Volitional Flutter
Bursts of back-to-back saccadic intrusions in the horizontal plane triggered voluntarily
Often mistaken for nystagmus
Episodes are brief and tiring to the patient, and they often frighten medical care providers into launching fruitless investigations
Core clinical features
Bursts of low-amplitude oscillations (“quivering movements”) in both eyes, usually initiated by convergence
Oscillations are difficult to sustain
Possible accompanying clinical features
Lid twitches and convergence spasms
Ocular flutter
Infantile motor or sensory nystagmus
Peripheral vestibular nystagmus
Sidebeat nystagmus
Ocular dysmetria
Habit spasms (tics)
Exclude other neurologic manifestations, such as nystagmus, skew deviation, myoclonus, and altered mentation, that would suggest that these are not volitional saccadic intrusions
Avoid all ancillary tests!
Alert other caregivers to this phenomenon
Advise psychosocial assistance if appropriate
