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Long-term follow-up of benign positional vertical opsoclonus in infants: retrospective cohort
  1. Amir Sternfeld1,
  2. Daniella Lobel2,
  3. Hana Leiba3,
  4. Judith Luckman4,
  5. Shalom Michowiz5,
  6. Nitza Goldenberg-Cohen6,7,8
  1. 1Department of Ophthalmology, Rabin Medical Center–Beilinson Hospital, Petach Tikva, Israel
  2. 2Department of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
  3. 3Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
  4. 4Department of Radiology, Rabin Medical Center–Beilinson Hospital, Petach Tikva, Israel
  5. 5Department of Pediatric Neurosurgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
  6. 6Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel
  7. 7The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
  8. 8The Krieger Eye Research Laboratory, Felsenstein Medical Research Center,, Tel Aviv University, Petach Tikva, Israel
  1. Correspondence to Dr Nitza Goldenberg-Cohen, Department of Ophthalmology, Bnai Zion Medical Center, Haifa 3339419, Israel; ncohen1{at}


Background/Aims Benign positional vertical opsoclonus in infants, also described as paroxysmal tonic downgaze, is an unsettling phenomenon that leads to extensive work-up, although benign course has been reported in sporadic cases. We describe long-term follow-up of a series of infants with the phenomenon.

Methods This retrospective cohort included all infants diagnosed with rapid downgaze eye movement in 2012–2015 and followed until 2016. The databases of two medical centres were retrospectively reviewed. Benign positional vertical opsoclonus was diagnosed based on clinical findings of experienced neuro-ophthalmologists. Data were collected on demographics, symptoms and signs, neuro-ophthalmological and neurological evaluations, and outcome. Imaging studies were reviewed. Main outcome measures were long-term outcome and findings of the thorough investigation.

Results The cohort included six infants. All infants were born at term. Age at presentation was several days to 12 weeks. Episodes lasted a few seconds and varied in frequency from <10 to dozens per day. In five infants, symptoms occurred in the supine position. There was a wide variability in the work-up without any pathological findings. Follow-up ranged from 1 to 2.5 years. Ocular symptoms gradually decreased until resolution. Infants reached normal developmental milestones.

Conclusions Our identification of six patients in only 3 years suggests benign positional vertical opsoclonus may be more prevalent than previously described. In our experience, it affects otherwise healthy infants and resolves spontaneously. In view of the good long-term outcome, a comprehensive clinical investigation may not be necessary.

  • Benign positional vertical opsoclonus
  • paroxysmal tonic downgaze
  • infants
  • vertical opsoclonus
  • gaze abnormality

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  • Contributors AS acquisition of data, analysis and interpretation of data, drafting the article. DL and JL acquisition of data, analysis and interpretation of data. HL acquisition of data. SM conception and design, revision of the manuscript. NGC conception and design, acquisition of data, analysis and interpretation of data, drafting the article.

  • Funding This study was partially supported by the Zanvyl and Isabelle Krieger Fund, Baltimore, Maryland, USA. The funding organisation had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent A retrospective study. A BMJ consent form was signed by the guardians of the infants whose videos are attached.

  • Ethics approval Institutional review boards of Schneider Children's Hospital and Kaplan Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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