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Lage C, Sánchez-Rodríguez A, Rivera-Sánchez M, Sierra M, González-Aramburu I, Madera J, Delgado-Alvarado M, López-García S, Martínez-Dubarbie F, Fernández-Matarrubia M, Martínez-Amador N, Martínez-Rodríguez I, Calvo-Córdoba A, Rodríguez-Rodríguez E, García-Cena C, Sánchez-Juan P, Infante J. Oculomotor Dysfunction in Idiopathic and LRRK2-Parkinson's Disease and At-Risk Individuals. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230416. [PMID: 38701160 DOI: 10.3233/jpd-230416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Video-oculography constitutes a highly-sensitive method of characterizing ocular movements, which could detect subtle premotor changes and contribute to the early diagnosis of Parkinson's disease (PD). Objective To investigate potential oculomotor differences between idiopathic PD (iPD) and PD associated with the G2019S variant of LRRK2 (L2PD), as well as to evaluate oculomotor function in asymptomatic carriers of the G2019S variant of LRRK2. Methods The study enrolled 129 subjects: 30 PD (16 iPD, 14 L2PD), 23 asymptomatic carriers, 13 non-carrier relatives of L2PD patients, and 63 unrelated HCs. The video-oculographic evaluation included fixation, prosaccade, antisaccade, and memory saccade tests. Results We did not find significant differences between iPD and L2PD. Compared to controls, PD patients displayed widespread oculomotor deficits including larger microsaccades, hypometric vertical prosaccades, increased latencies in all tests, and lower percentages of successful antisaccades and memory saccades. Non-carrier relatives showed oculomotor changes with parkinsonian features, such as fixation instability and hypometric vertical saccades. Asymptomatic carriers shared multiple similarities with PD, including signs of unstable fixation and hypometric vertical prosaccades; however, they were able to reach percentages of successful antisaccade and memory saccades similar to controls, although at the expense of longer latencies. Classification accuracy of significant oculomotor parameters to differentiate asymptomatic carriers from HCs ranged from 0.68 to 0.74, with BCEA, a marker of global fixation instability, being the parameter with the greatest classification accuracy. Conclusions iPD and LRRK2-G2019S PD patients do not seem to display a differential oculomotor profile. Several oculomotor changes in asymptomatic carriers of LRRK2 mutations could be considered premotor biomarkers.
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Affiliation(s)
- Carmen Lage
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California - San Francisco (UCSF), San Francisco, CA, USA
| | - Antonio Sánchez-Rodríguez
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- Neurology Service, Hospital de Cabueñes, Gijón, Spain
| | - María Rivera-Sánchez
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Sierra
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Isabel González-Aramburu
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Jorge Madera
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Manuel Delgado-Alvarado
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
- Neurology Service, Hospital de Sierrallana, Santander, Spain
| | - Sara López-García
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Francisco Martínez-Dubarbie
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Marta Fernández-Matarrubia
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Néstor Martínez-Amador
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- Nuclear Medicine Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Isabel Martínez-Rodríguez
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- University of Cantabria, Santander, Spain
- Nuclear Medicine Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Alberto Calvo-Córdoba
- Universidad Politécnica de Madrid, Centre for Automation and Robotics, Escuela Técnica de Ingenieros Industriales (ETSII), Madrid, Spain
| | - Eloy Rodríguez-Rodríguez
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Cecilia García-Cena
- Universidad Politécnica de Madrid, Centre for Automation and Robotics, UPM-CSIC, Escuela Técnica Superiorde Ingeniería y Diseño Industrial, Madrid, Spain
| | - Pascual Sánchez-Juan
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- CIEN Foundation/Queen Sofia Foundation Alzheimer Center, Madrid, Spain
| | - Jon Infante
- Neurology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Institute for Research Marqués de Valdecilla (IDIVAL), Santander, Spain
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III (ISCIII), Madrid, Spain
- University of Cantabria, Santander, Spain
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Zhou D, Ma Q, Huang H, Xu X. Clinical value of video oculomotor evaluation in the differential diagnosis of multiple system atrophy and Parkinson's disease. Brain Behav 2024; 14:e3510. [PMID: 38715394 PMCID: PMC11077249 DOI: 10.1002/brb3.3510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 04/13/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a neurodegenerative disease that progresses rapidly and has a poor prognosis. This study aimed to assess the value of video oculomotor evaluation (VOE) in the differential diagnosis of MSA and Parkinson's disease (PD). METHODS In total, 28 patients with MSA, 31 patients with PD, and 30 age- and sex-matched healthy controls (HC) were screened and included in this study. The evaluation consisted of a gaze-holding test, smooth pursuit eye movement (SPEM), random saccade, and optokinetic nystagmus (OKN). RESULTS The MSA and PD groups had more abnormalities and decreased SPEM gain than the HC group (64.29%, 35.48%, 10%, p < .001). The SPEM gain in the MSA group was significantly lower than that in the PD group at specific frequencies. Patients with MSA and PD showed prolonged latencies in all saccade directions compared with those with HC. However, the two diseases had no significant differences in the saccade parameters. The OKN gain gradually decreased from the HC to the PD and the MSA groups (p < .05). Compared with the PD group, the gain in the MSA group was further decreased in the OKN test at 30°/s (Left, p = .010; Right p = .016). Receiver operating characteristic curves showed that the combination of oculomotor parameters with age and course of disease could aid in the differential diagnosis of patients with MSA and PD, with a sensitivity of 89.29% and a specificity of 70.97%. CONCLUSIONS The combination of oculomotor parameters and clinical data may aid in the differential diagnosis of MSA and PD. Furthermore, VOE is vital in the identification of neurodegenerative diseases.
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Affiliation(s)
- Dongxiao Zhou
- Department of Neurology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological DiseasesNational Key Clinical Department and Key Discipline of NeurologyGuangzhouChina
| | - Qian Ma
- Department of Neurology, The Fifth Affiliated HospitalSun Yat‐sen UniversityZhuhaiChina
| | - Haiwei Huang
- Department of Neurology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological DiseasesNational Key Clinical Department and Key Discipline of NeurologyGuangzhouChina
| | - Xue Xu
- Department of Neurology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological DiseasesNational Key Clinical Department and Key Discipline of NeurologyGuangzhouChina
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3
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Leng Q, Deng B, Ju Y. Application and progress of advanced eye movement examinations in cognitive impairment. Front Aging Neurosci 2024; 16:1377406. [PMID: 38694260 PMCID: PMC11061382 DOI: 10.3389/fnagi.2024.1377406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/04/2024] [Indexed: 05/04/2024] Open
Abstract
The worldwide incidence of cognitive impairment is escalating, yet no effective solutions for these afflictions have been discovered. Consequently, the importance of early identification and immediate intervention is heightened. Advanced eye movements-a form of voluntary eye movements that includes anti-saccades, memory-guided saccades, predictive saccades, pro-saccades and gap/overlap saccades, mediated by the cerebral cortex and subcortical pathways reflect cognitive levels and functions across different domains. In view of their objectivity, reproducibility, and non-invasive characteristics, advanced eye movement examination possesses significant prospective utility across a wide range of cognitive impairment. This paper extensively reviews various models associated with advanced eye movement examinations and their current applications in cognitive impairment such as Alzheimer's disease, Lewy body dementia and frontotemporal dementia. Advanced eye movement examination can serve as a biomarker for early screening diagnosis and research on cognitive impairment. In the future, combining advanced eye movement examination with neuropsychological scale assessment and other diagnostic methods may contribute to further early identification of these types of diseases.
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Affiliation(s)
- Qi Leng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Deng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases, Beijing, China
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4
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Aust E, Graupner ST, Günther R, Linse K, Joos M, Grosskreutz J, Prudlo J, Pannasch S, Hermann A. Impairment of oculomotor functions in patients with early to advanced amyotrophic lateral sclerosis. J Neurol 2024; 271:325-339. [PMID: 37713127 PMCID: PMC10770212 DOI: 10.1007/s00415-023-11957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) can result into an incomplete locked in state (iLIS), in which communication depends on eye tracking computer devices. Oculomotor function impairments in ALS have been reported, but there is little research, particularly with respect to patients in iLIS. In the present study, we compared reflexive and executive oculomotor function by means of an eye tracking test battery between three groups: advanced ALS patients in iLIS (n = 22), patients in early to middle ALS stages (n = 44) and healthy subjects (n = 32). Patients with ALS showed significant deteriorations in oculomotor functions, with stronger impairments in iLIS. More specifically, ALS patients produced visually guided prosaccades with longer latencies and more frequent hypometria compared to healthy subjects. Longest latencies were obtained in iLIS patients, with a stronger prolongation for vertical than for horizontal prosaccades. ALS patients made more antisaccade errors and generated antisaccades with longer latencies. Smooth pursuit was also impaired in ALS. In the earlier ALS stages, bulbar onset patients presented stronger antisaccade and smooth pursuit deficits than spinal onset patients. Our findings reveal a relevant deterioration of important oculomotor functions in ALS, which increases in iLIS. It includes impairments of reflexive eye movements to loss of executive inhibitory control, indicating a progressing pathological involvement of prefrontal, midbrain and brainstem areas. The assessment of oculomotor functions may therefore provide clinically relevant bio- and progression marker, particularly in advanced ALS.
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Affiliation(s)
- Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Sven-Thomas Graupner
- Verkehrspsychologie, Fakultät Verkehrswissenschaften, Technische Universität Dresden, Dresden, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | - Julian Grosskreutz
- Precision Neurology and Cluster "Precision Medicine in Inflammation", University of Lübeck, Lübeck, Germany
| | - Johannes Prudlo
- Department of Neurology, University of Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Sebastian Pannasch
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Andreas Hermann
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, Rostock, Germany.
- Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University of Rostock, Rostock, Germany.
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Seo H, Chung WG, Kwon YW, Kim S, Hong YM, Park W, Kim E, Lee J, Lee S, Kim M, Lim K, Jeong I, Song H, Park JU. Smart Contact Lenses as Wearable Ophthalmic Devices for Disease Monitoring and Health Management. Chem Rev 2023; 123:11488-11558. [PMID: 37748126 PMCID: PMC10571045 DOI: 10.1021/acs.chemrev.3c00290] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Indexed: 09/27/2023]
Abstract
The eye contains a complex network of physiological information and biomarkers for monitoring disease and managing health, and ocular devices can be used to effectively perform point-of-care diagnosis and disease management. This comprehensive review describes the target biomarkers and various diseases, including ophthalmic diseases, metabolic diseases, and neurological diseases, based on the physiological and anatomical background of the eye. This review also includes the recent technologies utilized in eye-wearable medical devices and the latest trends in wearable ophthalmic devices, specifically smart contact lenses for the purpose of disease management. After introducing other ocular devices such as the retinal prosthesis, we further discuss the current challenges and potential possibilities of smart contact lenses.
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Affiliation(s)
- Hunkyu Seo
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Won Gi Chung
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Yong Won Kwon
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Sumin Kim
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Yeon-Mi Hong
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Wonjung Park
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Enji Kim
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Jakyoung Lee
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Sanghoon Lee
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Moohyun Kim
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Kyeonghee Lim
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Inhea Jeong
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Hayoung Song
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Jang-Ung Park
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
- Department
of Neurosurgery, Yonsei University College
of Medicine, Seoul 03722, Republic of Korea
- Center
for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic
of Korea
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6
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Watanabe Y, Takeuchi S, Uehara K, Takeda H, Hanajima R. Clinical availability of eye movement during reading. Neurosci Res 2023; 195:52-61. [PMID: 37245663 DOI: 10.1016/j.neures.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023]
Abstract
Eyes provide valuable information for neurological diagnosis. So far, the use of diagnostic devices to analyze eye movement is limited. We explored whether the analysis of eye movements can be efficacious. Patients with Parkinson's disease (PD) (n = 29), spinocerebellar degeneration (SCD) (21), progressive supranuclear palsy (PSP) (19), and control individuals (19) participated in this study. The patients read aloud two sets of sentences displayed on a monitor: one was displayed horizontally, and the other vertically. Parameters such as eye movement speed, travel distance, and fixation/saccade ratio were extracted, and comparisons between groups were performed. Maneuvers of eye movements were also subjected to image classification using deep learning. Reading velocity and fixation/saccade ratio were altered in the PD group, and the SCD group exhibited ineffective eye movements due to dysmetria and nystagmus. Vertical gaze parameters showed aberrant values in the PSP group. Vertical written sentences were more sensitive than horizontal ones in detecting these abnormalities. In the regression analysis, vertical reading indicated a high accuracy in identifying each group. The machine learning analysis showed more than 90 % accuracy in distinguishing between the control and SCD groups and between the SCD and PSP groups. Analyzing eye movements is useful and easily applicable.
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Affiliation(s)
- Yasuhiro Watanabe
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Suzuha Takeuchi
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kazutake Uehara
- Department of Mechanical Engineering, National Institute of Technology, Yonago College, Yonago, Japan
| | - Haruka Takeda
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
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7
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de Villers-Sidani É, Voss P, Bastien N, Cisneros-Franco JM, Hussein S, Mayo NE, Koch NA, Drouin-Picaro A, Blanchette F, Guitton D, Giacomini PS. Oculomotor analysis to assess brain health: preliminary findings from a longitudinal study of multiple sclerosis using novel tablet-based eye-tracking software. Front Neurol 2023; 14:1243594. [PMID: 37745656 PMCID: PMC10516298 DOI: 10.3389/fneur.2023.1243594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
A growing body of evidence supports the link between eye movement anomalies and brain health. Indeed, the oculomotor system is composed of a diverse network of cortical and subcortical structures and circuits that are susceptible to a variety of degenerative processes. Here we show preliminary findings from the baseline measurements of an ongoing longitudinal cohort study in MS participants, designed to determine if disease and cognitive status can be estimated and tracked with high accuracy based on eye movement parameters alone. Using a novel gaze-tracking technology that can reliably and accurately track eye movements with good precision without the need for infrared cameras, using only an iPad Pro embedded camera, we show in this cross-sectional study that several eye movement parameters significantly correlated with clinical outcome measures of interest. Eye movement parameters were extracted from fixation, pro-saccade, anti-saccade, and smooth pursuit visual tasks, whereas the clinical outcome measures were the scores of several disease assessment tools and standard cognitive tests such as the Expanded Disability Status Scale (EDSS), Brief International Cognitive Assessment for MS (BICAMS), the Multiple Sclerosis Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT). Furthermore, partial least squares regression analyses show that a small set of oculomotor parameters can explain up to 84% of the variance of the clinical outcome measures. Taken together, these findings not only replicate previously known associations between eye movement parameters and clinical scores, this time using a novel mobile-based technology, but also the notion that interrogating the oculomotor system with a novel eye-tracking technology can inform us of disease severity, as well as the cognitive status of MS participants.
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Affiliation(s)
- Étienne de Villers-Sidani
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrice Voss
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - J. Miguel Cisneros-Franco
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Nancy E. Mayo
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Nils A. Koch
- Innodem Neurosciences, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | | | | | - Daniel Guitton
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Paul S. Giacomini
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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8
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Mertin R, Diesta C, Brüggemann N, Rosales RL, Hanssen H, Westenberger A, Steinhardt J, Heldmann M, Manalo HTS, Oropilla JQ, Klein C, Helmchen C, Sprenger A. Oculomotor abnormalities indicate early executive dysfunction in prodromal X-linked dystonia-parkinsonism (XDP). J Neurol 2023; 270:4262-4275. [PMID: 37191726 PMCID: PMC10421788 DOI: 10.1007/s00415-023-11761-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND X-Linked dystonia-parkinsonism (XDP) is a movement disorder characterized by the presence of both dystonia and parkinsonism with one or the other more prominent in the initial stages and later on manifesting with more parkinsonian features towards the latter part of the disease. XDP patients show oculomotor abnormalities indicating prefrontal and striatal impairment. This study investigated oculomotor behavior in non-manifesting mutation carriers (NMC). We hypothesized that oculomotor disorders occur before the appearance of dystonic or parkinsonian signs. This could help to functionally identify brain regions already affected in the prodromal stage of the disease. METHODS Twenty XDP patients, 13 NMC, and 28 healthy controls (HC) performed different oculomotor tasks typically affected in patients with parkinsonian signs. RESULTS The error rate for two types of volitional saccades, i.e., anti-saccades and memory-guided saccades, was increased not only in XDP patients but also in NMC compared to HC. However, the increase in error rates of both saccade types were highly correlated in XDP patients only. Hypometria of reflexive saccades was only found in XDP patients. Initial acceleration and maintenance velocity of smooth pursuit eye movements were only impaired in XDP patients. CONCLUSIONS Despite being asymptomatic, NMC already showed some oculomotor deficits reflecting fronto-striatal impairments, typically found in XDP patients. However, NMC did not show saccade hypometria and impaired smooth pursuit as seen in advanced Parkinson's disease and XDP, suggesting oculomotor state rather than trait signs in these mutation carriers. Neurodegeneration may commence in the striatum and prefrontal cortex, specifically the dorsolateral prefrontal cortex.
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Affiliation(s)
- Renana Mertin
- Department of Neurology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Cid Diesta
- Makati Medical Center, Makati City, Philippines
- Asian Hospital and Medical Center, Manila, Philippines
| | - Norbert Brüggemann
- Department of Neurology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Raymond L Rosales
- Department of Neurology and Psychiatry, University of Santo Thomas, Manila, Philippines
| | - Henrike Hanssen
- Department of Neurology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Ana Westenberger
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Julia Steinhardt
- Department of Neurology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Marcus Heldmann
- Department of Neurology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- Institute of Psychology II, University Lübeck, Lübeck, Germany
| | | | - Jean Q Oropilla
- Makati Medical Center, Makati City, Philippines
- Asian Hospital and Medical Center, Manila, Philippines
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Christoph Helmchen
- Department of Neurology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Andreas Sprenger
- Department of Neurology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany.
- Institute of Psychology II, University Lübeck, Lübeck, Germany.
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de Villers-Sidani É, Voss P, Guitton D, Cisneros-Franco JM, Koch NA, Ducharme S. A novel tablet-based software for the acquisition and analysis of gaze and eye movement parameters: a preliminary validation study in Parkinson's disease. Front Neurol 2023; 14:1204733. [PMID: 37396780 PMCID: PMC10310943 DOI: 10.3389/fneur.2023.1204733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
The idea that eye movements can reflect certain aspects of brain function and inform on the presence of neurodegeneration is not a new one. Indeed, a growing body of research has shown that several neurodegenerative disorders, such as Alzheimer's and Parkinson's Disease, present characteristic eye movement anomalies and that specific gaze and eye movement parameters correlate with disease severity. The use of detailed eye movement recordings in research and clinical settings, however, has been limited due to the expensive nature and limited scalability of the required equipment. Here we test a novel technology that can track and measure eye movement parameters using the embedded camera of a mobile tablet. We show that using this technology can replicate several well-known findings regarding oculomotor anomalies in Parkinson's disease (PD), and furthermore show that several parameters significantly correlate with disease severity as assessed with the MDS-UPDRS motor subscale. A logistic regression classifier was able to accurately distinguish PD patients from healthy controls on the basis of six eye movement parameters with a sensitivity of 0.93 and specificity of 0.86. This tablet-based tool has the potential to accelerate eye movement research via affordable and scalable eye-tracking and aid with the identification of disease status and monitoring of disease progression in clinical settings.
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Affiliation(s)
- Étienne de Villers-Sidani
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrice Voss
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Daniel Guitton
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - J. Miguel Cisneros-Franco
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Nils A. Koch
- Innodem Neurosciences, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Simon Ducharme
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
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Castricum J, Tulen JHM, Taal W, Pel JJM, Elgersma Y. Visual-spatial and visuomotor functioning in adults with neurofibromatosis type 1. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:362-374. [PMID: 36625000 DOI: 10.1111/jir.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a neurodevelopmental genetic disorder associated with visual-spatial and visuomotor deficits, which have not been studied well in adults with NF1. METHODS In 22 adults with NF1 and 31 controls, visuomotor functioning was assessed by measuring eye latency, hand latency and hand accuracy during visuomotor tasks. Visual-spatial functioning was assessed by measuring eye movement responses during the Visual Threshold Task. RESULTS The NF1 group had a significantly shorter eye latency than the control group and was less accurate in their hand movements during specific visuomotor tasks. The groups showed no differences in eye movement responses during the Visual Threshold Task and in hand latency during the visuomotor tasks. CONCLUSIONS In contrast to studies in children with NF1, we found no alterations in visual-spatial information processing in adults. Impairments in eye latency and hand accuracy during specific visuomotor tasks may indicate deficits in visuomotor functioning in adults with NF1.
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Affiliation(s)
- J Castricum
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J H M Tulen
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W Taal
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Neurology/Neuro-oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - J J M Pel
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Y Elgersma
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Neurology/Neuro-oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
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Eye movement study in essential tremor patients and its clinical correlates. J Neural Transm (Vienna) 2023; 130:537-548. [PMID: 36894713 DOI: 10.1007/s00702-023-02614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
Essential tremor (ET) encompasses a wide spectrum of motor and non-motor features. Eye movement abnormalities were first reported two decades ago as an atypical finding in ET. Today, a growing number of publications about eye movement abnormalities in neurodegenerative diseases have helped understand their pathophysiology and the basis of their phenotypic variability. Thus, addressing such aspect in ET may disentangle, based on the oculomotor network abnormalities, the dysfunctional brain pathways in ET. In this study, we aimed to describe neurophysiological eye movement abnormalities in ET and their clinical correlates in terms of cognition and other associated clinical signs. We conducted a cross-sectional study in a tertiary neurology referral center including consecutive ET patients and cognitively normal healthy controls (HC) matched for age and sex. The study protocol included the assessment of voluntary horizontal saccades, smooth pursuit, anti-saccades and saccadic intrusions. We assessed the associated motor signs, cognitive functions and the presence of rapid eye movement disorder (RBD). Sixty-two ET patients and 66 HC were enrolled in the study. Eye movement examination showed significant abnormalities in comparison with HC (46.7% vs 20%, p = 0.002). Prolonged saccadic latency (38.7%, p = 0.033) and altered smooth pursuit (38.7%, p = 0.033) were the most common abnormalities in ET patients. Anti-saccadic errors (16% vs 0% in HC, p = 0.034) correlated with the presence of rigidity (p = 0.046), bradykinesia (p = 0.001), cognitive dysfunction (p = 0.006), executive dysfunction (p = 0.0002), apraxia (p = 0.0001), altered verbal fluency (p = 0.013) and altered backward digit span (p = 0.045) along with the presence of RBD (p = 0.035). Square-wave jerks (11.5% vs 0% in HC, p = 0.0024) correlated with rest tremor. A distinctive phenotype of ET could emerge out of this study characterized by anti-saccadic errors and a sub-cortical cognitive profile, consecutive to the disruption of the cerebello-thalamo-cortical loop. Patients with anti-saccadic errors could be cognitively vulnerable and in need of a close monitoring of their cognitive efficiency during the disease's progression. They may as well convert to Parkinson disease if they present with parkinsonism, RBD and square-wave jerks and require, consequently, a close observation of their motor progression.
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Trofimov AO, Agarkova DI, Trofimova KA, Lidji-Goryaev K, Bragin DE. Moderate Severity SARS-CoV-2 (COVID-19) Affects Ocular Vergence Indices: Eye Tracking-Based Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:325-330. [PMID: 37581806 DOI: 10.1007/978-3-031-31986-0_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Since the start of the SARS-CoV-2 (COVID-19) pandemic, it has become clear that the brain is one of the main targets for acute and chronic damage. Although neurodegenerative changes have yet to be investigated, there is already a large body of data on damage to its fiber tracts. A mobile eye tracker is possibly one of the best tools to study such damage in a COVID hospital setting. At the same time, the available data indicate that eye tracking parameters, even in healthy volunteers, demonstrate a distinct gender-specific difference.The aim of the work is to evaluate functional and structural impairments of the fiber tracts and to find possible gender-specific dynamics of eye tracking indicators in the acute period of COVID-19 pneumonia (Delta variant) of moderate severity. MATERIALS AND METHODS A single-center non-randomized retrospective study included 84 patients in the acute period of moderate severity SARS-CoV-2 (COVID-19) pneumonia (Delta variant) (Group 1). The mean time from admission was 1.4 ± 1.2 days. M:41, F:43. According to thoracic CT, the lung involvement ranged from CT 1 to CT 2. SpO2 ranged from 95% to 99%. The mean age was 35.5 ± 14.8 years (from 18 to 60). The control group (Group 2) included 158 healthy volunteers without pathology of the vision organs and central nervous system.The eye vergence index (VRx) was determined using eye tracking as a motion correlation coefficient between the angular velocities of the left and right eyeballs and was a measure of the conjugation of horizontal and vertical eye movements.The mobile complex Eye Tracker Low-Speed 20 (BVG LLC, the Netherlands) was used. Eye tracking parameters were assessed by vertical and horizontal eye vergence (VVRx and HVRx).Statistical analysis was done using the methods of parametric and non-parametric statistics. RESULTS Moderate COVID-19 pneumonia resulted in a significant decrease in both VVRx and HVRx compared to controls (0.763 ± 0.127 and 0.856 ± 0.043; p < 0.000001; 0.729 ± 0.018 and 0.776 ± 0.023 p < 0.000001, respectively). VVRx values were significantly higher in men (0.775 ± 0.046 and 0.747 ± 0.091, p = 0.019, respectively), while ХVRx values were significantly higher in women (0.665 ± 0.018 and 0.728 ± 0.024, p < 0.0000001, respectively). CONCLUSIONS SARS-CoV-2 (COVID-19) of moderate severity is accompanied by a significant deterioration in eye tracking performance proving functional and structural impairments (p < 0.05). VVRx was significantly higher in men, and HVRx was substantially greater in women reflecting gender-specific differences.
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Affiliation(s)
- Alex O Trofimov
- Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Darya I Agarkova
- Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Kseniia A Trofimova
- Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Kyrill Lidji-Goryaev
- Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Denis E Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Slower velocity perception with stronger optokinetic nystagmus: A paradoxical perception in virtual reality. J Neurol Sci 2022; 441:120384. [PMID: 36027643 DOI: 10.1016/j.jns.2022.120384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Optokinetic nystagmus (OKN) was studied in an immersive virtual reality (VR) environment with both typical optokinetic stimulation (OKs) wherein the head-tracking is active (similar to be sitting in front of a rotating drum) or a unique stimulus (VR-OKs) wherein the head-tracking is turned off, so head movements do not update the visual image (which moves with the head). OBJECTIVE To study both the perception of the stimulus velocity and eye movements while subjects rotated their head from side to side and the visual scene was either a typical OKs or VR-OKs. METHODS 9 healthy participants (aged 23 ± 2.4 y/o) had head and eye movements recorded under typical OKs and VR-OKS while smoothly rotating their head horizontally from side to side. Stimulation was delivered using a virtual reality setup on top of an eye movements recording system. RESULTS Under VR-OKs participants perceived faster stimulus velocity when the head and stimulus had the same direction as compared to the head and stimulus in opposite directions. When the head turned in the same direction as the stimulus, there were fewer fast phase eye movements than when it rotated counter to stimulus motion direction. Conversely, with typical OKs, participants perceived faster stimulus velocity when the head and stimulus had opposite directions as compared to the head and stimulus having the same direction. CONCLUSIONS The seemingly paradoxical results in which slower stimulus velocity is perceived in tandem with stronger nystagmus can be explained by the simultaneous activation of the Vestibulo-Ocular Reflex and OKN in accordance with the various visual and vestibular stimuli.
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Zhou H, Sun Y, Wei L, Wang X, Jiang Y, Li F, Chen J, Sun W, Zhang L, Zhao G, Wang Z. Quantitative assessment of oculomotor function by videonystagmography in multiple system atrophy. Clin Neurophysiol 2022; 141:15-23. [DOI: 10.1016/j.clinph.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/30/2022] [Accepted: 05/29/2022] [Indexed: 11/25/2022]
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Monitoring Eye Movements Depending on the Type of Visual Stimulus in Patients with Impaired Consciousness Due to Brain Damage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106280. [PMID: 35627817 PMCID: PMC9140856 DOI: 10.3390/ijerph19106280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 02/06/2023]
Abstract
The eyeballs are often the only way to communicate messages as a result of brain damage. However, it is not uncommon for them to become dysfunctional, thus requiring the introduction of appropriate therapy. The trajectory of eye movements (saccadic movements and gaze fixation) during observation of a static and dynamic point presented with an eye tracker was analyzed in the present study. Twelve patients with brain injury of different etiology, with different degrees of consciousness disorders and not communicating through verbal and motor skills, qualified for the study. All participants demonstrated greater eye movement activity when presented with a dynamic task in which they observed a moving point. The findings suggest that effective eye movement therapy must incorporate dynamic stimuli.
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Azami H, Chang Z, Arnold SE, Sapiro G, Gupta AS. Detection of Oculomotor Dysmetria From Mobile Phone Video of the Horizontal Saccades Task Using Signal Processing and Machine Learning Approaches. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2022; 10:34022-34031. [PMID: 36339795 PMCID: PMC9632643 DOI: 10.1109/access.2022.3156964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Eye movement assessments have the potential to help in diagnosis and tracking of neurological disorders. Cerebellar ataxias cause profound and characteristic abnormalities in smooth pursuit, saccades, and fixation. Oculomotor dysmetria (i.e., hypermetric and hypometric saccades) is a common finding in individuals with cerebellar ataxia. In this study, we evaluated a scalable approach for detecting and quantifying oculomotor dysmetria. Eye movement data were extracted from iPhone video recordings of the horizontal saccade task (a standard clinical task in ataxia) and combined with signal processing and machine learning approaches to quantify saccade abnormalities. Entropy-based measures of eye movements during saccades were significantly different in 72 individuals with ataxia with dysmetria compared with 80 ataxia and Parkinson's participants without dysmetria. A template matching-based analysis demonstrated that saccadic eye movements in patients without dysmetria were more similar to the ideal template of saccades. A support vector machine was then used to train and test the ability of multiple signal processing features in combination to distinguish individuals with and without oculomotor dysmetria. The model achieved 78% accuracy (sensitivity= 80% and specificity= 76%). These results show that the combination of signal processing and machine learning approaches applied to iPhone video of saccades, allow for extraction of information pertaining to oculomotor dysmetria in ataxia. Overall, this inexpensive and scalable approach for capturing important oculomotor information may be a useful component of a screening tool for ataxia and could allow frequent at-home assessments of oculomotor function in natural history studies and clinical trials.
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Affiliation(s)
- Hamed Azami
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Zhuoqing Chang
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27707, USA
| | - Steven E Arnold
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27707, USA
- Department of Computer Science, Duke University, Durham, NC 27707, USA
- Department of Biomedical Engineering, Duke University, Durham, NC 27707, USA
- Department of Mathematics, Duke University, Durham, NC 27707, USA
| | - Anoopum S Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Eye Movement Alterations in Post-COVID-19 Condition: A Proof-of-Concept Study. SENSORS 2022; 22:s22041481. [PMID: 35214383 PMCID: PMC8875414 DOI: 10.3390/s22041481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
There is much evidence pointing out eye movement alterations in several neurological diseases. To the best of our knowledge, this is the first video-oculography study describing potential alterations of eye movements in the post-COVID-19 condition. Visually guided saccades, memory-guided saccades, and antisaccades in horizontal axis were measured. In all visual tests, the stimulus was deployed with a gap condition. The duration of the test was between 5 and 7 min per participant. A group of n=9 patients with the post-COVID-19 condition was included in this study. Values were compared with a group (n=9) of healthy volunteers whom the SARS-CoV-2 virus had not infected. Features such as centripetal and centrifugal latencies, success rates in memory saccades, antisaccades, and blinks were computed. We found that patients with the post-COVID-19 condition had eye movement alterations mainly in centripetal latency in visually guided saccades, the success rate in memory-guided saccade test, latency in antisaccades, and its standard deviation, which suggests the involvement of frontoparietal networks. Further work is required to understand these eye movements' alterations and their functional consequences.
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Liu Z, Yang Z, Gu Y, Liu H, Wang P. The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis. PLoS One 2021; 16:e0254059. [PMID: 34252113 PMCID: PMC8274929 DOI: 10.1371/journal.pone.0254059] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
Background Eye tracking (ET) is a viable marker for the recognition of cognitive disorders. We assessed the accuracy and clinical value of ET for the diagnosis of cognitive disorders in patients. Methods We searched the Medline, Embase, Web of Science, Cochrane Library, and Pubmed databases from inception to March 2, 2021, as well as the reference lists of identified primary studies. We included articles written in English that investigated ET for cognitive disorder patients—Mild cognitive impairment (MCI), Alzheimer’s disease (AD), Amyotrophic lateral sclerosis (ALS), and dementia. Two independent researchers extracted the data and the characteristics of each study; We calculated pooled sensitivities and specificities. A hierarchical summary of receiver performance characteristics (HSROC) model was used to test the diagnostic accuracy of ET for cognitive impairment (CI). Findings 11 studies met the inclusion criteria and were included in qualitative comprehensive analysis. Meta-analysis was performed on 9 trials using Neuropsychological Cognitive Testing (NCT) as the reference standard. The comprehensive sensitivity and specificity of ET for detecting cognitive disorders were 0.75 (95% CI 0.72–0.79) and 0.73 (95% CI 0.70 to 0.76), respectively. The combined positive likelihood ratio (LR+) was 2.74 (95%CI 2.32–3.24) and the negative likelihood ratio (LR−) was 0.27 (95%CI 0.18–0.42). Conclusions This review showed that ET technology could be used to detect the decline in CI, clinical use of ET techniques in combination with other tools to assess CI can be encouraged.
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Affiliation(s)
- Zicai Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Zhen Yang
- Histology and Imaging platform, Core Facilities of West China Hospital, Sichuan University, China
| | - Yueming Gu
- Rehabilitation College of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The 7th Affiliated Hospital of Sun Yat-Sen University (Shenzhen), Shenzhen, Guangdong, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
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Zhou H, Wang X, Ma D, Jiang Y, Li F, Sun Y, Chen J, Sun W, Pinkhardt EH, Landwehrmeyer B, Ludolph A, Zhang L, Zhao G, Wang Z. The differential diagnostic value of a battery of oculomotor evaluation in Parkinson's Disease and Multiple System Atrophy. Brain Behav 2021; 11:e02184. [PMID: 34056874 PMCID: PMC8323034 DOI: 10.1002/brb3.2184] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Clinical diagnosis of Parkinsonism is still challenging, and the diagnostic biomarkers of Multiple System Atrophy (MSA) are scarce. This study aimed to investigate the diagnostic value of the combined eye movement tests in patients with Parkinson's disease (PD) and those with MSA. METHODS We enrolled 96 PD patients, 33 MSA patients (18 with MSA-P and 15 with MSA-C), and 40 healthy controls who had their horizontal ocular movements measured. The multiple-step pattern of memory-guided saccade (MGS), the hypometria/hypermetria of the reflexive saccade, the abnormal saccade in smooth pursuit movement (SPM), gaze-evoked nystagmus, and square-wave jerks in gaze-holding test were qualitatively analyzed. The reflexive saccadic parameters and gain of SPM were also quantitatively analyzed. RESULTS The MGS test showed that patients with either diagnosis had a significantly higher incidence of multiple-step pattern compared with controls (68.6%, 65.2%, and versus. 2.5%, p < .05, in PD, MSA, versus. controls, respectively). The reflexive saccade test showed that MSA patients showing a prominent higher incidence of the abnormal saccade (63.6%, both hypometria and hypermetria) than that of PD patients and controls (33.3%, 7.5%, respectively, hypometria) (p < .05). The SPM test showed PD patients had mildly decreased gain among whom 28.1% presenting "saccade intrusions"; and that MSA patients had the significant decreased gain with 51.5% presenting "catch-up saccades"(p < .05). Only MSA patients showed gaze-evoked nystagmus (24.2%), square-wave jerks (6.1%) in gaze-holding test (p < .05). CONCLUSIONS A panel of eye movements tests may help to differentiate PD from MSA. The combined presence of hypometria and hypermetria in saccadic eye movement, the impaired gain of smooth pursuit movement with "catch-up saccades," gaze-evoked nystagmus, square-wave jerks in gaze-holding test, and multiple-step pattern in MGS may provide clues to the diagnosis of MSA.
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Affiliation(s)
- Hong Zhou
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Di Ma
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yanyan Jiang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yunchuang Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jing Chen
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | | | | | | | - Lin Zhang
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Guiping Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
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21
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Wunderlich J, Behler A, Dreyhaupt J, Ludolph AC, Pinkhardt EH, Kassubek J. Diagnostic value of video-oculography in progressive supranuclear palsy: a controlled study in 100 patients. J Neurol 2021; 268:3467-3475. [PMID: 33744980 PMCID: PMC8357639 DOI: 10.1007/s00415-021-10522-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/18/2023]
Abstract
Background The eponymous feature of progressive supranuclear palsy (PSP) is oculomotor impairment which is one of the relevant domains in the Movement Disorder Society diagnostic criteria. Objective We aimed to investigate the value of specific video-oculographic parameters for the use as diagnostic markers in PSP. Methods An analysis of video-oculography recordings of 100 PSP patients and 49 age-matched healthy control subjects was performed. Gain of smooth pursuit eye movement and latency, gain, peak eye velocity, asymmetry of downward and upward velocities of saccades as well as rate of saccadic intrusions were analyzed. Results Vertical saccade velocity and saccadic intrusions allowed for the classification of about 70% and 56% of the patients, respectively. By combining both parameters, almost 80% of the PSP patients were covered, while vertical velocity asymmetry was observed in approximately 34%. All parameters had a specificity of above 95%. The sensitivities were lower with around 50–60% for the velocity and saccadic intrusions and only 27% for vertical asymmetry. Conclusions In accordance with oculomotor features in the current PSP diagnostic criteria, video-oculographic assessment of vertical saccade velocity and saccadic intrusions resulted in very high specificity. Asymmetry of vertical saccade velocities, in the opposite, did not prove to be useful for diagnostic purposes. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10522-9.
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Affiliation(s)
- Jessica Wunderlich
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Anna Behler
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Elmar H Pinkhardt
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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Tsitsi P, Benfatto MN, Seimyr GÖ, Larsson O, Svenningsson P, Markaki I. Fixation Duration and Pupil Size as Diagnostic Tools in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:865-875. [PMID: 33612496 PMCID: PMC8150520 DOI: 10.3233/jpd-202427] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Visual and oculomotor problems are very common in Parkinson's disease (PD) and by using eye-tracking such problems could be characterized in more detail. However, eye-tracking is not part of the routine clinical investigation of parkinsonism. OBJECTIVE To evaluate gaze stability and pupil size in stable light conditions, as well as eye movements during sustained fixation in a population of PD patients and healthy controls (HC). METHODS In total, 50 PD patients (66% males) with unilateral to mild-to-moderate disease (Hoehn & Yahr 1-3, Schwab and England 70-90%) and 43 HC (37% males) were included in the study. Eye movements were recorded with Tobii Pro Spectrum, a screen-based eye tracker with a sampling rate of 1200 Hz. Logistic regression analysis was applied to investigate the strength of association of eye-movement measures with diagnosis. RESULTS Median pupil size (OR 0.811; 95% CI 0.666-0.987; p = 0.037) and longest fixation period (OR 0.798; 95% CI 0.691-0.921; p = 0.002), were the eye-movement parameters that were independently associated with diagnosis, after adjustment for sex (OR 4.35; 95% CI 1.516-12.483; p = 0.006) and visuospatial/executive score in Montreal Cognitive Assessment (OR 0.422; 95% CI 0.233-0.764; p = 0.004). The area under the ROC curve was determined to 0.817; 95% (CI) 0.732-0.901. CONCLUSION Eye-tracking based measurements of gaze fixation and pupil reaction may be useful biomarkers of PD diagnosis. However, larger studies of eye-tracking parameters integrated into the screening of patients with suspected PD are necessary, to further investigate and confirm their diagnostic value.
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Affiliation(s)
- Panagiota Tsitsi
- Department of Clinical Neuroscience, Neuro, Karolinska Institutet, Stockholm, Sweden.,Center of Neurology, Academic Specialist Center, Region Stockholm, Sweden
| | | | - Gustaf Öqvist Seimyr
- Department of Clinical Neuroscience, Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Olof Larsson
- Department of Clinical Neuroscience, Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Neuro, Karolinska Institutet, Stockholm, Sweden.,Center of Neurology, Academic Specialist Center, Region Stockholm, Sweden.,Neurology Department, Karolinska University Hospital, Stockholm, Sweden
| | - Ioanna Markaki
- Department of Clinical Neuroscience, Neuro, Karolinska Institutet, Stockholm, Sweden.,Center of Neurology, Academic Specialist Center, Region Stockholm, Sweden
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Deciphering the saccade velocity profile of progressive supranuclear palsy: A sign of latent cerebellar/brainstem dysfunction? Clin Neurophysiol 2021; 141:147-159. [PMID: 33632587 DOI: 10.1016/j.clinph.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To study whether the velocity profile of horizontal saccades could be used as an indicator of brainstem and cerebellar output dysfunction, depending on progressive supranuclear palsy (PSP) subtype. METHODS We compared the velocity profiles in 32 PSP patients of various subtypes with 38 age-matched normal subjects, including Richardson syndrome (RS), PSP-parkinsonism (PSPp), and pure akinesia (PAGF), and cerebellar subtypes of PSP (PSPc). RESULTS PSP patients showed reduced peak velocity along with increased duration, especially in the deceleration phase. This alteration was more prominent for larger target eccentricities (20-30 degrees), and correlated with disease severity. The changes were most pronounced in PSPc patients, with irregular increases and decreases in velocity profile, followed by RS patients, whereas the change was smaller in PSPp and normal in PAGF patients. CONCLUSIONS Saccade velocity profile can be an indicator of brainstem and/or cerebellar output. Altered velocity profile of PSP patients may reflect the pathology in the brainstem, but may also reflect cerebellar dysfunction, most prominently in PSPc. SIGNIFICANCE Saccade velocity profile may be used as an indicator of latent cerebellar/brainstem dysfunction.
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24
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Frei K. Abnormalities of smooth pursuit in Parkinson's disease: A systematic review. Clin Park Relat Disord 2020; 4:100085. [PMID: 34316663 PMCID: PMC8299966 DOI: 10.1016/j.prdoa.2020.100085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
Abnormalities of saccades, vergence and smooth pursuit have been found in PD. SPEM abnormalities in PD consist of reduced gain and saccadic pursuit. PD patients have normal SPEM interspersed with catch up and anticipatory saccades. SP may reflect an inability to inhibit extraneous saccades or be a sign of executive dysfunction. Degeneration of SNr in PD may be reason behind SPEM abnormalities in PD.
Smooth pursuit eye movement (SPEM) abnormalities are commonly seen in Parkinson’s disease (PD). Both reduced speed and saccades seen during SPEM, also known as saccadic pursuit (SP), have been studied in PD. A comprehensive literature review analyzed 26 studies of SPEM and PD. It appears that a greater proportion of PD patients have SPEM abnormalities consisting of reduced SPEM gain and/or SP compared to the normal population. It is not clear whether SPEM abnormalities are present early in the disease or begin sometime during disease progression. SPEM abnormalities may be correlated with disease severity but do not fluctuate or respond to dopaminergic medication in the same manner as other motor symptoms in PD. SPEM in PD is composed of normal SPEM interspersed with SP composed of both catch up and anticipatory saccades. This differs from other neurodegenerative disorders and may be related to an inability to inhibit extraneous saccades or to increased distraction reflecting executive dysfunction. Because the basal ganglia are involved in SPEM physiology, degeneration of the SNr neurons in PD may explain abnormal SPEM in this disorder. Since dementia, aging and medication effects influence SPEM, they should be controlled for in future studies of SPEM in PD. SP is easily detected on clinical exam and may be a biomarker for the disease or for disease progression. Oculomotor testing can be an important part of the Parkinson’s exam.
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Affiliation(s)
- Karen Frei
- Loma Linda University, Loma Linda, CA, United States
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25
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Bilbao C, Piñero DP. Clinical Characterization of Oculomotricity in Children with and without Specific Learning Disorders. Brain Sci 2020; 10:brainsci10110836. [PMID: 33187134 PMCID: PMC7697867 DOI: 10.3390/brainsci10110836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/16/2022] Open
Abstract
Children with specific learning disorders have been associated with oculomotor problems, with their analysis even suggested to be a potential diagnostic tool. A prospective non-randomized comparative study evaluating 59 children (6–13 years old) divided into three groups was conducted: a control group (CG) including 15 healthy emmetropic children; a group of 18 healthy children with oculomotor abnormalities (OAG); and a group of 26 children diagnosed with specific learning disorders (LDG). In all groups, besides a complete eye exam, oculomotricity was characterized with two clinical tests: Northeastern State University College of Optometry’s Oculomotor (NSUCO) and Developmental Eye Movement (DEM) tests. Concerning the NSUCO test, lower ability, precision, and head/body movement associated scorings were obtained for both smooth pursuits and saccades in OAG and LDG when compared to the CG (p < 0.001). Likewise, significantly longer time needed to read the horizontal sheet of the DEM test and a higher DEM ratio were found in OAG and LDG compared to CG (p ≤ 0.003). No differences between LDG and OAG were found in the performance with the two oculomotor tests (p ≥ 0.141). Oculomotor anomalies can be present in children with and without specific learning disorders, and therefore cannot be used as diagnostic criteria of these type of disorders.
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Affiliation(s)
- Carmen Bilbao
- Department of Optometry, Policlínica Alto Aragón, 22003 Huesca, Spain;
| | - David P. Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 San Vicente del Raspeig-Alicante, Spain
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain
- Correspondence: ; Tel.: +34-965-90-34-00
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26
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Imaoka Y, Flury A, de Bruin ED. Assessing Saccadic Eye Movements With Head-Mounted Display Virtual Reality Technology. Front Psychiatry 2020; 11:572938. [PMID: 33093838 PMCID: PMC7527608 DOI: 10.3389/fpsyt.2020.572938] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
As our society is ageing globally, neurodegenerative disorders are becoming a relevant issue. Assessment of saccadic eye movement could provide objective values to help to understand the symptoms of disorders. HTC Corporation launched a new virtual reality (VR) headset, VIVE Pro Eye, implementing an infrared-based eye tracking technique together with VR technology. The purpose of this study is to evaluate whether the device can be used as an assessment tool of saccadic eye movement and to investigate the technical features of eye tracking. We developed a measurement system of saccadic eye movement with a simple VR environment on Unity VR design platform, following an internationally proposed standard saccade measurement protocol. We then measured the saccadic eye movement of seven healthy young adults to analyze the oculo-metrics of latency, peak velocity, and error rate of pro- and anti-saccade tasks: 120 trials in each task. We calculated these parameters based on the saccade detection algorithm that we have developed following previous studies. Consequently, our results revealed latency of 220.40 ± 43.16 ms, peak velocity of 357.90 ± 111.99°/s, and error rate of 0.24 ± 0.41% for the pro-saccade task, and latency of 343.35 ± 76.42 ms, peak velocity of 318.79 ± 116.69°/s, and error rate of 0.66 ± 0.76% for the anti-saccade task. In addition, we observed pupil diameter of 4.30 ± 1.15 mm (left eye) and 4.29 ± 1.08 mm (right eye) for the pro-saccade task, and of 4.21 ± 1.04 mm (left eye) and 4.22 ± 0.97 mm (right eye) for the anti-saccade task. Comparing between the descriptive statistics of previous studies and our results suggests that VIVE Pro Eye can function as an assessment tool of saccadic eye movement since our results are in the range of or close to the results of previous studies. Nonetheless, we found technical limitations especially about time-related measurement parameters. Further improvements in software and hardware of the device and measurement protocol, and more measurements with diverse age-groups and people with different health conditions are warranted to enhance the whole assessment system of saccadic eye movement.
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Affiliation(s)
- Yu Imaoka
- Motor Control & Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andri Flury
- Motor Control & Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control & Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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27
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The effect of impulsivity and inhibitory control deficits in the saccadic behavior of premanifest Huntington's disease individuals. Orphanet J Rare Dis 2019; 14:246. [PMID: 31703597 PMCID: PMC6839196 DOI: 10.1186/s13023-019-1218-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aims to test response inhibition in premanifest Huntington's disease individuals (Pre-HD), in the context of a saccadic paradigm with working memory demands and fronto-executive load as a way to measure inhibitory control deficits and impulsive behavior in Huntington's disease (HD). METHODS The oculomotor function of 15 Pre-HD and 22 Control individuals was assessed using an experimental paradigm comprising four horizontal saccadic tasks: prosaccade (PS), antisaccade (AS), 1- or 2-back memory prosaccade (MPS), and 1- or 2-back memory antisaccade (MAS). Success rate, latency, directional and timing errors were calculated for each task. A comprehensive battery of neuropsychological tests was also used to assess the overall cognitive functioning of study participants. Statistical correlations between oculomotor, clinical and cognitive measures were computed for the Pre-HD group. RESULTS Pre-HD participants showed reduced success rate in the AS task, increased direction errors in the AS and MAS tasks and decreased latency in the MAS task when compared to Controls, despite presenting similar executive and memory scores in the conventional neuropsychological tests applied. Significant associations were identified between specific AS and MAS parameters and disease-related measures, cognitive skills and other oculomotor results of Pre-HD participants. CONCLUSIONS Our results show that oculomotor performance in premanifest Huntington's disease deteriorates once inhibitory control, working memory and/or fronto-executive load are added to the task. A more automatic pattern of performance, including a faster response time and directionally erroneous eye movements were detected in the oculomotor behavior of the Pre-HD group-these alterations were significantly correlated with disease stage and cognitive status. Our saccadic paradigm was able to capture impulsivity and inhibitory control deficits in a group of Pre-HD individuals on average far from symptom onset, thus holding the potential to identify the earliest disease-related changes.
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Bueno APA, Sato JR, Hornberger M. Eye tracking - The overlooked method to measure cognition in neurodegeneration? Neuropsychologia 2019; 133:107191. [PMID: 31521634 DOI: 10.1016/j.neuropsychologia.2019.107191] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/26/2019] [Accepted: 09/08/2019] [Indexed: 12/11/2022]
Abstract
Eye tracking (ET) studies are becoming increasingly popular due to rapid methodological and technological advances as well as the development of cost efficient and portable eye trackers. Although historically ET has been mostly employed in psychophysics or developmental cognition studies, there is also promising scope to use ET for movement disorders and measuring cognitive processes in neurodegeneration. Particularly, ET can be a powerful tool for cognitive and neuropsychological assessments of patients with pathologies affecting motor and verbal abilities, as tasks can be adapted without requiring motor (except eye movements) or verbal responses. In this review, we will examine the existing evidence of ET methods in neurodegenerative conditions and its potential clinical impact for cognitive assessment. We highlight that current evidence for ET is mostly focused on diagnostics of cognitive impairments in neurodegenerative disorders, where it is debatable whether it has any more sensitivity or specificity than existing cognitive assessments. By contrast, there is currently a lack of ET studies in more advanced disease stages, when patients' motor and verbal functions can be significantly affected, and standard cognitive assessments are challenging or often not possible. We conclude that ET is a promising method not only for cognitive diagnostics but more importantly, for potential cognitive disease tracking in progressive neurodegenerative conditions.
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Affiliation(s)
- A P A Bueno
- - Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil; - Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - J R Sato
- - Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - M Hornberger
- - Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK; - Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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29
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Lal V, Truong D. Eye movement abnormalities in movement disorders. Clin Park Relat Disord 2019; 1:54-63. [PMID: 34316601 PMCID: PMC8288550 DOI: 10.1016/j.prdoa.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/12/2022] Open
Abstract
The visual system represents the most well-developed sensory system in humans, who are highly dependent on vision for organized response to their environment. The region of eye that is responsible for sharp central vision is the fovea. Thus, to see the world, images of objects of interest should fall on fovea. This is achieved through various sets of eye movements, all of which work together to keep the image of the target object on the fovea. It is therefore not surprising that a large part of the human brain is devoted to eye movements (e.g., several cortical and subcortical areas, including the brainstem, cerebellum and basal ganglia). Given that a large area of brain is devoted to eye movements, it is not surprising to find eye movement abnormalities in various brain disorders, including movement disorders. In fact, many of the movement disorders commonly encountered in clinical practice are associated with characteristic eye movement abnormalities that not only help in specific diagnosis, but also contribute to morbidity associated with these disorders. In this article, we review the pathophysiology, clinical characteristics, and significance of various eye movement abnormalities in patients with various movement disorders.
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Affiliation(s)
- Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daniel Truong
- The Truong Neuroscience Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA 92708, USA
- Department of Psychiatry and Neuroscience, University of California Riverside, Riverside, CA, USA
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30
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Coiner B, Pan H, Bennett ML, Bodien YG, Iyer S, O'Neil-Pirozzi TM, Leung L, Giacino JT, Stern E. Functional neuroanatomy of the human eye movement network: a review and atlas. Brain Struct Funct 2019; 224:2603-2617. [PMID: 31407103 DOI: 10.1007/s00429-019-01932-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/30/2019] [Indexed: 12/13/2022]
Abstract
The human eye movement network is a complex system that requires the integration of sensory, motor, attentional, and executive processes. Here, we review the neuroanatomy of the eye movement network with an emphasis on functional neuroimaging applications. We consolidate the literature into a concise resource designed to be immediately accessible and applicable to diverse research interests, and present the novel Functional Oculomotor System (FOcuS) Atlas-a tool in stereotaxic space that will simplify and standardize the inclusion of the eye movement network in future functional neuroimaging studies. We anticipate this review and the FOcuS Atlas will facilitate increased examination of the eye movement network across disciplines leading to a thorough understanding of how eye movement network function contributes to higher-order cognition and how it is integrated with other brain networks. Furthermore, functional examination of the eye movement network in patient populations offers the potential for deeper insight into the role of eye movement circuitry in functional network activity, diagnostic assessments, and the indications for augmentative communication systems that rely on eye movement control.
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Affiliation(s)
- Benjamin Coiner
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, BLI442, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Eskind Family Biomedical Library and Learning Center, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
| | - Hong Pan
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, BLI442, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Monica L Bennett
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, BLI442, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Yelena G Bodien
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA, 02129, USA
| | - Swathi Iyer
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, BLI442, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,The MathWorks, Inc, 1 Apple Hill Drive, Natick, MA, 01760, USA
| | - Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA, 02129, USA.,Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA
| | - Lorene Leung
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, BLI442, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - Joseph T Giacino
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA, 02129, USA
| | - Emily Stern
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, BLI442, 75 Francis St, Boston, MA, 02115, USA. .,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. .,Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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Larrazabal A, García Cena C, Martínez C. Video-oculography eye tracking towards clinical applications: A review. Comput Biol Med 2019; 108:57-66. [DOI: 10.1016/j.compbiomed.2019.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/20/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
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Sprenger A, Hanssen H, Hagedorn I, Prasuhn J, Rosales RL, Jamora RDG, Diesta CC, Domingo A, Klein C, Brüggemann N, Helmchen C. Eye movement deficits in X-linked dystonia-parkinsonism are related to striatal degeneration. Parkinsonism Relat Disord 2019; 61:170-178. [DOI: 10.1016/j.parkreldis.2018.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/14/2018] [Accepted: 10/14/2018] [Indexed: 11/16/2022]
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Effect of subthalamic nucleus deep brain stimulation on visual scanning. Clin Neurophysiol 2018; 129:2421-2432. [DOI: 10.1016/j.clinph.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/12/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
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The Area under the Main Sequence as an Alternative Method to Measure Saccadic Dynamics. Optom Vis Sci 2018; 95:1004-1026. [PMID: 30339642 DOI: 10.1097/opx.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This study shows that the area under the main sequence (MSAREA) is a valid alternative to the standard peak-velocity main sequence in measuring saccadic dynamics. A one-parameter area model, MSAREA = GPW = 1.55 × SACSIZE, with SACSIZE as the size of the saccade, 1.55 as a power factor, and GPW = 1.55 as a gain parameter, is presented. PURPOSE SACPEAK = Vmax × (1 - e) is the traditional model used to describe the saccadic main sequence, the relationship between the size of the movement and its peak velocity (SACPEAK). In the previous article, we have shown that there is a strong linear correlation between the two parameters Vmax and SAT, which severely affects the model's clinical applicability. The purpose of this study is to see if, by using the MSAREA as an alternative approach, we can overcome the limitations of the traditional model. METHODS Participants and main sequence data are the same as the previous study. A trapezoidal integration was used to estimate the MSAREAs as a function of SACSIZE. RESULTS A two-parameter area model was computed to determine the range of variability of its parameters and R values. These were then used as reference values in the search for one-parameter alternatives. The one-parameter model MSAREA = GPW = 1.55 × SACSIZE performed well for all data sets. We tested its validity by performing a comparison with other one-parameter area models. CONCLUSIONS Area models are superior to peak-velocity models in terms of R and stability and can be reduced to robust one-parameter expressions with only limited degradation in R. This not only greatly simplifies the determination if a set is inside or outside a reference population but also allows for direct comparisons between sets, with the saccadic dynamics expressed by a simple linear gain factor (GPW = 1.55).
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Nij Bijvank JA, Petzold A, Balk LJ, Tan HS, Uitdehaag BMJ, Theodorou M, van Rijn LJ. A standardized protocol for quantification of saccadic eye movements: DEMoNS. PLoS One 2018; 13:e0200695. [PMID: 30011322 PMCID: PMC6047815 DOI: 10.1371/journal.pone.0200695] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Quantitative saccadic testing is a non-invasive method of evaluating the neural networks involved in the control of eye movements. The aim of this study is to provide a standardized and reproducible protocol for infrared oculography measurements of eye movements and analysis, which can be applied for various diseases in a multicenter setting. METHODS Development of a protocol to Demonstrate Eye Movement Networks with Saccades (DEMoNS) using infrared oculography. Automated analysis methods were used to calculate parameters describing the characteristics of the saccadic eye movements. The two measurements of the subjects were compared with descriptive and reproducibility statistics. RESULTS Infrared oculography measurements of all subjects were performed using the DEMoNS protocol and various saccadic parameters were calculated automatically from 28 subjects. Saccadic parameters such as: peak velocity, latency and saccade pair ratios showed excellent reproducibility (intra-class correlation coefficients > 0.9). Parameters describing performance of more complex tasks showed moderate to good reproducibility (intra-class correlation coefficients 0.63-0.78). CONCLUSIONS This study provides a standardized and transparent protocol for measuring and analyzing saccadic eye movements in a multicenter setting. The DEMoNS protocol details outcome measures for treatment trial which are of excellent reproducibility. The DEMoNS protocol can be applied to the study of saccadic eye movements in various neurodegenerative and motor diseases.
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Affiliation(s)
- J. A. Nij Bijvank
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
- * E-mail:
| | - A. Petzold
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
- Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - L. J. Balk
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
| | - H. S. Tan
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
| | - B. M. J. Uitdehaag
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
| | - M. Theodorou
- Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - L. J. van Rijn
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
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Gorges M, Müller HP, Kassubek J. Structural and Functional Brain Mapping Correlates of Impaired Eye Movement Control in Parkinsonian Syndromes: A Systems-Based Concept. Front Neurol 2018; 9:319. [PMID: 29867729 PMCID: PMC5949537 DOI: 10.3389/fneur.2018.00319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/23/2018] [Indexed: 01/18/2023] Open
Abstract
The investigation of the human oculomotor system by eye movement recordings provides an approach to behavior and its alterations in disease. The neurodegenerative process underlying parkinsonian syndromes, including Parkinson’s disease (PD), progressive supranuclear palsy (PSP), and multisystem atrophy (MSA) changes structural and functional brain organization, and thus affects eye movement control in a characteristic manner. Video-oculography has been established as a non-invasive recording device for eye movements, and systematic investigations of eye movement control in a clinical framework have emerged as a functional diagnostic tool in neurodegenerative parkinsonism. Disease-specific brain atrophy in parkinsonian syndromes has been reported for decades, these findings were refined by studies utilizing diffusion tensor imaging (DTI) and task-based/task-free functional MRI—both MRI techniques revealed disease-specific patterns of altered structural and functional brain organization. Here, characteristic disturbances of eye movement control in parkinsonian syndromes and their correlations with the structural and functional brain network alterations are reviewed. On this basis, we discuss the growing field of graph-based network analysis of the structural and functional connectome as a promising candidate for explaining abnormal phenotypes of eye movement control at the network level, both in health and in disease.
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Affiliation(s)
- Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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Pretegiani E, Optican LM. Eye Movements in Parkinson's Disease and Inherited Parkinsonian Syndromes. Front Neurol 2017; 8:592. [PMID: 29170650 PMCID: PMC5684125 DOI: 10.3389/fneur.2017.00592] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/23/2017] [Indexed: 12/02/2022] Open
Abstract
Despite extensive research, the functions of the basal ganglia (BG) in movement control have not been fully understood. Eye movements, particularly saccades, are convenient indicators of BG function. Here, we review the main oculomotor findings reported in Parkinson’s disease (PD) and genetic parkinsonian syndromes. PD is a progressive, neurodegenerative disorder caused by dopaminergic cell loss within the substantia nigra pars compacta, resulting in depletion of striatal dopamine and subsequent increased inhibitory BG output from the internal globus pallidus and the substantia nigra pars reticulata. Eye movement abnormalities are common in PD: anomalies are more evident in voluntary than reflexive saccades in the initial stages, but visually guided saccades may also be involved at later stages. Saccadic hypometria (including abnormally fragmented saccades), reduced accuracy, and increased latency are among the most prominent deficits. PD patients show also unusually frequent and large square wave jerks and impaired inhibition of reflexive saccades when voluntary mirror saccades are required. Poor convergence ability and altered pursuit are common. Inherited parkinsonisms are a heterogeneous group of rare syndromes due to gene mutations causing symptoms resembling those of PD. Eye movement characteristics of some parkinsonisms have been studied. While sharing some PD features, each syndrome has a distinctive profile that could contribute to better define the clinical phenotype of parkinsonian disorders. Moreover, because the pathogenesis and the underlying neural circuit failure of inherited parkinsonisms are often well defined, they might offer a better prospect than idiopathic PD to understand the BG function.
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Affiliation(s)
- Elena Pretegiani
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, MD, United States
| | - Lance M Optican
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, MD, United States
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Regional microstructural damage and patterns of eye movement impairment: a DTI and video-oculography study in neurodegenerative parkinsonian syndromes. J Neurol 2017; 264:1919-1928. [PMID: 28762086 DOI: 10.1007/s00415-017-8579-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 01/18/2023]
Abstract
Characteristic alterations of eye movement control are a common feature of neurodegenerative parkinsonism, including Parkinson's disease (PD), progressive supranuclear palsy (PSP), and multiple system atrophy (MSA). Regional microstructural alterations as assessed by diffusion tensor imaging (DTI) have been reported in PD, PSP, and MSA. Therefore, we investigated the specific association between eye movement disturbances and microstructural impairment in these diseases. Video-oculographic recordings of smooth pursuit and visually guided reactive saccades as well as fractional anisotropy (FA) maps computed from whole-brain DTI data were analyzed for 36 PD, 30 PSP, 18 MSA patients, and 23 matched healthy control subjects. In PSP, peak eye velocity was pathologically slowed compared to controls (p < 0.001) and correlated significantly with microstructural impairment in the midbrain (p < 0.001, corrected). Smooth pursuit eye movements were substantially disturbed in MSA mainly by characteristic 'catch-up' saccades resulting in significantly reduced pursuit gain (p < 0.001, corrected), and the shape of saccadized pursuit in MSA was significantly correlated with FA reductions in the middle cerebral peduncle (p < 0.001, FDR corrected). The prevalence of saccadic intrusions as a measure for inhibitory control was significantly increased in PD compared with controls (p < 0.001), but was uncorrelated with FA in cortical and subcortical white matter. Eye movement disturbances in PSP and MSA-but not in PD-are associated with diagnosis-specific regional microstructural alterations in the white matter. The non-invasive quantified oculomotor function analysis can give clues to the underlying structural connectivity network pathology and underpins its role as a technical marker in PSP and MSA.
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Stuart S, Galna B, Delicato LS, Lord S, Rochester L. Direct and indirect effects of attention and visual function on gait impairment in Parkinson's disease: influence of task and turning. Eur J Neurosci 2017; 46:1703-1716. [PMID: 28444834 DOI: 10.1111/ejn.13589] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 12/26/2022]
Abstract
Gait impairment is a core feature of Parkinson's disease (PD) which has been linked to cognitive and visual deficits, but interactions between these features are poorly understood. Monitoring saccades allows investigation of real-time cognitive and visual processes and their impact on gait when walking. This study explored: (i) saccade frequency when walking under different attentional manipulations of turning and dual-task; and (ii) direct and indirect relationships between saccades, gait impairment, vision and attention. Saccade frequency (number of fast eye movements per-second) was measured during gait in 60 PD and 40 age-matched control participants using a mobile eye-tracker. Saccade frequency was significantly reduced in PD compared to controls during all conditions. However, saccade frequency increased with a turn and decreased under dual-task for both groups. Poorer attention directly related to saccade frequency, visual function and gait impairment in PD, but not controls. Saccade frequency did not directly relate to gait in PD, but did in controls. Instead, saccade frequency and visual function deficit indirectly impacted gait impairment in PD, which was underpinned by their relationship with attention. In conclusion, our results suggest a vital role for attention with direct and indirect influences on gait impairment in PD. Attention directly impacted saccade frequency, visual function and gait impairment in PD, with connotations for falls. It also underpinned indirect impact of visual and saccadic impairment on gait. Attention therefore represents a key therapeutic target that should be considered in future research.
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Affiliation(s)
- Samuel Stuart
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Newcastle upon Tyne Hospitals NHS foundation trust, Newcastle upon Tyne, UK
| | - Brook Galna
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise S Delicato
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,School of Psychology, University of Sunderland, Sunderland, UK
| | - Sue Lord
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Lynn Rochester
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Newcastle upon Tyne Hospitals NHS foundation trust, Newcastle upon Tyne, UK
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Vintonyak O, Gorges M, Müller HP, Pinkhardt EH, Ludolph AC, Huppertz HJ, Kassubek J. Patterns of Eye Movement Impairment Correlate with Regional Brain Atrophy in Neurodegenerative Parkinsonism. NEURODEGENER DIS 2017; 17:117-126. [PMID: 28268209 DOI: 10.1159/000454880] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/02/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND One common feature of neurodegenerative parkinsonism including Parkinson's disease (PD), multisystem atrophy (MSA), and progressive supranuclear palsy (PSP) is altered eye movement control. Characteristic regional structural atrophy patterns in MRI can be observed in PD, MSA, and PSP. OBJECTIVE To investigate the association between eye movement disturbances and regional brain atrophy in patients with PD, MSA, and PSP. METHODS High-resolution 3-dimensional T1-weighted MRI images and video-oculographic recordings (EyeLink®) were obtained from 39 PD, 32 PSP, and 18 MSA patients and 24 matched healthy control subjects. Automatic regional volumetric assessment was performed using atlas-based volumetry (ABV). RESULTS The prevalence of saccadic intrusions as a measure of inhibitory control was significantly increased in PD patients compared to controls (p < 0.001) and negatively correlated with whole brain volume, cerebral brain volume, and occipital lobe volume (p = 0.0057, p = 0.0049, and p = 0.0059, respectively; all p values are false discovery rate corrected). In MSA, smooth pursuit was disturbed by characteristic "catch-up" saccades (p < 0.001) and it was significantly correlated with cerebellar volume (p = 0.004) and pontine volume (p < 0.001). The hallmark of PSP was pathologically slowed vertical peak eye velocities (p < 0.001); the lower the peak eye velocity, the more marked midbrain atrophy (p = 0.007). CONCLUSIONS Foci of regional atrophy correlated with disease-specific eye movement alterations in all investigated parkinsonian syndromes. Oculomotor impairment in PD, predominantly the result of executive dysfunction, was linked to cerebral atrophy. Impairment in the corresponding oculomotor pathways was associated with atrophy of pontocerebellar oculomotor structures in MSA and midbrain atrophy in PSP.
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Affiliation(s)
- Olga Vintonyak
- Department of Neurology, University of Ulm, Ulm, Germany
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Höglinger GU, Kassubek J, Csoti I, Ehret R, Herbst H, Wellach I, Winkler J, Jost WH. Differentiation of atypical Parkinson syndromes. J Neural Transm (Vienna) 2017; 124:997-1004. [DOI: 10.1007/s00702-017-1700-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/20/2017] [Indexed: 01/31/2023]
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TERAO Y, FUKUDA H, HIKOSAKA O. What do eye movements tell us about patients with neurological disorders? - An introduction to saccade recording in the clinical setting. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2017; 93:772-801. [PMID: 29225306 PMCID: PMC5790757 DOI: 10.2183/pjab.93.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/17/2017] [Indexed: 06/01/2023]
Abstract
Non-invasive and readily implemented in the clinical setting, eye movement studies have been conducted extensively not only in healthy human subjects but also in patients with neurological disorders. The purpose of saccade studies is to "read out" the pathophysiology underlying neurological disorders from the saccade records, referring to known primate physiology. In the current review, we provide an overview of studies in which we attempted to elucidate the patterns of saccade abnormalities in over 250 patients with neurological disorders, including cerebellar ataxia and brainstem pathology due to neurodegenerative disorders, and what they tell about the pathophysiology of patients with neurological disorders. We also discuss how interventions, such as deep brain stimulation, affect saccade performance and provide further insights into the workings of the oculomotor system in humans. Finally, we argue that it is important to understand the functional significance and behavioral correlate of saccade abnormalities in daily life, which could require eye tracking methodologies to be performed in settings similar to daily life.
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Affiliation(s)
- Yasuo TERAO
- Department of Cell Physiology, Kyorin University, Tokyo, Japan
| | | | - Okihide HIKOSAKA
- Section of Neuronal Networks, Laboratory of Sensorimotor Research, National Eye Institute, U.S.A.
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Gorges M, Müller HP, Lulé D, Pinkhardt EH, Ludolph AC, Kassubek J. The association between alterations of eye movement control and cerebral intrinsic functional connectivity in Parkinson's disease. Brain Imaging Behav 2016; 10:79-91. [PMID: 25749936 DOI: 10.1007/s11682-015-9367-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with Parkinson's disease (PD) present with eye movement disturbances that accompany the cardinal motor symptoms. Previous studies have consistently found evidence that large-scale functional networks are critically involved in eye movement control. We challenged the hypothesis that altered eye movement control in patients with PD is closely related to alterations of whole-brain functional connectivity in association with the neurodegenerative process. Saccadic and pursuit eye movements by video-oculography and 'resting-state' functional MRI (3 Tesla) were recorded from 53 subjects, i.e. 31 patients with PD and 22 matched healthy controls. Video-oculographically, a broad spectrum of eye movement impairments was demonstrated in PD patients vs. controls, including interrupted smooth pursuit, hypometric saccades, and a high distractibility in anti-saccades. Significant correlations between altered oculomotor parameters and functional connectivity measures were observed, i.e. the worse the oculomotor performance was, the more the regional functional connectivity in cortical, limbic, thalamic, cerebellar, and brainstem areas was decreased. Remarkably, decreased connectivity between major nodes of the default mode network was tightly correlated with the prevalence of saccadic intrusions as a measure for distractability. In conclusion, dysfunctional eye movement control in PD seems to be primarily associated with (cortical) executive deficits, rather than being related to the ponto-cerebellar circuits or the oculomotor brainstem nuclei. Worsened eye movement performance together with the potential pathophysiological substrate of decreased intrinsic functional connectivity in predominantly oculomotor-associated cerebral functional networks may constitute a behavioral marker in PD.
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Affiliation(s)
- Martin Gorges
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hans-Peter Müller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | | | - Elmar H Pinkhardt
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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Abstract
PURPOSE OF REVIEW Abnormalities of oculomotor control accompany the pathological changes underlying many neurodegenerative diseases. Clinical examination of eye movements can contribute to differential diagnosis, whereas quantitative laboratory measures can provide detailed insight into the disease process. In this review of eye movements in neurodegenerative disease, we summarise recent empirical findings and conceptual advances. RECENT FINDINGS Oculomotor researchers continue to be particularly prolific in studying Parkinson's disease but there is also substantial activity in Alzheimer's disease and spinocerebellar ataxia. Interesting findings have been reported in Huntington's, motor neuron disease, and glaucoma. Most studies report laboratory-based investigations but useful progress in clinical description continues to be made. SUMMARY Eye movements remain an active field of investigation across a variety of neurodegenerative conditions. Progress continues to be made at the clinical level as well by using laboratory techniques.
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Affiliation(s)
- Michael R MacAskill
- aNew Zealand Brain Research Institute bDepartment of Medicine, University of Otago cDepartment of Neurology, Christchurch Hospital, Christchurch, New Zealand
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Eye Movement Deficits Are Consistent with a Staging Model of pTDP-43 Pathology in Amyotrophic Lateral Sclerosis. PLoS One 2015; 10:e0142546. [PMID: 26559944 PMCID: PMC4641606 DOI: 10.1371/journal.pone.0142546] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background The neuropathological process underlying amyotrophic lateral sclerosis (ALS) can be traced as a four-stage progression scheme of sequential corticofugal axonal spread. The examination of eye movement control gains deep insights into brain network pathology and provides the opportunity to detect both disturbance of the brainstem oculomotor circuitry as well as executive deficits of oculomotor function associated with higher brain networks. Objective To study systematically oculomotor characteristics in ALS and its underlying network pathology in order to determine whether eye movement deterioration can be categorized within a staging system of oculomotor decline that corresponds to the neuropathological model. Methods Sixty-eight ALS patients and 31 controls underwent video-oculographic, clinical and neuropsychological assessments. Results Oculomotor examinations revealed increased anti- and delayed saccades’ errors, gaze-palsy and a cerebellary type of smooth pursuit disturbance. The oculomotor disturbances occurred in a sequential manner: Stage 1, only executive control of eye movements was affected. Stage 2 indicates disturbed executive control plus ‘genuine’ oculomotor dysfunctions such as gaze-paly. We found high correlations (p<0.001) between the oculomotor stages and both, the clinical presentation as assessed by the ALS Functional Rating Scale (ALSFRS) score, and cognitive scores from the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). Conclusions Dysfunction of eye movement control in ALS can be characterized by a two-staged sequential pattern comprising executive deficits in Stage 1 and additional impaired infratentorial oculomotor control pathways in Stage 2. This pattern parallels the neuropathological staging of ALS and may serve as a technical marker of the neuropathological spreading.
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Svetozarskiy SN, Kopishinskaya SV, Gustov AV, Radyuk MA, Antonova VA, Smetankin IG, Svetozarskiy SN, Kopishinskaya SV, Gustov AV, Radyuk MA, Antonova VA, Smetankin IG. [Ophthalmic manifestations of Huntington's disease]. Vestn Oftalmol 2015; 131:82-86. [PMID: 26845877 DOI: 10.17116/oftalma2015131582-86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by a mutation in the huntingtin gene. The whole nervous system, including visual analyzer, is involved in the pathogenesis of the disease. Various ocular sings can be found in both preclinical and clinical stages of HD. Specific retinal damage, namely, abnormal proteins formation, photoreceptor degeneration and retinal remodeling, has been studied in animal models. Functional changes in occipital lobe activity and its atrophy as well as degeneration of visual pathways can already be present in the early stages of the disease. Oculomotor symptoms of HD include disturbed visual fixation, slower tracking eye movements and saccades, and suppressed vestibulo-ocular reflex. Visual perceptual disorders, such as visuospatial difficulties, problems of stimulus identification and motion perception, along with decreased contrast sensitivity, have also been described. The possibility of using certain ophthalmic parameters as biomarkers of HD is being discussed.
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Affiliation(s)
- S N Svetozarskiy
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - S V Kopishinskaya
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - A V Gustov
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - M A Radyuk
- Volgograd State Medical University, Ministry of Health of the Russian Federation, 1 Pavshikh Bortsov Sq., Volgograd, Russian Federation, 400131
| | - V A Antonova
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - I G Smetankin
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - S N Svetozarskiy
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - S V Kopishinskaya
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - A V Gustov
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - M A Radyuk
- Volgograd State Medical University, Ministry of Health of the Russian Federation, 1 Pavshikh Bortsov Sq., Volgograd, Russian Federation, 400131
| | - V A Antonova
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
| | - I G Smetankin
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, 10/1 Minina Sq., Nizhny Novgorod, Russian Federation, 603005
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Terao Y, Fukuda H, Tokushige S, Inomata-Terada S, Yugeta A, Hamada M, Ichikawa Y, Hanajima R, Ugawa Y. Is multiple system atrophy with cerebellar ataxia (MSA-C) like spinocerebellar ataxia and multiple system atrophy with parkinsonism (MSA-P) like Parkinson's disease? - A saccade study on pathophysiology. Clin Neurophysiol 2015; 127:1491-1502. [PMID: 26350408 DOI: 10.1016/j.clinph.2015.07.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 07/07/2015] [Accepted: 07/10/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with multiple system atrophy (MSA) are classified into those mainly manifesting cerebellar ataxia (MSA-C) and those mainly manifesting parkinsonism (MSA-P). Pathophysiological bases of these subtypes remain unclear. We hypothesized that MSA-C patients would resemble spinocerebellar degeneration patients and MSA-P patients would resemble Parkinson's disease (PD) patients in saccade abnormalities. METHODS We recorded visually guided and memory guided saccades (MGS) in 27 MSA-C and 15 MSA-P patients, as well as 50 age-matched normal subjects, 14 spinocerebellar degeneration patients showing pure cerebellar symptoms (SCD) and 61 Parkinson's disease (PD) patients. RESULTS Saccade parameters of both tasks showed similar changes with progressing disease in SCD and MSA-C patients, as did those of MSA-C and MSA-P patients, although hypometria was slightly more pronounced in MSA-P. In both subtypes of MSA, latency and success rate of MGS were stable throughout disease stages, whereas they deteriorated progressively with progressing disease in PD. CONCLUSIONS Pathophysiology underlying MSA-C and MSA-P is similar as viewed from saccade performance. The MGS performance in MSA was preserved. However, MSA-P patients showed more marked hypometria, suggesting a mixture of basal ganglia pathophysiology. SIGNIFICANCE The similarity of saccade performance between MSA-C and MSA-P may reflect common olivopontocerebellar pathology, while the direct pathway of the basal ganglia is relatively spared compared with PD, even in MSA-P.
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Affiliation(s)
- Yasuo Terao
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | | | - Shinnichi Tokushige
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Satomi Inomata-Terada
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Akihiro Yugeta
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Ritsuko Hanajima
- Department of Neurology, School of Medicine, Kitasato University, Japan
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Japan
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Gorges M, Müller HP, Ludolph A, Pinkhardt E, Kassubek J. P19. The brain’s default mode is associated with executive oculomotor deficits in Parkinson’s disease. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Popa L, Selejan O, Scott A, Mureşanu DF, Balea M, Rafila A. Reading beyond the glance: eye tracking in neurosciences. Neurol Sci 2015; 36:683-8. [DOI: 10.1007/s10072-015-2076-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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