Spasm of the Near Reflex: Literature Review and Proposed Management Strategy.

BACKGROUND AND PURPOSE:Spasm of the near reflex (SNR) can be a variable, unpredictable condition. There is no standard management strategy. The purpose of this paper is to summarize the pertinent information from a literature review to better identify, explain, and manage this condition.PATIENTS AND METHOD:Case presentations and retrospective literature review Results: The presumed cause of SNR can be grouped into four categories: psychogenic, head trauma, organic/neurologic, and other causes. Etiology is often presumed rather than confirmed and may be multifactorial. A number of treatments have been reported, all with unpredictable efficacy.Etiology may be the most important factor in predicting treatment outcomes. In general, SNR due to psychogenic causes often has a good prognosis but time required for resolution varies widely. SNR due to an organic/neurologic cause may resolve with treatment of the underlying condition, but a psychogenic component may also occur in these cases. SNR due to head trauma has the poorest prognosis with incomplete resolution for many.CONCLUSION:SNR is highly variable in presentation and may have various causes. Response to treatment is unpredictable but may be dependent on etiology. A standardized treatment protocol for SNR may not be attainable, but it is possible to approach management of SNR in a methodical manner. A proposed management strategy is presented.