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When a Withdrawal Aid Mimics a Brainstem Lesion: Gabapentin-associated Transient Ophthalmoplegia
Journal of Addiction Medicine
|February 16, 2026
Summary
Gabapentin can cause reversible neurological side effects like double vision during alcohol withdrawal treatment. Discontinuation of the medication leads to rapid symptom resolution, highlighting the need for careful monitoring.
Area of Science:
- Neurology
- Pharmacology
- Addiction Medicine
Background:
- Gabapentin is a common benzodiazepine-sparing agent for alcohol withdrawal.
- Neurological adverse effects are known but ocular motor abnormalities are rarely reported.
- Early recognition is crucial for patient management.
Purpose of the Study:
- To report a case of gabapentin-induced ocular motor abnormalities during alcohol withdrawal.
- To emphasize the importance of considering medication side effects in alcohol withdrawal management.
Main Methods:
- A case report of a 60-year-old male treated for alcohol use disorder.
- Gabapentin initiated for mild alcohol withdrawal; developed diplopia and ophthalmoplegia within 24 hours.
- Symptoms resolved rapidly after gabapentin discontinuation; neuroimaging and labs were normal.
Main Results:
- A clear temporal link between gabapentin initiation and neurological symptoms (diplopia, nystagmus, ataxia).
- Symptoms localized to cerebellar-brainstem pathways, consistent with gabapentin's mechanism.
- Medication-induced effect confirmed by rapid symptom resolution upon discontinuation.
Conclusions:
- Gabapentin is effective for mild-moderate alcohol withdrawal but rapid dose increases risk reversible neurological effects.
- New-onset diplopia or ocular motor issues warrant medication review and neurological assessment.
- This case underscores the need for vigilance regarding gabapentin's potential neurological adverse effects.
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