Saccadic velocities in multiple sclerosis

[Internuclear ophthalmoplegia and associated oculomotor syndrome (author's transl)]

Fifteen patients with internuclear ophthalmoplegia (INO) were examined by simultaneous electro-oculography of each eye. In 11 patients the INO was bilateral and in 4 patients unilateral. In 6 of the bilateral cases, the INO was asymmetric. A classic presentation of the INO was shown by only 2 patients. The rest had additional disorders of eye mobility (INO plus). The high percentage of additional affections, which were not often clinically apparent, consisted of slowing of abduction (45%), impairment of vertical movements (80%) and convergence (30%), and dysmetric overshoot of the abducing eye (65%). Impairment of vertical movements were combined in 3 patients with unilateral INO. Isolated downward vertical gaze paresis was found in 4 patients. Thus an investigation by quantitative methods demonstrates the very rare occurrence of isolated lesions of the medial longitudinal fascicle (MLF). Affections of the MLF mostly are combined with lesions of the surrounding reticular formation and therefore with additional optomotoric defects.

Computerized tomography of brain and optic nerve in multiple sclerosis. Observations in 100 patients, including serial studies in 16

Computerized tomography (CT) of the brain was carried out in 100 patients with established or suspected multiple sclerosis (MS). The optic nerves were also examined in 53 of these patients. Areas compatible with demyelinating lesions were found in the cerebral hemisphere white matter and less frequently in the brain stem in 47% of cases. The hemisphere lesions were commonly multiple, typically situated in the deep white matter and periventricular regions, and were often asymptomatic. Small areas with unduly low attenuation coefficients were found in one or both optic nerves in 52% of patients in whom the optic nerves were examined. While these areas may represent demyelinating lesions their significance remains uncertain in view of poor correlation with clinical and electrophysiological parameters of optic nerve damage. Cerebral cortical atrophy and/or ventricular dilatation was found in 44% of cases, the frequency and severity of atrophy increasing with age and duration of disease. Serial studies after intervals of up to 21 months were performed in 16 patients, providing the opportunity to study the natural history of the cerebral lesions. While in some cases no significant change occurred, in others white matter lesions underwent an increase or a reduction in size, and in some cases new lesions appeared. In some patients minor degrees of atrophy became apparent over the period of the study. The value of CT in the investigation of patients with suspected MS and as a means of studying the natural history of the disease is discussed.

Evoked potentials, saccadic velocities, and computerized tomography in diagnosis of multiple sclerosis

One hundred and two patients with suspected or established multiple sclerosis (MS) were investigated by one or more of the following techniques: measurement of visual evoked potentials (VEP); measurement of cervical and cortical somatosensory evoked potentials (SEP); measurement of horizontal saccadic eye movement velocities (SV); and computerised axial tomography of the cranium and orbits (CT). Each of the techniques was valuable in detecting abnormalities, some of which were subclinical, in many patients. More abnormalities were found in patients studied by more than one technique, the most being detected in patients who were studied by all five techniques. We conclude that the techniques have a complementary role in investigating suspected MS.