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Eyelid Closure Downbeat Nystagmus: A Rare Cause of Insomnia.

E yelid closure downbeat nystagmus (ECDN) is an involuntary extraocular movement abnormality characterized by a slow upward drift of the eyes, followed by a fast downward corrective saccade that is only present when the eyes are closed. This has most often been associated with structural disruption of vestibular circuitry (1). In recent years, downbeat nystagmus (DBN) has been reported in association with motor neuron disease (MND) and given the name finger extension weakness and DBN with MND (FEWDON-MND) (2). Despite occasional case reports within the medical literature, the underlying pathophysiology of this phenomenon is unclear. We present a case of insomnia related to ECDN in a patient with concomitant distal weakness and response to immunomodulatory therapy, suggesting an autoimmune etiology.