{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:49:56Z","timestamp":1791366596828,"version":"4.3.1"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"11","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Spontaneous downbeat nystagmus (DBN) is the most common form of acquired nystagmus, characterized by a slow upward ocular drift and a corrective downward quick phase. The pathophysiology involves a final common pathway leading to decreased inhibition of the superior vestibular nucleus, often secondary to lesions in the flocculonodular lobes (flocculus\/paraflocculus, FL\/PFL), the paramedian tract (PMT), or the dorsal vermis. The clinical presentation generally includes chronic dizziness, gait unsteadiness, and oscillopsia. The causes are diverse, encompassing Chiari malformation, vascular and demyelinating lesions, hereditary and acquired cerebellar ataxias, and toxic-metabolic causes. Approximately 40% of DBN cases remain idiopathic. The treatment involves disease-specific management, prism glasses, and vestibular rehabilitation. Pharmacotherapy, such as clonazepam, gabapentin, or baclofen (with 4-aminopyridine being the most beneficial but often unavailable), is considered a second-line intervention.<\/jats:p>","DOI":"10.1055\/s-0046-1827165","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T22:41:23Z","timestamp":1786660883000},"page":"001-005","source":"Crossref","is-referenced-by-count":0,"title":["Downbeat nystagmus: a practical approach based on a clinical case"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5847-278X","authenticated-orcid":false,"given":"Rebecca Ranzani","family":"Martins","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Departamento de Neurologia, Grupo de Dist\u00farbios Vestibulares e do Equil\u00edbrio, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8417-1699","authenticated-orcid":false,"given":"Cristiana Borges","family":"Pereira","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Departamento de Neurologia, Grupo de Dist\u00farbios Vestibulares e do Equil\u00edbrio, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1097\/ICU.0000000000000802","article-title":"Downbeat nystagmus: a clinical review of diagnosis and management","volume":"32","author":"T M Tran","year":"2021","journal-title":"Curr Opin Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/B978-0-444-52903-9.00019-4","article-title":"Nystagmus and saccadic intrusions","volume":"102","author":"M J Thurtell","year":"2011","journal-title":"Handb Clin Neurol"},{"issue":"06","key":"ref3","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1136\/jnnp.2007.126284","article-title":"Downbeat nystagmus: aetiology and comorbidity in 117 patients","volume":"79","author":"J N Wagner","year":"2008","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1394859","DOI":"10.3389\/fneur.2024.1394859","article-title":"Downbeat nystagmus: a clinical and pathophysiological review","volume":"15","author":"V Marcelli","year":"2024","journal-title":"Front Neurol"},{"issue":"11","key":"ref5","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1212\/01.wnl.0000276953.00969.48","article-title":"Structural and functional MRIs disclose cerebellar pathologies in idiopathic downbeat nystagmus","volume":"69","author":"K H\u00fcfner","year":"2007","journal-title":"Neurology"},{"issue":"11","key":"ref6","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1016\/j.jocn.2012.03.017","article-title":"Downbeat nystagmus due to a paramedian medullary lesion","volume":"19","author":"K Nakamagoe","year":"2012","journal-title":"J Clin Neurosci"},{"issue":"04","key":"ref7","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1586\/17469899.2015.1057505","article-title":"Neuro-ophthalmology of type 1 Chiari malformation","volume":"10","author":"A G Shaikh","year":"2015","journal-title":"Expert Rev Ophthalmol"},{"issue":"05","key":"ref8","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1097\/00129492-200209000-00021","article-title":"The Chiari I malformation and the neurotologist","volume":"23","author":"A Kumar","year":"2002","journal-title":"Otol Neurotol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.2147\/OPTH.S6383","article-title":"Eye disorders in patients with multiple sclerosis: natural history and management","volume":"4","author":"J Graves","year":"2010","journal-title":"Clin Ophthalmol"},{"issue":"S 01","key":"ref10","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s00415-019-09326-9","article-title":"Vertical nystagmus in Wernicke's encephalopathy: pathogenesis and role of central processing of information from the otoliths","volume":"266","author":"J C Kattah","year":"2019","journal-title":"J Neurol"},{"issue":"02","key":"ref11","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1002\/mdc3.12896","article-title":"The Characteristic Eye Movement Disorder of RFC1-Linked CANVAS","volume":"7","author":"J Terryn","year":"2020","journal-title":"Mov Disord Clin Pract"},{"issue":"08","key":"ref12","doi-asserted-by":"publisher","first-page":"859","DOI":"10.3390\/brainsci15080859","article-title":"Downbeat Nystagmus: Case Report, Updated Review, Therapeutics, and Neurorehabilitation","volume":"15","author":"T M Parker","year":"2025","journal-title":"Brain Sci"}],"container-title":["Arquivos de Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0046-1827165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:54:31Z","timestamp":1791363271000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0046-1827165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":12,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,8,13]]},"published-print":{"date-parts":[[2026,11]]}},"alternative-id":["s00461827165"],"URL":"https:\/\/doi.org\/10.1055\/s-0046-1827165","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]}}}