Internal organization of medial rectus and inferior rectus muscle neurons in the C group of the oculomotor nucleus in monkey

Mammalian extraocular muscles contain singly innervated twitch muscle fibers (SIF) and multiply innervated nontwitch muscle fibers (MIF). In monkey, MIF motoneurons lie around the periphery of oculomotor nuclei and have premotor inputs different from those of the motoneurons inside the nuclei. The most prominent MIF motoneuron group is the C group, which innervates the medial rectus (MR) and inferior rectus (IR) muscle. To explore the organization of both cell groups within the C group, we performed small injections of choleratoxin subunit B into the myotendinous junction of MR or IR in monkeys. In three animals the IR and MR myotendinous junction of one eye was injected simultaneously with different tracers (choleratoxin subunit B and wheat germ agglutinin). This revealed that both muscles were supplied by two different, nonoverlapping populations in the C group. The IR neurons lie adjacent to the dorsomedial border of the oculomotor nucleus, whereas MR neurons are located farther medially. A striking feature was the differing pattern of dendrite distribution of both cell groups. Whereas the dendrites of IR neurons spread into the supraoculomotor area bilaterally, those of the MR neurons were restricted to the ipsilateral side and sent a focused bundle dorsally to the preganglionic neurons of the Edinger-Westphal nucleus, which are involved in the "near response." In conclusion, MR and IR are innervated by independent neuron populations from the C group. Their dendritic branching pattern within the supraoculomotor area indicates a participation in the near response providing vergence but also reflects their differing functional roles.

Delineation of motoneuron subgroups supplying individual eye muscles in the human oculomotor nucleus

The oculomotor nucleus (nIII) contains the motoneurons of medial, inferior, and superior recti (MR, IR, and SR), inferior oblique (IO), and levator palpebrae (LP) muscles. The delineation of motoneuron subgroups for each muscle is well-known in monkey, but not in human. We studied the transmitter inputs to human nIII and the trochlear nucleus (nIV), which innervates the superior oblique muscle (SO), to outline individual motoneuron subgroups. Parallel series of sections from human brainstems were immunostained for different markers: choline acetyltransferase combined with glutamate decarboxylase (GAD), calretinin (CR) or glycine receptor. The cytoarchitecture was visualized with cresyl violet, Gallyas staining and expression of non-phosphorylated neurofilaments. Apart from nIV, seven subgroups were delineated in nIII: the central caudal nucleus (CCN), a dorsolateral (DL), dorsomedial (DM), central (CEN), and ventral (VEN) group, the nucleus of Perlia (NP) and the non-preganglionic centrally projecting Edinger–Westphal nucleus (EWcp). DL, VEN, NP, and EWcp were characterized by a strong supply of GAD-positive terminals, in contrast to DM, CEN, and nIV. CR-positive terminals and fibers were confined to CCN, CEN, and NP. Based on location and histochemistry of the motoneuron subgroups in monkey, CEN is considered as the SR and IO motoneurons, DL and VEN as the B- and A-group of MR motoneurons, respectively, and DM as IR motoneurons. A good correlation between monkey and man is seen for the CR input, which labels only motoneurons of eye muscles participating in upgaze (SR, IO, and LP). The CCN contained LP motoneurons, and nIV those of SO. This study provides a map of the individual subgroups of motoneurons in human nIII for the first time, and suggests that NP may contain upgaze motoneurons. Surprisingly, a strong GABAergic input to human MR motoneurons was discovered, which is not seen in monkey and may indicate a functional oculomotor specialization.

Do palisade endings in extraocular muscles arise from neurons in the motor nuclei?

PURPOSE

The purpose of this study was to localize the cell bodies of palisade endings that are associated with the myotendinous junctions of the extraocular muscles.

METHODS

Rhesus monkeys received tract-tracer injections (tetramethylrhodamine dextran [TMR-DA] or choleratoxin subunit B [CTB]) into the oculomotor and trochlear nuclei, which contain the motoneurons of extraocular muscles. All extraocular muscles were processed for the combined immunocytochemical detection of the tracer and SNAP-25 or synaptophysin for the visualization of the complete muscle innervation.

RESULTS

In all muscles--except the lateral rectus--en plaque and en grappe motor endings, but also palisade endings, were anterogradely labeled. In addition a few tracer-labeled tendon organs were found. One group of tracer-negative nerve fibers was identified as thin tyrosine hydroxylase-positive sympathetic fibers, and a second less numerous group of tracer-negative fibers may originate from the trigeminal ganglia. No cellular or terminal tracer labeling was present within the mesencephalic trigeminal nucleus or the trigeminal ganglia.

CONCLUSIONS

These results confirm those of earlier studies and furthermore suggest that the somata of palisade endings are located close to the extraocular motor nuclei--in this case, probably within the C and S groups around the periphery of the oculomotor nucleus. The multiple en grappe endings have also been shown to arise from these cells groups, but it is not possible to distinguish different populations in these experiments.

Orexin-A inputs onto visuomotor cell groups in the monkey brainstem

Orexin-A, synthesized by neurons of the lateral hypothalamus helps to maintain wakefulness through excitatory projections to nuclei involved in arousal. Obvious changes in eye movements, eyelid position and pupil reactions seen in the transition to sleep led to the investigation of orexin-A projections to visuomotor cell groups to determine whether direct pathways exist that may modify visuomotor behaviors during the sleep-wake cycle. Histological markers were used to define these specific visuomotor cell groups in monkey brainstem sections and combined with orexin-A immunostaining. The dense supply by orexin-A boutons around adjacent neurons in the dorsal raphe nucleus served as a control standard for a strong orexin-A input. The quantitative analysis assessing various functional cell groups of the oculomotor system revealed that almost no input from orexin-A terminals reached motoneurons supplying the singly-innervated muscle fibers of the extraocular muscles in the oculomotor nucleus, the omnipause neurons in the nucleus raphe interpositus and the premotor neurons in the rostral interstitial nucleus of the medial longitudinal fasciculus. In contrast, the motoneurons supplying the multiply-innervated muscle fibers of the extraocular muscles, the motoneurons of the levator palpebrae muscle in the central caudal nucleus, and especially the preganglionic neurons supplying the ciliary ganglion received a strong orexin input. We interpret these results as evidence that orexin-A does modulate pupil size, lid position, and possibly convergence and eye alignment via the motoneurons of multiply-innervated muscle fibres. However orexin-A does not directly modulate premotor pathways for saccades or the singly-innervated muscle fibre motoneurons.

Brainstem circuits controlling lid-eye coordination in monkey

In primate, the M-group is a cell cluster in the rostral mesencephalon which contains premotor neurons for the levator palpebrae (LP) and upward-pulling eye muscles. It is therefore thought to play a role in lid-eye coupling during vertical saccades. To further elucidate its role, the afferents to the M-group and LP motoneurons were studied in monkeys. Anterograde tracer injections were placed in one of the three eye-movement-related areas: 1. superior colliculus (SC), 2. interstitial nucleus of Cajal (INC), and 3. the omnipause neuron (OPN) region. Injections into the medial SC subtending upward saccades led to afferent labelling of the ipsilateral M-group and the adjacent rostral interstitial nucleus of the medial longitudinal fascicle (RIMLF), whereas only RIMLF was labelled after an injection into the lateral SC subtending downward saccades. Both RIMLF and M-group received bilateral projections from INC, but only RIMLF received glycineric inputs from the OPN region. This connectivity pattern supports the hypothesis that the M-group mediates lid-eye coupling during vertical upgaze, but is indirectly driven by collaterals of saccadic burst neurons in the RIMLF during lid saccades. A selective projection from the OPN area to the LP motoneurons, but not to other oculomotor neurons is reported here for the first time. The result is supported by the presence of glycinergic terminals only over LP motoneurons, and implies that a subset of OPNs may directly trigger saccade-related blinks.

Torsional deviations with voluntary saccades caused by a unilateral midbrain lesion

Three dimensional eye rotations were measured using the magnetic search coil technique in a patient with a lesion of the right rostral interstitial nucleus of the medial longitudinal fasciculus (RIMLF) and in four control subjects. Up to 10° contralesional torsional deviations with each voluntary saccade were revealed, which also could be seen during bedside examination. There was no spontaneous nystagmus. Based on MRI criteria, the lesion involved the RIMLF but spared the interstitial nucleus of Cajal. To date, this deficit has not been described in patients. Our results support the hypothesis that the vertical-torsional saccade generator in humans is organised similarly as in monkeys: each RIMLF encodes torsional saccades in one direction, while both participate in vertical saccades.

Selective, circuit-wide sparing of floccular connections in hereditary olivopontine cerebellar atrophy with slow saccades

We present a systems-oriented histopathologic analysis of the ocular motor control circuits in the cerebellum and brainstem from a patient with a hereditary form of olivopontine cerebellar atrophy of the Wadia type, which has a characteristic ocular motor presentation of slow saccades but relative preservation of smooth pursuit and gaze-holding. This differential pattern of clinical involvement is associated with a lobule-specific pattern of cerebellar degeneration. We asked whether these patterns of sparing and degeneration were consistent throughout the associated deep cerebellar and brainstem structures. Specimens were fixed in formalin, embedded in paraffin, and stained for various markers. We found that elements of the floccular and nodular pathways, controlling smooth pursuit and vestibular reflexes, were relatively spared, particularly those structures that are interconnected with the medial regions. Conversely, the elements of the dorsal vermis pathway controlling saccade adaptation were relatively involved. This subregional specificity of degeneration further defines possible areas of investigation for elucidating pathophysiology, testing biomarkers of disease, and developing areas for therapeutic intervention.

Torsional deviations with voluntary saccades caused by a unilateral midbrain lesion

Three dimensional eye rotations were measured using the magnetic search coil technique in a patient with a lesion of the right rostral interstitial nucleus of the medial longitudinal fasciculus (RIMLF) and in four control subjects. Up to 10 degree contralesional torsional deviations with each voluntary saccade were revealed, which also could be seen during bedside examination. There was no spontaneous nystagmus. Based on MRI criteria, the lesion involved the RIMLF but spared the interstitial nucleus of Cajal. To date, this deficit has not been described in patients. Our results support the hypothesis that the vertical-torsional saccade generator in humans is organised similarly as in monkeys: each RIMLF encodes torsional saccades in one direction, while both participate in vertical saccades.

Anatomy of the Oculomotor System

The sensory and motor control of eye muscles are considered in this chapter. Eye muscles differ from skeletal muscles in several ways. One is the absence of muscle spindles and Golgi tendon organs in the eye muscles of some species, and their poor development in others. Second, eye muscles have an inner 'global layer', and the outer 'orbital layer', each containing different types of muscle fiber. Third, eye muscles contain not only twitch muscle fibers with a single endplate zone (SIFs), but also nontwitch muscle fibers with multiple endplate zones (MIFs), which are otherwise absent from mammalian muscles. There are cuffs of nerve terminals, called palisade endings, around the myotendinous junctions of global layer MIFs. Palisade endings are unique to eye muscles, and have been found in all mammalian species investigated up to now. The function of palisade endings is uncertain, but it is possible that they are 'sensory receptors'. Motoneurons innervating the eye muscles lie in the oculomotor, trochlear and abducens motor nuclei, and are contacted by several relatively independent premotor networks, which generate different types of eye movements such as saccades, vestibulo-ocular reflexes, optokinetic responses, smooth pursuit convergence or gaze-holding. In each motor nucleus, the motoneurons can be divided into two distinct sets: the first set innervating SIF muscle fibers and receiving inputs from all oculomotor premotor networks, and the second set innervating the MIFs and receiving premotor afferents from the gaze holding, convergence or smooth pursuit premotor networks, but not from the saccadic and vestibulo-oculomotor networks. We suggest that the SIF motoneurons and muscles are more suited to driving eye movements, and the MIF motoneurons and muscles to setting the tonic tension in eye muscles. Furthermore the 'palisade ending-MIF unit' may be part of a sensory feedback system in eye muscles, which should be considered in association with the causes and treatment of strabismus.

Proprioception and Palisade Endings in Extraocular Eye Muscles

Palisade endings occur only in extraocular muscles, and their function is unknown. They form a cuff of nerve terminals around the tips of muscle fibers. We describe here the advantages of using antibodies to a synaptosomal-associated protein (SNAP-25) to study properties of palisade endings in man, monkey, and rat. The stain can be combined readily with other immunofluorescence procedures, and results suggest that the synapses of palisade endings do not bind alpha-bungarotoxin (i.e., are not motor), nor do they contain substance P. These double-labeling data support the hypothesis that palisade endings are non-nociceptive sensory receptors, and could serve a proprioceptive function. With SNAP-25 immunolabeling, palisade endings were identified in the rat for the first time. Thus, palisade endings appear to be present in all vertebrate extraocular muscles studied to date. Their apparent universality, which contrasts with the more variable manifestation of extraocular muscle spindles and Golgi tendon organs, would be expected if proprioceptive feedback is necessary to the function of the ocular motor system, and if palisade endings are the critical proprioceptive structure.

The extraocular motor nuclei: organization and functional neuroanatomy

The organization of the motoneuron subgroups in the brainstem controlling each extraocular eye muscle is highly stable through the vertebrate species. The subgroups are topographically organized in the oculomotor nucleus (III) and are usually considered to form the final common pathway for eye muscle control. Eye muscles contain a unique type of slow non-twitch, fatigue-resistant muscle fiber, the multiply innervated muscle fibers (MIFs). The recent identification the MIF motoneurons shows that they too have topographic organization, but very different from the classical singly innervated muscle fiber (SIF) motoneurons. The MIF motoneurons lie around the periphery of the oculomotor nucleus (III), trochlear nucleus (IV), and abducens nucleus (VI), slightly separated from the SIF subgroups. The location of four different types of neurons in VI are described and illustrated: (1) SIF motoneurons, (2) MIF motoneurons, (3) internuclear neurons, and (4) the paramedian tract neurons which project to the flocculus. Afferents to the motoneurons arise from the vestibular nuclei, the oculomotor and abducens internuclear neurons, the mesencephalic and pontine burst neurons, the interstitial nucleus of Cajal, nucleus prepositus hypoglossi, the supraoculomotor area and the central mesencephalic reticular formation and the pretectum. The MIF and SIF motoneurons have different histochemical properties and different afferent inputs. The hypothesis that SIFs participate in moving the eye and MIFs determine the alignment seems possible but is not compatible with the concept of a final common pathway.

Identification of motoneurons supplying multiply- or singly-innervated extraocular muscle fibers in the rat

In mammals, the extraocular muscle fibers can be categorized in singly-innervated and multiply-innervated muscle fibers. In the monkey oculomotor, trochlear and abducens nucleus the motoneurons of multiply-innervated muscle fibers lie separated from those innervating singly-innervated muscle fibers and show different histochemical properties. In order to discover, if this organization is a general feature of the oculomotor system, we investigated the location of singly-innervated muscle fiber and multiply-innervated muscle fiber motoneurons in the rat using combined tract-tracing and immunohistochemical techniques. The singly-innervated muscle fiber and multiply-innervated muscle fiber motoneurons of the medial and lateral rectus muscle were identified by retrograde tracer injections into the muscle belly or the distal myotendinous junction. The belly injections labeled the medial rectus muscle subgroup of the oculomotor nucleus or the greatest part of abducens nucleus, including some cells outside the medial border of abducens nucleus. In contrast, the distal injections labeled only a subset of the medial rectus muscle motoneurons and exclusively cells outside the medial border of abducens nucleus. The tracer detection was combined with immunolabeling using antibodies for perineuronal nets (chondroitin sulfate proteoglycan) and non-phosphorylated neurofilaments. In monkeys both antibodies permit a distinction between singly-innervated muscle fiber and multiply-innervated muscle fiber motoneurons. The experiments revealed that neurons labeled from a distal injection lack both markers and are assumed to represent multiply-innervated muscle fiber motoneurons, whereas those labeled from a belly injection are chondroitin sulfate proteoglycan- and non-phosphorylated neurofilament-immunopositive and assumed to represent singly-innervated muscle fiber motoneurons. The overall identification of multiply-innervated muscle fiber and singly-innervated muscle fiber motoneurons within the rat oculomotor nucleus, trochlear nucleus, and abducens nucleus revealed that the smaller multiply-innervated muscle fiber motoneurons tend to lie separate from the larger diameter singly-innervated muscle fiber motoneurons. Our data provide evidence that rat extraocular muscles are innervated by two sets of motoneurons that differ in their molecular, morphological, and anatomical properties.

Sensory control of extraocular muscles

The role of sensory receptors in eye muscles is not well understood, but there is physiological and clinical evidence for the presence of proprioceptive signals in many areas of the central nervous system. It is unclear which structures generate these sensory signals, and which central neural pathways are involved. Three different types of receptors are associated with eye muscles: (1) muscle spindles, (2) palisade endings, and (3) Golgi tendon organs, but their occurrence varies wildly between species. A review of their organization shows that each receptor is mainly confined to a morphologically separate layer of the eye muscle. The palisade endings - which are unique to eye muscles, are associated with the global layer; and they have been found in all mammals studied so far. Their function is unknown. The muscle spindles, if they are present in a species, lie in the orbital layer, or at its junction to the global layer. Golgi tendon organs appear to be unique to artiodactyls (i.e., sheep and goats, etc.); they lie in an outer distal marginal layer of the eye muscle, called the "peripheral patch layer" in sheep. The specific association between palisade endings and the multiply innervated type of muscle fibers of the global layer has led to the hypothesis that together they may act as a sensory receptor, and provide a source of central proprioceptive signals. But other interpretations of the morphological evidence do not support this role.

Present concepts of oculomotor organization

This chapter gives an introduction to the oculomotor system, thus providing a framework for the subsequent chapters. This chapter describes the characteristics, and outlines the structures involved, of the five basic types of eye movements, for gaze holding ("neural integrator") and eye movements in three dimensions (Listing's law, pulleys).

Spatial properties of central vestibular neurons of monkeys after bilateral lateral canal nerve section

Thirty-seven neurons were recorded in the superior vestibular nucleus (SVN) of two cynomolgus monkeys 1-2 yr after bilateral lateral canal nerve section to test whether the central neurons had spatially adapted for the loss of lateral canal input. The absence of lateral canal function was verified with eye movement recordings. The relation of unit activity to the vertical canals was determined by oscillating the animals about a horizontal axis with the head in various orientations relative to the axis of rotation. Animals were also oscillated about a vertical axis while upright or tilted in pitch. In the second test, the vertical canals are maximally activated when the animals are tilted back about -50 degrees from the spatial upright and the lateral canals when the animals are tilted forward about 30 degrees . We reasoned that if central compensation occurred, the head orientation at which the response of the vertical canal-related neurons was maximal should be shifted toward the plane of the lateral canals. No lateral canal-related units were found after nerve section, and vertical canal-related units were found only in SVN not in the rostral medial vestibular nucleus. SVN canal-related units were maximally activated when the head was tilted back at -47 +/- 17 and -50 +/- 12 degrees (means +/- SD) in the two animals, close to the predicted orientation of the vertical canals. This indicated that spatial adaptation of vertical canal-related vestibular neurons had not occurred. There were substantial neck and/or otolith-related inputs activating the vertical canal-related neurons in the nerve-sectioned animals, which could have contributed to oculomotor compensation after nerve section.

Palisade endings in extraocular eye muscles revealed by SNAP-25 immunoreactivity

Palisade endings form a cuff of nerve terminals around the tip of muscle fibres. They are found only in extraocular muscles, but no definite evidence for their role in eye movements has been established. Palisade endings have been reported in all species so far investigated except the rat. In this study we demonstrate that antibodies against SNAP-25, the synaptosomal associated protein of 25 kDa, reliably visualize the complete motor, sensory and autonomic innervation of the extraocular muscles in human, monkey and rat. The SNAP-25 antibody can be combined with other immunofluorescence procedures, and is used here to study properties of palisade endings. With SNAP-25 immunolabelling putative palisade endings are identified in the rat for the first time. They are not well branched, but fulfil several criteria of palisade endings, being associated with non-twitch fibres as shown by double labelling with 'myosin heavy chain slow-twitch' antibodies. The putative palisade endings of the rat lack alpha-bungarotoxin binding, which implies that these synapses are sensory. If palisade endings are sensory then they could function as an eye muscle proprioceptor. They seem to be a general feature of all vertebrate eye muscles, unlike the other two extraocular proprioceptors, muscle spindles and Golgi tendon organs, the presence of which varies widely between species.

Histochemical differences between motoneurons supplying multiply and singly innervated extraocular muscle fibers

The extraocular muscle fibers of vertebrates can be classified into two categories: singly innervated fibers (SIFs) and multiply innervated fibers (MIFs). In monkeys, the motoneurons of SIFs lie within the oculomotor, trochlear, and abducens nucleus, whereas the motoneurons of MIFs appear in separate subgroups in the periphery of the classical nuclei borders. In the present study, we investigated the histochemical properties of SIF and MIF motoneurons by using combined tract-tracing and immunofluorescence techniques. In monkeys, SIF and MIF motoneurons of extraocular muscles were identified by tracer injections into the belly or the distal myotendinous junction of the medial or lateral rectus muscle. Alternatively, the motoneurons were identified by choline acetyltransferase immunostaining. These techniques were combined with the detection of histochemical markers for perineuronal nets, nonphosphorylated neurofilaments, parvalbumin, or cytochrome oxidase. The experiments revealed that the MIF motoneurons in the periphery of the motonuclei do not contain nonphosphorylated neurofilaments or parvalbumin and lack perineuronal nets. In contrast, SIF motoneurons express all markers at high intensity. Cytochrome oxidase immunostaining was found in both motoneuron populations. An additional population of motoneurons with "MIF properties" was identified within the boundaries of the abducens nucleus, which could represent the motoneurons innervating MIFs in the orbital layer of lateral rectus muscle. Our data provide evidence that SIF and MIF motoneurons, which can be correlated with twitch motoneurons and presumed non-twitch motoneurons, differ in their histochemical properties. The absence of perineuronal nets, nonphosphorylated neurofilaments, and parvalbumin may help to identify the homologous MIF motoneurons in other species, including humans.

Twitch and nontwitch motoneuron subgroups in the oculomotor nucleus of monkeys receive different afferent projections

Motoneurons in the primate oculomotor nucleus can be divided into two categories, those supplying twitch muscle fibers and those supplying nontwitch muscle fibers. Recent studies have shown that twitch motoneurons lie within the classical oculomotor nucleus (nIII), and nontwitch motoneurons lie around the borders. Nontwitch motoneurons of medial and inferior rectus are in the C group dorsomedial to nIII, whereas those of inferior oblique and superior rectus lie near the midline are in the S group. In this anatomical study, afferents to the twitch and nontwitch subgroups of nIII have been anterogradely labeled by injections of tritiated leucine into three areas and compared. 1) Abducens nucleus injections gave rise to silver grain deposits over all medial rectus subgroups, both twitch and nontwitch. 2) Laterally placed vestibular complex injections that included the central superior vestibular nucleus labeled projections only in twitch motoneuron subgroups. However, injections into the parvocellular medial vestibular nucleus (mvp), or Y group, resulted in labeled terminals over both twitch and nontwitch motoneurons. 3) Pretectal injections that included the nucleus of the optic tract (NOT), and the olivary pretectal nucleus (OLN), labeled terminals only over nontwitch motoneurons, in the contralateral C group and in the S group. Our study demonstrates that twitch and nontwitch motoneuron subgroups do not receive identical afferent inputs. They can be controlled either in parallel, or independently, suggesting that they have basically different functions. We propose that twitch motoneurons primarily drive eye movements and nontwitch motoneurons the tonic muscle activity, as in gaze holding and vergence, possibly involving a proprioceptive feedback system.

Motor and sensory innervation of extraocular eye muscles

Eye muscles are unusual in several ways; one is that they have up to three different layers-the inner global layer, the outer orbital layer, and in some species an external marginal layer has been described. In sheep this is called the "peripheral patch layer." Three different types of proprioceptors are found in eye muscles-muscle spindles, Golgi tendon organs, and palisade endings. A survey of the organization of their location leads us to the hypothesis that each receptor is confined to a separate layer of the eye muscle. The palisade endings are associated with the global layer, the muscle spindles lie predominantly in the orbital layer, and the Golgi tendon organs are found only in the peripheral patch layer. This well-organized scheme may help us to understand the proprioceptive system in eye muscles.

Localizing value of torsional nystagmus in small midbrain lesions

BACKGROUND

The topodiagnostic value and specificity of nystagmus in patients with mesencephalic lesions and its relation to tonic torsional deficits and vertical saccade deficits is controversial and anecdotal.

METHODS

The authors examined 11 patients with vascular MRI-identified mesencephalic lesions and clinical evidence of vertical-torsional nystagmus on gaze straight ahead, focusing on the three-dimensional nystagmus components recorded with the three-dimensional search coil technique.

RESULTS

Combined lesions of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) and the interstitial nucleus of Cajal (iC) are much more frequent than riMLF and, in particular, iC lesions alone. Eight patients showed contralesional torsional nystagmus with a conjugate vertical component on gaze straight ahead and had anatomic (MRI) and clinical evidence (slowing of vertical saccades) for riMLF involvement. Tonic ocular torsion and the subjective visual vertical were shifted to the contralesional side (n = 7). Torsional nystagmus to the ipsilesional side was uncommon (n = 3) and found in patients with midbrain lesions involving the iC, all of whom also had decreased time constants of the slow phases of gaze-evoked nystagmus.

CONCLUSIONS

Contrary to previous proposals, contralesional torsional nystagmus was the most frequent direction and is probably not compensatory for contralesional tonic ocular torsion. Small amplitude vertical saccades with normal velocities in association with ipsilesional torsional nystagmus may indicate isolated iC lesions. Torsional nystagmus following mesencephalic lesions may last for years and may help to distinguish rostral (riMLF) from caudal (iC) midbrain lesions.

The neuroanatomical basis of oculomotor disorders: the dual motor control of extraocular muscles and its possible role in proprioception

Current investigations show that two separate sets of motoneurons control the extraocular eye muscles, and that is there is a dual final common pathway. We propose that one set of motoneurons are the major source of tension generating eye movements, whereas the other may participate in a proprioceptive system concerned more with the exact alignment and stabilization of the eyes. In this article we discuss the structures that may participate in the proprioceptive circuits; and consider several recent publications in the light of this sensory feedback hypothesis, emphasizing the relevance to eye movement disorders.

Pathophysiology of slow vertical saccades in progressive supranuclear palsy

OBJECTIVES

To investigate the relative roles of burst neurons (which generate the saccadic command) and omnipause neurons (which gate the activity of burst neurons) in the pathogenesis of slow saccades in progressive supranuclear palsy (PSP).

BACKGROUND

Experimental inactivation of mesencephalic burst neurons impairs vertical but not horizontal saccades. Experimental inactivation of omnipause neurons causes slowing of both horizontal and vertical saccades. Combining saccadic with vergence movements in healthy subjects induces small, high-frequency, conjugate oscillations, which indicate that omnipause neurons are inhibited.

METHODS

The authors studied seven patients with PSP, six patients with other parkinsonian syndromes, and seven age-matched control subjects. They compared vertical saccades of similar sizes made with or without associated vergence movements. They compared the speed of vertical and horizontal saccades.

RESULTS

Five patients with PSP and the six patients with other parkinsonian made vertical saccades in combination with horizontal vergence; all showed conjugate horizontal oscillations (29 to 41 Hz) during 27% to 93% of saccade-vergence trials. Vertical saccades made in conjunction with vergence movements were not speeded up or increased in size compared with saccades made between equidistant targets for the PSP or parkinsonian groups. Vertical saccades were slowed more than horizontal saccades in the PSP group (p < 0.005) but not in the parkinsonian group.

CONCLUSIONS

Dysfunction of omnipause neurons ("gate dysfunction") is unlikely to be the primary cause of slow vertical saccades in progressive supranuclear palsy. Deficient generation of the motor command by midbrain burst neurons is the more likely cause.

Motoneurons of twitch and nontwitch extraocular muscle fibers in the abducens, trochlear, and oculomotor nuclei of monkeys

Eye muscle fibers can be divided into two categories: nontwitch, multiply innervated muscle fibers (MIFs), and twitch, singly innervated muscle fibers (SIFs). We investigated the location of motoneurons supplying SIFs and MIFs in the six extraocular muscles of monkeys. Injections of retrograde tracers into eye muscles were placed either centrally, within the central SIF endplate zone; in an intermediate zone, outside the SIF endplate zone, targeting MIF endplates along the length of muscle fiber; or distally, into the myotendinous junction containing palisade endings. Central injections labeled large motoneurons within the abducens, trochlear or oculomotor nucleus, and smaller motoneurons lying mainly around the periphery of the motor nuclei. Intermediate injections labeled some large motoneurons within the motor nuclei but also labeled many peripheral motoneurons. Distal injections labeled small and medium-large peripheral neurons strongly and almost exclusively. The peripheral neurons labeled from the lateral rectus muscle surround the medial half of the abducens nucleus: from superior oblique, they form a cap over the dorsal trochlear nucleus; from inferior oblique and superior rectus, they are scattered bilaterally around the midline, between the oculomotor nucleus; from both medial and inferior rectus, they lie mainly in the C-group, on the dorsomedial border of oculomotor nucleus. In the medial rectus distal injections, a "C-group extension" extended up to the Edinger-Westphal nucleus and labeled dendrites within the supraoculomotor area. We conclude that large motoneurons within the motor nuclei innervate twitch fibers, whereas smaller motoneurons around the periphery innervate nontwitch, MIF fibers. The peripheral subgroups also contain medium-large neurons which may be associated with the palisade endings of global MIFs. The role of MIFs in eye movements is unclear, but the concept of a final common pathway must now be reconsidered.

The premotor region essential for rapid vertical eye movements shows early involvement in Alzheimer's disease-related cytoskeletal pathology

The rostral interstitial nucleus of the medial longitudinal fascicle (riMLF) contains premotor neurons essential for the generation of rapid vertical eye movements. The Alzheimer's disease (AD)-related cytoskeletal changes and beta-amyloid deposits in this nucleus were examined in 30 autopsy cases and compared to the involvement of three associated nuclei - Edinger-Westphal nucleus, nucleus of Darkschewitsch and interstitial nucleus of Cajal. The riMLF displays slight cytoskeletal alterations already in the early stages in the development of the cortical cytoskeletal pathology (cortical NFT/NT-stages I-II, representing the preclinical phase of AD). In the cortical NFT/NT-stages III-IV (i.e. incipient phase of AD), the cytoskeletal pathology in the riMLF is pronounced and in stages V-VI (i.e. clinical phase of AD) it is severe. The progression of the cytoskeletal pathology in the riMLF correlates significantly with the cortical NFT/NT-stages I-VI that reflect the clinical course of AD. Isolated beta-amyloid deposits appear in the riMLF for the first time in the final beta-amyloid stage. In the Edinger-Westphal nucleus, in the nucleus of Darkschewitsch and most markedly in the interstitial nucleus of Cajal, the pathological changes were significantly less severe than those in the riMLF. In the event that the cytoskeletal pathology impairs the function of the premotor neurons of the riMLF, one would predict a progressive slowing of vertical saccades corresponding to the advancing cortical NFT/NT-stages.

Neuroanatomical identification of mesencephalic premotor neurons coordinating eyelid with upgaze in the monkey and man

Except during blinks, movements of the upper eyelid are tightly coupled to vertical eye movements. The premotor source for the coordination of lid and eye movements is unknown. The present paper provides the anatomical identification of a new premotor cell group in the rostral mesencephalon of the monkey and human, which lies in close proximity to the premotor center for vertical saccades and is thought to participate in lid-eye coordination. After injections of a retrograde transsynaptic tracer (tetanus toxin fragment C or BII(b)) into the levator palpebrae (LP), the superior rectus (SR), or the inferior oblique (IO) muscle of macaque monkeys, a small circumscribed group of premotor neurons was labeled in the central gray of the rostral mesencephalon, but not after superior oblique or inferior rectus muscle injections. This group lies immediately rostral to the interstitial nucleus of Cajal and medial to the rostral interstitial nucleus of the medial longitudinal fasciculus, each of which contain premotor neurons for vertical saccades, and was termed the M-group. Injections of tritiated leucine into the M-group led to afferent labeling primarily over LP motoneurons. In addition, label was present over the SR- and IO-motoneuron subgroups in the oculomotor nucleus and frontalis muscle motoneurons in the facial nucleus. This projection pattern of the M-group suggests a role in the coordination of the upper eyelid and eyes during upgaze. Double-labeling experiments in macaque monkeys revealed that the M-group is strongly parvalbumin immunoreactive and contains high levels of cytochrome oxidase activity. With these two histochemical markers, the homologue of the M-group was identified in the human brain as well.

Projections from the superior colliculus motor map to omnipause neurons in monkey

Descending projections from the superior colliculus (SC) motor map to the saccadic omnipause neurons (OPNs) were examined in monkeys by using anterograde transport of tritiated leucine. The SC was divided into three zones: the rostral pole of the motor map, a small horizontal saccade zone in central SC, and a large horizontal saccade zone in caudal SC. Tracer injections into the intermediate layers of the three zones led to different patterns of silver grain deposits in and around nucleus raphe interpositus (RIP), which contains the OPNs: 1) From the rostral pole of the motor map, coarse axon branches of the crossed predorsal bundle spread medially into the RIP, branched, and terminated predominantly unilaterally over cells on the same side. 2) From the small horizontal saccade zone, the axon branches were of a finer caliber and terminated diffusely in the RIP, mainly on the same side. 3) From the large horizontal saccade zone, no terminal labeling was found within the RIP. 4) From the rostral pole of the motor map and small horizontal saccade zone, fiber branches from the ipsilateral descending pathway terminated diffusely over RIP. 5) In addition, terminal labeling in reticulospinal areas of the pons and medulla increased in parallel with the size of the saccade according to the SC motor map. The results suggest that there are multiple projections directly onto OPNs from the rostral SC but not from the caudal SC associated with large gaze shifts. The efferents from the rostral pole of the motor map may subserve the suppression of saccades during visual fixation, and those from the small horizontal saccade zone could inhibit anatagonist premotor circuits.

A review of otolith pathways to brainstem and cerebellum

Our knowledge of otolith pathways is developing rapidly, but is still far from complete. Primary afferents from the sacculus and utricle terminate mainly in the lateral, inferior and caudal superior vestibular nuclei, and the ventral cerebellum, in particular the nodulus. Otolith signals descend via reticulo- and vestibulospinal pathways in the spinal cord to influence neck motoneurons and ascending proprioceptive afferents. Utricular information can reach the extraocular eye muscles via mono-, di-, and multisynaptic pathways, but saccular afferents probably only by multisynaptic pathways. The otolith signals are relayed from the vestibular nuclei, medullary reticular formation, inferior olive, and lateral reticular nucleus to sagittal zones in the caudal cerebellar vermis (nodulus and uvula), and influence the deep cerebellar nuclei. The graviceptive information could be channeled by the cerebellar efferents back to the vestibular and inferior olive complex, or fed into ascending pathways that would innervate the mescencephalon, the thalamus, and cerebral cortex.

Premotor neurons for vertical eye movements in the rostral mesencephalon of monkey and human: histologic identification by parvalbumin immunostaining

In the monkey, premotor neurons for vertical gaze are located in the mesencephalic reticular formation: the rostral interstitial nucleus of the medial longitudinal fascicle (riMLF) contains medium-lead burst neurons, and the interstitial nucleus of Cajal (iC) acts as integrator for the eye-velocity signals to eye-position signals. Both nuclei lie adjacent to each other and are similar in appearance at the transition zone in Nissl-stained sections, which makes a delineation of the functionally different nuclei difficult in human. For a neuropathologic analysis of degenerative changes in saccadic disorders of patients, the histologic identification of the riMLF and the iC is important. The aim of this study is to identify both nuclei in human by using parvalbumin as a histologic marker. First, in monkeys the premotor neurons in riMLF and iC were identified by trans-synaptic labelling after injections of tetanus toxin fragment C into vertical-pulling eye muscles. Premotor neurons were found in the riMLF mainly ipsilateral to the corresponding eye muscle motoneurons and on both sides within the iC, but here the labelled cell populations differed: the contralateral side contained more medium-sized cells compared with the mainly small-sized cell population on the ipsilateral side. Double labelling showed that almost all premotor neurons in the iC and all premotor neurons in the riMLF were parvalbumin-immunoreactive. The immunocytochemical staining of human brainstem sections revealed the riMLF as a cluster of medium-sized, elongated parvalbumin-positive cells, with a similar appearance and at a similar location as that in monkey: a wing-shaped nucleus dorsomedial to the red nucleus, rostral to the traversing tractus retroflexus, dorsally bordered by the thalamo-subthalamic paramedian artery. The adjacent iC could be distinguished easily by its more densely packed, round parvalbumin-immunoreactive neurons. The exact identification of premotor neurons of the vertical system in the normal human brain provides a reference basis for the neuropathologic analysis of vertical gaze disorders at a cellular level.

Anatomical substrates of oculomotor control

It is convenient to describe oculomotor neuroanatomy in terms of five to six different eye movement types, each with relatively independent neural circuitry: saccades, vestibulo-ocular reflex, optokinetic response, smooth pursuit, vergence and, most recently added to the list, gaze-holding. Current research indicates that many structures participate in several eye movement types, such as the nucleus reticularis tegmenti pontis, frontal eye fields and pretectum. However, the circuits appear to run in parallel rather than being integrated.

A neuroanatomical analysis of lid-eye coordination in cases of ptosis and downgaze paralysis

Ptosis and downgaze paralysis, in a case of vascular insufficiency, were the result of a specific loss of levator palpebrae (LP) motoneurons in the oculomotor nucleus, and a partial cell loss in the rostral interstitial nucleus of the MLF (riMLF), respectively. In a previous case with similar symptoms there was a comparable riMLF cell loss, but some LP motoneurons were spared; in addition there was destruction of a cell group on the mesencephalic midline, which projects to all motoneurons involved in upward eye movements including LP. This cell group is called the M-group in the monkey. The M-group was intact in the present, but not in the previous case, which may have contributed to the ptosis and to the loss of upward ocular pursuit in the latter. The results show that there is more than one premotor cell group responsible for upward eye movements in the rostral mesencephalon.

Efferent pathways of the nucleus of the optic tract in monkey and their role in eye movements

To clarify the role of the pretectal nucleus of the optic tract (NOT) in ocular following, we traced NOT efferents with tritiated leucine in the monkey and identified the cell groups they targeted. Strong local projections from the NOT were demonstrated to the superior colliculus and the dorsal terminal nucleus bilaterally and to the contralateral NOT. The contralateral oculomotor complex, including motoneurons (C-group) and subdivisions of the Edinger-Westphal complex, including motoneurons (C-group) and subdivisions of the Edinger-Westphal complex, also received inputs. NOT efferents terminated in all accessory optic nuclei (AON) ipsilaterally; contralateral AON projections arose from the pretectal olivary nucleus embedded in the NOT. Descending pathways contacted precerebellar nuclei: the dorsolateral and dorsomedial pontine nuclei, the nucleus reticularis tegmenti pontis, and the inferior olive. Direct projections from NOT to the ipsilateral nucleus prepositus hypoglossi (ppH) appeared to be weak, but retrograde tracer injections into rostral ppH verified this projection; furthermore, the injections demonstrated that AON efferents also enter this area. Efferents from the NOT also targeted ascending reticular networks from the pedunculopontine tegmental nucleus and the locus coeruleus. Rostrally, NOT projections included the magnocellular layers of the lateral geniculate nucleus (lgn); the pregeniculate, peripeduncular, and thalamic reticular nuclei; and the pulvinar, the zona incerta, the mesencephalic reticular formation, the intralaminar thalamic nuclei, and the hypothalamus. The NOT could generate optokinetic nystagmus through projections to the AON, the ppH, and the precerebellar nuclei. However, NOT also projects to structures controlling saccades, ocular pursuit, the near response, lgn motion sensitivity, visual attention, vigilance, and gain modification of the vestibulo-ocular reflex. Any hypothesis on the function of NOT must take into account its connectivity to all of these visuomotor structures.

Abnormalities of torsional fast phase eye movements in unilateral rostral midbrain disease

In a patient with a unilateral rostral midbrain lesion, three-dimensional scleral search coil eye movement recordings demonstrated slowing of ipsidirectional torsional fast phase eye movements without any abnormalities of torsional slow phases. On high-resolution MRI, the brainstem lesion localized to the area of the efferent pathways from the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). This supports the experimental finding that unilateral inactivation of the riMLF results in a loss of ipsidirectional torsional fast phase eye movements and the hypothesis that there is lateralization of function throughout the torsional fast eye movement generating system.

Pathways from cell groups of the paramedian tracts to the floccular region

A group of cells lying along the midline of the mid-medulla, nucleus pararaphales, is shown to play a role in vertical eye movements. Its efferents project along the midline, then pass laterally to follow the ventral external arcuate fibers around the surface of the medulla into the restiform body. The fibers terminate in the flocculus and ventral paraflocculus. This nucleus is one of the "cell groups of the paramedian tracts," which, based on their connectivity, could provide a motor-feedback signal for eye-head position to the cerebellum. Lesions of these pathways could lead to gaze-evoked nystagmus.

Pretectal projections to the oculomotor complex of the monkey and their role in eye movements

The nucleus of the optic tract (NOT) is associated with the generation of optokinetic nystagmus (OKN), whereas the olivary pretectal nucleus (ol), which lies embedded in the primate NOT, is believed to be essential for the pupillary light reflex. In this anatomical study of the pretectum, projections from NOT and ol to structures around the oculomotor nucleus were traced in the monkey, to determine which cell groups they innervated. 1. 3[H]-leucine injections were placed into NOT and ol, and labelled terminals were observed just outside the classical oculomotor nucleus (nIII), in the "C-group' and midline cell clusters, both of which contain small motoneurons of the extraocular eye muscles. In addition, there were strong projections to the lateral visceral cell column of the Edinger-Westphal complex (lvc), but not to the Edinger-Westphal nucleus (EW) itself. All of these projections were mainly contralateral. 2. NOT efferents terminated over the ipsilateral medial accessory nucleus of Bechterew (nB), but not over the adjacent nucleus Darkschewitsch. 3. Injections of a retrograde tracer into the oculomotor complex showed that the pretectal afferents described above originated mainly from the dorsomedial part of NOT and from ol. 4. The use of a transsynaptic retrograde tracer, tetanus toxin fragment (BIIb), established the monosynaptic nature of the connection between dorsomedial NOT (contralaterally) and ol (bilaterally), to the small extraocular motoneurons outside classical nIII. The "C-group' motoneurons may play a role in vergence, and lvc in pupillary constriction and depth of focus. Our results imply that NOT and ol participate in the control of some aspects of the near-response, which may be important in the generation of some components of OKN in primates.

Histological identification of premotor neurons for horizontal saccades in monkey and man by parvalbumin immunostaining

The premotor excitatory and inhibitory burst neurons are essential for horizontal saccades. In the monkey, excitatory burst neurons lie in the ipsilateral paramedian pontine reticular formation, and the inhibitory burst neurons lie more caudally in the contralateral nucleus paragigantocellularis dorsalis. For a neuropathological analysis of degenerative changes in saccadic disorders of patients, the histological identification of the burst neuron areas in man is important. Here, we show that this is possible with parvalbumin immunostaining as a histological marker. First, in monkeys, the premotor burst neurons were backlabeled by injections of wheat germ agglutinin-horseradish peroxidase or cholera toxin subunit B into the abducens nucleus or tetanus toxin fragment C into the lateral rectus muscle and shown by double labeling to contain parvalbumin. Then, human brainstem sections were immunoreacted for parvalbumin, and, by comparing the resulting staining pattern to that in the monkey, the homologous burst neuron areas were defined in man. In the monkey, excitatory burst neurons were confirmed to the nucleus reticularis pontis caudalis and did not extend farther rostrally into the nucleus reticularis pontis oralis. All retrogradely labeled cells in both burst neuron areas were parvalbumin positive, and approximately 70% of the parvalbumin-positive cells were retrogradely labeled. Both burst neuron areas were highlighted by their parvalbumin staining pattern and could be outlined in man as well. The putative excitatory burst neuron area in man is in the medial part of the nucleus reticularis pontis caudalis (extending 2.5 mm mediolaterally), immediately rostral (250 microns) to the omnipause neurons and extending 2.2 mm rostrally, and the putative inhibitory burst neuron area lies in the medial part of the paragigantocellular nucleus caudal to the abducens nucleus, extending 1.8 mm caudally. The location of the burst neuron areas, including the burst neurons themselves, via parvalbumin immunostaining will help in the analysis of clinical cases with slow saccades.

Deficits in torsional and vertical rapid eye movements and shift of Listing's plane after uni- and bilateral lesions of the rostral interstitial nucleus of the medial longitudinal fasciculus

The rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) contains burst neurons whose activity precedes rapid eye movements with a vertical and/or torsional component. To ascertain their causal role in the generation of conjugate eye movements, we placed uni- and bilateral kainic acid lesions in that region. Unilateral inactivation of the riMLF leads to a loss of all rapid eye movements with an ipsitorsional component (ipsitorsional is defined as movement of the upper pole of the ipsilateral eye in a temporal direction). Vertical eye movements are impaired in an asymmetric way, with downward movements slowed and upward movements little affected. Listing's plane is shifted in the contratorsional direction, i.e., we find a constant torsional offset for all eye positions. With bilateral lesions one observes a total loss of all vertical and torsional eye movements, while Listing's plane retains its shape and position. These results show that burst neurons in the riMLF play a decisive role in generating rapid eye movements with a vertical and torsional component.

Neurotransmitter profile of saccadic omnipause neurons in nucleus raphe interpositus

Saccadic omnipause neurons (OPNs) are essential for the generation of saccadic eye movements. In primates OPNs are located near the midline within the nucleus raphe interpositus (rip). In the present study we used several different neuroanatomical methods to investigate the transmitters associated with OPNs in the monkey. Immunolabeling for the calcium-binding protein parvalbumin was employed to mark OPNs in the monkey and define the homologous cell group in cat and human. The use of antibodies against GABA, glycine (GLY), glutamate (GLU), serotonin (5-HT), and tyrosine hydroxylase revealed that the somata of OPNs are GLY immunoreactive, but they are devoid of GABA and 5-HT immunostaining. In situ hybridization with the GAD67 mRNA probe confirmed the negative GABA immunostaining of OPNs. 3H-GLY was injected into a projection field of OPNs, the rostral interstitial nucleus of the medial longitudinal fascicle (riMLF)--the vertical saccadic burst neuron area. This resulted in selective retrograde labeling of the OPNs in rip, while no labeling was found in the superior colliculus, which sends an excitatory projection to the riMLF. The somata and dendrites of putative burst neurons in the riMLF were contacted by numerous GLY-immunoreactive terminals. The quantitative analysis of immunoreactive terminal-like structures contacting OPNs revealed a strong input from GLY- and GABA-positive terminals on somata and dendrites, whereas GLU-positive puncta were mainly confined to the dendrites. Very few 5-HT and catecholaminergic terminals contacted OPN somata. Our findings suggest that OPNs use GLY as a neurotransmitter, and they receive numerous contacts from GABAergic, glycinergic, and glutaminergic afferents, and significantly fewer from monoaminergic inputs.

Neuroanatomy of the ocular motor pathways

Oculomotor-related structures in the brain stem extend from the rostral mesencephalon to the hypoglossal nucleus in the caudal medulla. This chapter reviews their location in man, their connections and some basic features of their function; these are summarized in Table 1. In addition to the extraocular motor nuclei (the oculomotor, trochlear and abducens nuclei) the brain stem contains premotor areas responsible for all five different types of eye movements and for gaze-holding. These premotor structures include the riMLF and PPRF for the generation of vertical/torsional and horizontal saccades, respectively. The role of the vestibular nuclei in the VOR and optokinetic responses is well established, and they probably also mediate smooth pursuit eye movements along with the dorsolateral pontine nuclei and the floccular region. In contrast, there is only scanty evidence for the function of the accessory optic nuclei relaying optokinetic information in man. Little is known about the neuroanatomy of the premotor areas for convergence. There is accumulating evidence that the INC and the vestibular and perihypoglossal nuclei are essential for the maintenance of gaze.

Nervous control of eyelid function. A review of clinical, experimental and pathological data

This review of the clinical and experimental literature on pre-motor eyelid control, including an analysis of available clinico-pathological reports, suggests support for the following hypotheses: (1) cortex, extrapyramidal motor systems and rostral brainstem structures contribute to the control of the levator palpebrae muscle (LP) in various eyelid functions; (2) though the LP motor nucleus is unpaired, the pre-motor control of LP is at least in part lateralized; (3) signals of the rostral interstitial nucleus of the medial longitudinal fasciculus (MLF) are involved in the control of coordinated lid movements with saccadic up- and downgaze movements; (4) lesions of the medial and/or principal portion of the nuclear complex of the posterior commissure are essential for the production of lid retraction. These structures are assumed to be involved in lid-eye coordination by providing inhibitory modulation of LP motor neuronal activity; (5) the ventral periaqueductal grey is assumed to play a role in the generation of tonic LP motor neuronal activity; (6) neurons of the caudal supraoculomotor area could play a role in the mediation of converging inhibitory inputs onto LP motor neurons.

The time course of retrograde transsynaptic transport of tetanus toxin fragment C in the oculomotor system of the rabbit after injection into extraocular eye muscles

The aim of this study was to determine the optimal survival time for labelling those neurons that monosynaptically terminate on extraocular motoneurons, i.e. the premotor neurons, after an injection of tetanus toxin fragment C, a retrograde transsynaptic tracer substance, into the eye muscle of the rabbit. Concentrated fragment C was injected into the inferior rectus or inferior oblique muscle and detected immunocytochemically in the brain after survival times of 8 h, 17 h, 2 d, 3 d, 4 d, 5 d, 6 d, 8 d, and 12 d. Immunoreactivity was confined to granules within motoneuronal and premotor neuronal cell bodies, but became associated with punctate profiles outlining the somata with longer survival times. The strongest and most consistent labelling of premotor cell bodies was seen after 4 days survival time. The transsynaptic labelling pattern was shown to vary for individual premotor pathways.

Ptosis and supranuclear downgaze paralysis

A patient developed the unusual combination of a supranuclear downward gaze paralysis and bilateral ptosis. It was caused by a single midbrain glioma. Other ocular motor functions were intact. The neuropathologic examination showed a tumor growing mainly around the third ventricle and the aqueduct. The findings agree with recent experimental evidence that a network of neural elements involved in eyelid control lies in the supraoculomotor area immediately dorsal to the oculomotor nucleus.

Raphe nucleus of the pons containing omnipause neurons of the oculomotor system in the monkey, and its homologue in man

Omnipause neurons take part in the generation of saccadic eye movements. They lie around the midline in the caudal pontine reticular formation, in an area usually ascribed to the nucleus raphe pontis (rp). In this study of the monkey (Macaca fascicularis and M. mulatta), we describe four series of experiments aimed at establishing that omnipause neurons lie within a distinctive cytoarchitectonic entity, which we call the nucleus raphe interpositus (rip): (1) cytoarchitectural study, (2) recording-lesion experiments to establish in which cell group omnipause neurons lie, (3) cytochrome oxidase distribution in the omnipause region and neighboring structures, and (4) neuroanatomical tracing experiments to demonstrate afferents to the omnipause region. In the detailed cytoarchitectural study of the midline structures in the caudal pons and rostral medulla, a distinctive group of neurons (rip) adjoining the ventrocaudal border of rp and dorsal to the nucleus raphe magnus (rm) is described. The striking features of rip are the uniformly arranged, narrow row of the cells either side of the midline, and the extensive horizontally oriented dendritic trees of its neurons. The abducens rootlets (NVI) pass through the reticular formation at the same rostrocaudal level as rip and form a reliable landmark for its location. Cytochrome-oxidase-stained sections demonstrated additional differences between rip and adjacent cell groups: in rip the neurons and their extensive dendrites stained strongly, but not the surrounding neuropile, whereas in rp both the neurons and the neuropile stained darkly, so that individual neurons were difficult to see. Unlike rp, rip coincides with the location of omnipause neurons, and lesions marking the sites of individual omnipause units lay within its boundaries. Tritiated leucine was injected into superior colliculus (sc), which is known to have monosynaptic connections with omnipause neurons. Labelled axons and patterns of silver grains taken to indicate the presence of terminal branching were found in and around rip, but no significant labelling was seen in rp or rm. It is concluded that the omnipause neurons lie within the rip in the monkey. These functional and morphological differences between rip and the adjacent raphe nuclei are used to justify its characterization as an independent cell group in the monkey. In order to relate these findings to man, cytochrome oxidase experiments were carried out on the human brainstem, and the pattern of staining at the level of the abducens rootlets was correlated with the cytoarchitecture.(ABSTRACT TRUNCATED AT 400 WORDS)

Omnipause neurons in two cases of opsoclonus associated with oat cell carcinoma of the lung

Opsoclonus is an involuntary eye movement disorder in which there are chaotic, usually conjugate, multidimensional saccadic eye movements. In this paper 2 cases of opsoclonus are reported, as a paraneoplastic phenomenon in association with oat cell carcinoma of the lung. It has previously been hypothesized that opsoclonus results from dysfunction of a group of premotor neurons in the brainstem called omnipause neurons. We describe the location of these cells in man by homology with animal studies, and describe the light microscopic appearance of these neurons in the 2 cases of opsoclonus. Although these neurons appeared normal it is still possible that their function was disturbed as a result of metabolic or neurotransmitter abnormalities.