372. View

Eren O, Schoberl F, Schankin C, Straube A . Visual snow syndrome after start of citalopram-novel insights into underlying pathophysiology. Eur J Clin Pharmacol. 2020; 77(2):271-272. PMC: 7803695. DOI: 10.1007/s00228-020-02996-9. View

Graber M, Scutelnic A, Klein A, Puledda F, Goadsby P, Schankin C . Natural course of visual snow syndrome: a long-term follow-up study. Brain Commun. 2022; 4(5):fcac230. PMC: 9487631. DOI: 10.1093/braincomms/fcac230. View

Guay M, Lagman-Bartolome A . Onset of Visual Snow Syndrome After the First Migraine Episode in a Pediatric Patient: A Case Report and Review of Literature. Pediatr Neurol. 2021; 126:46-49. DOI: 10.1016/j.pediatrneurol.2021.08.005. View

Healy D, Mangin D, Lochhead J . Development and persistence of patient-reported visual problems associated with serotonin reuptake inhibiting antidepressants. Int J Risk Saf Med. 2021; 33(1):37-47. DOI: 10.3233/JRS-210018. View

Kondziella D, Olsen M, Dreier J . Prevalence of visual snow syndrome in the UK. Eur J Neurol. 2020; 27(5):764-772. DOI: 10.1111/ene.14150. View

Kroenke K, Strine T, Spitzer R, Williams J, Berry J, Mokdad A . The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2008; 114(1-3):163-73. DOI: 10.1016/j.jad.2008.06.026. View

Lampl C, Katsarava Z, Diener H, Limmroth V . Lamotrigine reduces migraine aura and migraine attacks in patients with migraine with aura. J Neurol Neurosurg Psychiatry. 2005; 76(12):1730-2. PMC: 1739463. DOI: 10.1136/jnnp.2005.063750. View

10.

Launer L, Terwindt G, Ferrari M . The prevalence and characteristics of migraine in a population-based cohort: the GEM study. Neurology. 1999; 53(3):537-42. DOI: 10.1212/wnl.53.3.537. View

11.

Lauschke J, Plant G, Fraser C . Visual snow: A thalamocortical dysrhythmia of the visual pathway?. J Clin Neurosci. 2016; 28:123-7. DOI: 10.1016/j.jocn.2015.12.001. View

12.

Liu G, Schatz N, Galetta S, Volpe N, Skobieranda F, Kosmorsky G . Persistent positive visual phenomena in migraine. Neurology. 1995; 45(4):664-8. DOI: 10.1212/wnl.45.4.664. View

13.

Mehta D, Garza I, Robertson C . Two hundred and forty-eight cases of visual snow: A review of potential inciting events and contributing comorbidities. Cephalalgia. 2021; 41(9):1015-1026. DOI: 10.1177/0333102421996355. View

14.

Puledda F, ODaly O, Schankin C, Ffytche D, Williams S, Goadsby P . Disrupted connectivity within visual, attentional and salience networks in the visual snow syndrome. Hum Brain Mapp. 2021; 42(7):2032-2044. PMC: 8046036. DOI: 10.1002/hbm.25343. View

15.

Puledda F, Schankin C, Goadsby P . Visual snow syndrome: A clinical and phenotypical description of 1,100 cases. Neurology. 2020; 94(6):e564-e574. PMC: 7136068. DOI: 10.1212/WNL.0000000000008909. View

16.

Puledda F, Vandenbussche N, Moreno-Ajona D, Eren O, Schankin C, Goadsby P . Evaluation of treatment response and symptom progression in 400 patients with visual snow syndrome. Br J Ophthalmol. 2021; 106(9):1318-1324. PMC: 9411880. DOI: 10.1136/bjophthalmol-2020-318653. View

17.

Rasmussen B, Olesen J . Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia. 1992; 12(4):221-8; discussion 186. DOI: 10.1046/j.1468-2982.1992.1204221.x. View

18.

Schankin C, Maniyar F, Digre K, Goadsby P . 'Visual snow' - a disorder distinct from persistent migraine aura. Brain. 2014; 137(Pt 5):1419-28. DOI: 10.1093/brain/awu050. View

19.

Schankin C, Maniyar F, Sprenger T, Chou D, Eller M, Goadsby P . The relation between migraine, typical migraine aura and "visual snow". Headache. 2014; 54(6):957-66. DOI: 10.1111/head.12378. View

20.

Simpson J, Goadsby P, Prabhakar P . Positive persistent visual symptoms (visual snow) presenting as a migraine variant in a 12-year-old girl. Pediatr Neurol. 2013; 49(5):361-3. DOI: 10.1016/j.pediatrneurol.2013.07.005. View