Gaze and attention: Mechanisms underlying the therapeutic effect of optokinetic stimulation in spatial neglect

Left smooth pursuit eye movement training in response to large-field visual motion (optokinetic stimulation) has become a promising rehabilitation method in left spatial inattention or neglect. The mechanisms underlying the therapeutic effect, however, remain unknown. During optokinetic stimulation, there is an error in visual localisation ahead of the line of sight. This could indicate a change in the brain's estimate of one's own direction of gaze. We hypothesized that optokinetic stimulation changes the brain's estimate of gaze. Because this estimate is critical for coding the locus of attention in the visual space relative to the body and across sensory modalities, its change might underlie the change in spatial attention. Here, we report that in healthy participants optokinetic stimulation causes not only a directional bias in the proprioceptive signal from the extraocular muscles, but also a corresponding shift of the locus of attention. Both changes outlasted the period of stimulation. This result forms a step in investigating a causal link between the adaptation in the sensorimotor gaze signals and the recovery in spatial neglect.

Pseudo-time Series Structural MRI Revealing Progressive Gray Matter Changes with Elevated Intraocular Pressure in Primary Open-Angle Glaucoma: A Preliminary Study

RATIONALE AND OBJECTIVES

Primary open-angle glaucoma (POAG) is accompanied with gray matter (GM) changes across the brain. However, causal relationships of the GM changes have not been fully understood. Our aim was to investigate the causality of GM progressive changes in POAG using Granger causality (GC) analysis and structural MRI.

MATERIALS AND METHODS

Structural MRI from 20 healthy controls and 30 POAG patients with elevated intraocular pressure (IOP) were collected. We performed voxel-wise GM volume comparisons between control and POAG groups, and between control and four POAG subgroups (categorized by IOP). Then, we sequenced the structural MRI data of all POAG patients and conducted both voxel-wise and region of interest (ROI)-wise GC analysis to investigate the causality of GM volume changes in POAG brain.

RESULTS

Compared to healthy controls, reduced GM volumes across the brain were found, GM volume enlargements in the thalamus, caudate nucleus and cuneus were also observed in POAG brain (false discovery rate (FDR) corrected at q< 0.05). As IOP elevated, the reductions of GM volume were more severe in the cerebellum and frontal lobe. GC analysis revealed that the bilateral cerebellum, visual cortices, and the frontal regions served independently as primary hubs of the directional causal network, and projected causal effects to the parietal and temporal regions of the brain (FDR corrected at q<0.05).

CONCLUSION

POAG exhibits progressive GM alterations across the brain, with oculomotor regions and visual cortices as independent primary hubs. The current results may deepen our understanding of neuropathology of POAG.

Quantitative Oculomotor Assessment in Hereditary Ataxia: Discriminatory Power, Correlation with Severity Measures, and Recommended Parameters for Specific Genotypes

Characterizing bedside oculomotor deficits is a critical factor in defining the clinical presentation of hereditary ataxias. Quantitative assessments are increasingly available and have significant advantages, including comparability over time, reduced examiner dependency, and sensitivity to subtle changes. To delineate the potential of quantitative oculomotor assessments as digital-motor outcome measures for clinical trials in ataxia, we searched MEDLINE for articles reporting on quantitative eye movement recordings in genetically confirmed or suspected hereditary ataxias, asking which paradigms are most promising for capturing disease progression and treatment response. Eighty-nine manuscripts identified reported on 1541 patients, including spinocerebellar ataxias (SCA2, n = 421), SCA3 (n = 268), SCA6 (n = 117), other SCAs (n = 97), Friedreich ataxia (FRDA, n = 178), Niemann-Pick disease type C (NPC, n = 57), and ataxia-telangiectasia (n = 85) as largest cohorts. Whereas most studies reported discriminatory power of oculomotor assessments in diagnostics, few explored their value for monitoring genotype-specific disease progression (n = 2; SCA2) or treatment response (n = 8; SCA2, FRDA, NPC, ataxia-telangiectasia, episodic-ataxia 4). Oculomotor parameters correlated with disease severity measures including clinical scores (n = 18 studies (SARA: n = 9)), chronological measures (e.g., age, disease duration, time-to-symptom onset; n = 17), genetic stratification (n = 9), and imaging measures of atrophy (n = 5). Recurrent correlations across many ataxias (SCA2/3/17, FRDA, NPC) suggest saccadic eye movements as potentially generic quantitative oculomotor outcome. Recommendation of other paradigms was limited by the scarcity of cross-validating correlations, except saccadic intrusions (FRDA), pursuit eye movements (SCA17), and quantitative head-impulse testing (SCA3/6). This work aids in understanding the current knowledge of quantitative oculomotor parameters in hereditary ataxias, and identifies gaps for validation as potential trial outcome measures in specific ataxia genotypes.

The superior colliculus projection upon the macaque inferior olive

Saccade accommodation is a productive model for exploring the role of the cerebellum in behavioral plasticity. In this model, the target is moved during the saccade, gradually inducing a change in the saccade vector as the animal adapts. The climbing fiber pathway from the inferior olive provides a visual error signal generated by the superior colliculus that is believed to be crucial for cerebellar adaptation. However, the primate tecto-olivary pathway has only been explored using large injections of the central portion of the superior colliculus. To provide a more detailed picture, we have made injections of anterograde tracers into various regions of the macaque superior colliculus. As shown previously, large central injections primarily label a dense terminal field within the C subdivision at caudal end of the contralateral medial inferior olive. Several, previously unobserved, sites of sparse terminal labeling were noted: bilaterally in the dorsal cap of Kooy and ipsilaterally in the C subdivision of the medial inferior olive. Small, physiologically directed, injections into the rostral, small saccade portion of the superior colliculus produced terminal fields in the same regions of the medial inferior olive, but with decreased density. Small injections of the caudal superior colliculus, where large amplitude gaze changes are encoded, again labeled a terminal field located in the same areas. The lack of a topographic pattern within the main tecto-olivary projection suggests that either the precise vector of the visual error is not transmitted to the vermis, or that encoding of this error is via non-topographic means.

Patient-Related Outcome Measures for Oculomotor Symptoms in the Cerebellar Ataxias: Insights from Non-Cerebellar Disorders

In patients with cerebellar ataxia (CA), symptoms related to oculomotor dysfunction significantly affect quality of life (QoL). This study aimed to analyze the literature on patient-related outcome measures (PROMs) assessing QoL impacts of vestibular and cerebellar oculomotor abnormalities in patients with CA to identify the strengths and limitations of existing scales and highlight any areas of unmet need. A systematic review was conducted (Medline, Embase) of English-language original articles reporting on QoL measures in patients with vertigo, dizziness or CA. Pre-specified parameters were retrieved, including diseases studied, scales applied and conclusions drawn. Our search yielded 3671 articles of which 467 studies (n = 111,606 participants) were deemed relevant. The most frequently studied disease entities were (a) non-specific dizziness/gait imbalance (114 studies; 54,581 participants), (b) vestibular schwannomas (66; 15,360), and (c) vestibular disorders not further specified (66; 10,259). The Dizziness Handicap Inventory (DHI) was the most frequently used PROM to assess QoL (n = 91,851), followed by the Penn Acoustic Neuroma Quality-of-Life Scale (n = 12,027) and the Activities-Specific Balance Confidence Scale (n = 2'471). QoL-scores capturing symptoms related to oculomotor abnormalities in CA were rare, focused on visual impairments (e.g., National-Eye-Institute Visual Function Questionnaire, Oscillopsia Functional Impact, oscillopsia severity score) and were unvalidated. The DHI remains the most widely used and versatile scale for evaluating dizziness. A lack of well-established PROMs for assessing the impact of oculomotor-related symptoms on QoL in CA was noted, emphasizing the need for developing and validating a new QoL-score dedicated to the oculomotor domain for individuals with CA.

The effect of online visual games on visual perception, oculomotor, and balance skills of children with developmental dyslexia during the COVID-19 pandemic

PURPOSE

To evaluate the effect of online visual games on the balance, visual perception, and oculomotor skills of children with developmental dyslexia during the COVID-19 pandemic.

METHODS

In this single-blind randomized clinical trial, 50 children with developmental dyslexia, aged 7 to 11 years, were recruited from rehabilitation centers in Tehran, Iran, using a convenience sampling strategy. Participants were randomly divided into two groups: intervention (25) and control (25), with close matching based on sex, age, IQ, and type of disease. The interventions consisted of web-based online computer games focusing on visual perception and oculomotor skills. Outcome measures included the Test of Visual Perception Skills-Revised, the Pediatric Balance Scale, and videonystagmography. The Wechsler Intelligence Scale for Children-IV and the Reading and Dyslexia Test were used to evaluate IQ and reading skills, respectively.

RESULTS

The intervention group exhibited significant post-intervention improvements in the Test of Visual Perception Skills-Revised, tracking gain, saccade latency, and saccade velocity scores (all P < 0.001). In contrast, the control group showed no significant differences in these tests in pre- and post-intervention (all P > 0.05). Notably, post-intervention comparisons between the groups revealed significant differences in smooth pursuit eye movements (P < 0.001), saccade latency (P = 0.027), and saccade velocity (P < 0.001). The Pediatric Balance Scale scores remained unchanged in both groups post-intervention (intervention: P = 0.317; control: P = 0.999). Game face validity was affirmed with impact scores above 1.5 for all items, suggesting that the games were straightforward, clear, and relevant.

CONCLUSION

Online visual games enhanced oculomotor and visual perception skills in children with dyslexia but did not influence balance skills.

Brainstem sources of input to the central mesencephalic reticular formation in the macaque

Physiological studies indicate that the central mesencephalic reticular formation (cMRF) plays a role in gaze changes, including control of disjunctive saccades. Neuroanatomical studies have demonstrated strong interconnections with the superior colliculus, along with projections to extraocular motor nuclei, the preganglionic nucleus of Edinger-Westphal, the paramedian pontine reticular formation, nucleus raphe interpositus, medullary reticular formation and cervical spinal cord, as might be expected for a structure that is intimately involved in gaze control. However, the sources of input to this midbrain structure have not been described in detail. In the present study, the brainstem cells of origin supplying the cMRF were labeled by retrograde transport of tracer (wheat germ agglutinin conjugated horseradish peroxidase) in macaque monkeys. Within the diencephalon, labeled neurons were noted in the ventromedial nucleus of the hypothalamus, pregeniculate nucleus and habenula. In the midbrain, labeled cells were found in the substantia nigra pars reticulata, medial pretectal nucleus, superior colliculus, tectal longitudinal column, periaqueductal gray, supraoculomotor area, and contralateral cMRF. In the pons they were located in the paralemniscal zone, parabrachial nucleus, locus coeruleus, nucleus prepositus hypoglossi and the paramedian pontine reticular formation. Finally, in the medulla they were observed in the medullary reticular formation. The fact that this list of input sources is very similar to those of the superior colliculus supports the view that the cMRF represents an important gaze control center.

Fixation offset decreases pupillary inhibition of return

Inhibition of return (IOR) is reflected as a slower manual or saccadic response to a cued rather than an uncued target (manual IOR and saccadic IOR, respectively), and as a pupillary dilation when a bright, relative to a dark side of a display is cued (pupillary IOR). The aim of this study was to investigate the relation between an IOR and oculomotor system. According to the predominant view, only the saccadic IOR is strictly related to the visuomotor process, and the manual and pupillary IORs depend on non-motor factors (e.g., short-term visual depression). Alternatively, the after-effect of the covert-orienting hypothesis postulates that IOR is strictly related to the oculomotor system. As fixation offset affects oculomotor processes, this study investigated whether fixation offset also affects pupillary and manual IORs. The results show that fixation offset decreased IOR in pupillary but not manual responses, and provides support for the hypothesis that at least the pupillary IOR is tightly linked to eye movement preparation.

A single bout of passive exercise mitigates a mental fatigue-induced inhibitory control deficit

Sustained cognitive effort associated with the psychomotor vigilance task (PVT) increases objective and subjective measures of mental fatigue and elicits a post-PVT inhibitory control deficit. In contrast, passive exercise wherein an individual's limbs are moved via an external force (i.e., mechanically driven cycle ergometer flywheel) provides a postexercise inhibitory control benefit linked to an exercise-based increase in cerebral blood flow. Here, we examined whether passive exercise performed concurrently with the PVT 'blunts' an inhibitory control deficit. On separate days, participants (N = 27) completed a 20 min PVT protocol (control condition) and same duration PVT protocol paired with passive cycle ergometry (passive exercise condition). Prior to (i.e., baseline), immediately after and 30 min after each condition inhibitory control was assessed via the antisaccade task. Antisaccades require a goal-directed eye movement (i.e., saccade) mirror-symmetrical to a target and provide an ideal tool for evaluating task-based changes in inhibitory control. PVT results showed that vigilance (as assessed via reaction time: RT) during control and passive exercise conditions decreased from the first to last 5 min of the protocol and increased subjective ratings of mental fatigue. As well, in the control condition, immediate (but not 30-min) post-intervention antisaccade RTs were longer than their baseline counterparts-a result evincing a transient mental fatigue-based inhibitory control deficit. For the passive exercise condition, immediate and 30-min post-intervention antisaccade RTs were shorter than their baseline counterparts and this result was linked to decreased subjective ratings of mental fatigue. Thus, passive exercise ameliorated the selective inhibitory control deficit associated with PVT-induced mental fatigue and thus provides a potential framework to reduce executive dysfunction in vigilance-demanding occupations.

The Superior Colliculus Projection Upon the Macaque Inferior Olive

Saccade accommodation is a productive model for exploring the role of the cerebellum in behavioral plasticity. In this model, the target is moved during the saccade, gradually inducing a change in the saccade vector as the animal adapts. The climbing fiber pathway from the inferior olive provides a visual error signal generated by the superior colliculus that is believed to be crucial for cerebellar adaptation. However, the primate tecto-olivary pathway has only been explored using large injections of the central portion of the superior colliculus. To provide a more detailed picture, we have made injections of anterograde tracers into various regions of the macaque superior colliculus. As shown previously, large central injections primarily label a dense terminal field within the C subdivision at caudal end of the contralateral medial inferior olive. Several, previously unobserved, sites of sparse terminal labeling were noted: bilaterally in the dorsal cap of Kooy and ipsilaterally in C subdivision of the medial inferior olive. Small, physiologically directed, injections into the rostral, small saccade portion of the superior colliculus produced terminal fields in the same regions of the medial inferior olive, but with decreased density. Small injections of the caudal superior colliculus, where large amplitude gaze changes are encoded, again labeled a terminal field located in the same areas. The lack of a topographic pattern within the main tecto-olivary projection suggests that either the precise vector of the visual error is not transmitted to the vermis, or that encoding of this error is via non-topographic means.

Quantitative Oculomotor Assessment in Hereditary Ataxia: Systematic Review and Consensus by the Ataxia Global Initiative Working Group on Digital-motor Biomarkers

Oculomotor deficits are common in hereditary ataxia, but disproportionally neglected in clinical ataxia scales and as outcome measures for interventional trials. Quantitative assessment of oculomotor function has become increasingly available and thus applicable in multicenter trials and offers the opportunity to capture severity and progression of oculomotor impairment in a sensitive and reliable manner. In this consensus paper of the Ataxia Global Initiative Working Group On Digital Oculomotor Biomarkers, based on a systematic literature review, we propose harmonized methodology and measurement parameters for the quantitative assessment of oculomotor function in natural-history studies and clinical trials in hereditary ataxia. MEDLINE was searched for articles reporting on oculomotor/vestibular properties in ataxia patients and a study-tailored quality-assessment was performed. One-hundred-and-seventeen articles reporting on subjects with genetically confirmed (n=1134) or suspected hereditary ataxia (n=198), and degenerative ataxias with sporadic presentation (n=480) were included and subject to data extraction. Based on robust discrimination from controls, correlation with disease-severity, sensitivity to change, and feasibility in international multicenter settings as prerequisite for clinical trials, we prioritize a core-set of five eye-movement types: (i) pursuit eye movements, (ii) saccadic eye movements, (iii) fixation, (iv) eccentric gaze holding, and (v) rotational vestibulo-ocular reflex. We provide detailed guidelines for their acquisition, and recommendations on the quantitative parameters to extract. Limitations include low study quality, heterogeneity in patient populations, and lack of longitudinal studies. Standardization of quantitative oculomotor assessments will facilitate their implementation, interpretation, and validation in clinical trials, and ultimately advance our understanding of the evolution of oculomotor network dysfunction in hereditary ataxias.

Use of Oculomotor Behavior to Classify Children with Autism and Typical Development: A Novel Implementation of the Machine Learning Approach

This study segmented the time series of gaze behavior from nineteen children with autism spectrum disorder (ASD) and 20 children with typical development in a face-to-face conversation. A machine learning approach showed that behavior segments produced by these two groups of participants could be classified with the highest accuracy of 74.15%. These results were further used to classify children using a threshold classifier. A maximum classification accuracy of 87.18% was achieved, under the condition that a participant was considered as 'ASD' if over 46% of the child's 7-s behavior segments were classified as ASD-like behaviors. The idea of combining the behavior segmentation technique and the threshold classifier could maximally preserve participants' data, and promote the automatic screening of ASD.

Cerebral blood flow and immediate and sustained executive function benefits following single bouts of passive and active exercise

Passive exercise occurs when an individual's limbs are moved via an external force and is a modality that increases cerebral blood flow (CBF) and provides an immediate postexercise executive function (EF) benefit. To our knowledge, no work has examined for how long passive exercise benefits EF. Here, healthy young adults (N = 22; 7 female) used a cycle ergometer to complete three 20-min conditions: passive exercise (via mechanically driven flywheel), a traditional light intensity (37 W) "active" exercise condition (i.e., via volitional pedalling) and a non-exercise control condition. An estimate of CBF was obtained via transcranial Doppler ultrasound measurement of middle cerebral artery blood velocity (MCAv) and antisaccades (i.e., saccade mirror-symmetrical to a target) were completed prior to and immediately, 30- and 60-min following each condition to assess EF. Passive and active exercise increased MCAv; however, the increase was larger in the latter condition. In terms of antisaccades, passive and active exercise provided an immediate postexercise reaction time benefit. At the 30-min assessment, the benefit was observed for active but not passive exercise and neither produced a benefit at the 60-min assessment. Thus, passive exercise provided an evanescent EF "boost" and is a finding that may reflect a smaller cortical hemodynamic response.

Ocular motility as a measure of cerebral dysfunction in adults with focal epilepsy

OBJECTIVE

Using objective oculomotor measures, we aimed to: (1) compare oculomotor performance in patients with drug-resistant focal epilepsy to healthy controls, and (2) investigate the differential impact of epileptogenic focus laterality and location on oculomotor performance.

METHODS

We recruited 51 adults with drug-resistant focal epilepsy from the Comprehensive Epilepsy Programs of two tertiary hospitals and 31 healthy controls to perform prosaccade and antisaccade tasks. Oculomotor variables of interest were latency, visuospatial accuracy, and antisaccade error rate. Linear mixed models were performed to compare interactions between groups (epilepsy, control) and oculomotor tasks, and between epilepsy subgroups and oculomotor tasks for each oculomotor variable.

RESULTS

Compared to healthy controls, patients with drug-resistant focal epilepsy exhibited longer antisaccade latencies (mean difference = 42.8 ms, P = 0.001), poorer spatial accuracy for both prosaccade (mean difference = 0.4°, P = 0.002), and antisaccade tasks (mean difference = 2.1°, P < 0.001), and more antisaccade errors (mean difference = 12.6%, P < 0.001). In the epilepsy subgroup analysis, left-hemispheric epilepsy patients exhibited longer antisaccade latencies compared to controls (mean difference = 52.2 ms, P = 0.003), while right-hemispheric epilepsy was the most spatially inaccurate compared to controls (mean difference = 2.5°, P = 0.003). The temporal lobe epilepsy subgroup displayed longer antisaccade latencies compared to controls (mean difference = 47.6 ms, P = 0.005).

SIGNIFICANCE

Patients with drug-resistant focal epilepsy exhibit poor inhibitory control as evidenced by a high percentage of antisaccade errors, slower cognitive processing speed, and impaired visuospatial accuracy on oculomotor tasks. Patients with left-hemispheric epilepsy and temporal lobe epilepsy have markedly impaired processing speed. Overall, oculomotor tasks can be a useful tool to objectively quantify cerebral dysfunction in drug-resistant focal epilepsy.

Early deficits in GABA inhibition parallels an increase in L-type Ca2+ currents in the jaw motor neurons of SOD1G93A mouse model for ALS

Amyotrophic Lateral Sclerosis (ALS) involves protracted pre-symptomatic periods of abnormal motor neuron (MN) excitability occurring in parallel with central and peripheral synaptic perturbations. Focusing on inhibitory control of MNs, we first compared longitudinal changes in pre-synaptic terminal proteins for GABA and glycine neurotransmitters around the soma of retrogradely identified trigeminal jaw closer (JC) MNs and ChAT-labeled midbrain extraocular (EO) MNs in the SOD1^G93A mouse model for ALS. Fluorescence immunocytochemistry and confocal imaging were used to quantify GAD67 and GlyT2 synaptic bouton density (SBD) around MN soma at pre-symptomatic ages ∼P12 (postnatal), ∼P50 (adult) and near disease end-stage (∼P135) in SOD1^G93A mice and age-matched wild-type (WT) controls. We noted reduced GAD67 innervation in the SOD1^G93A trigeminal jaw closer MNs around P12, relative to age-matched WT and no significant difference around P50 and P135. In contrast, both GAD67 and GlyT2 innervation were elevated in the SOD1^G93A EO MNs at the pre-symptomatic time points. Considering trigeminal MNs are vulnerable in ALS while EO MNs are spared, we suggest that upregulation of inhibition in the latter might be compensatory. Notable contrast also existed in the innate co-expression patterns of GAD67 and GlyT2 with higher mutual information (co-dependency) in EO MNs compared to JC in both SOD1^G93A and WT mice, especially at adult stages (P50 and P135). Around P12 when GAD67 terminals expression was low in the mutant, we further tested for persistent GABA inhibition in those MNs using in vitro patch-clamp electrophysiology. Our results show that SOD1^G93A JC MNs have reduced persistent GABA inhibition, relative to WT. Pharmacological blocking of an underlying tonically active GABA conductance using the GABA-α5 subunit inverse agonist, L-655-708, disinhibited WT JC MNs and lowered their recruitment threshold, suggesting its role in the control of intrinsic MN excitability. Quantitative RT-PCR in laser dissected JC MNs further supported a reduction in GABA-α5 subunit mRNA expression in the mutant. In light of our previous report that JC MNs forming putative fast motor units have lower input threshold in the SOD1^G93A mice, we suggest that our present result on reduced GABA-α5 tonic inhibition provides for a mechanism contributing to such imbalance. In parallel with reduced GABA inhibition, we noted an increase in voltage-gated L-type Ca²⁺ currents in the mutant JC MNs around P12. Together these results support that, early modifications in intrinsic properties of vulnerable MNs could be an adaptive response to counter synaptic deficits.

Is the central mesencephalic reticular formation a purely horizontal gaze center?

Historically, the central mesencephalic reticular formation has been regarded as a purely horizontal gaze center based on the fact that electrical stimulation of this region produces horizontal saccades, it provides monosynaptic input to medial rectus motoneurons, and cells recorded in this region often display a peak in firing when horizontal saccades are made. We tested the proposition that the central mesencephalic reticular formation is purely a horizontal gaze center by examining whether this region also supplies terminals to superior rectus and levator palpebrae superioris motoneurons, both of which fire when making vertical eye movements. The experiments were carried out using dual tracer techniques at the light and electron microscopic level in macaque monkeys. Injections of biotinylated dextran amine or Phaseolus vulgaris leukoagglutinin into the central mesencephalic reticular formation produced anterogradely labeled terminals that were in synaptic contact with superior rectus and levator palpebrae superioris motoneurons that had been retrogradely labeled. These results indicate that this region is not purely connected with horizontal gaze motoneurons. In addition, we found that the number of contacts on vertical gaze motoneurons increased with more rostral injections involving the mesencephalic reticular formation adjacent to the interstitial nucleus of Cajal. This suggests that there is a caudal to rostral gradient for horizontal to vertical saccades, respectively, represented within the midbrain reticular formation. Finally, we utilized post-embedding immunohistochemistry to show that a portion of the labeled terminals were GABAergic, indicating they likely originate from downgaze premotor neurons.

Influence of concussion history and age of first concussion on visio-vestibular function

OBJECTIVES

To assess if abnormalities on visio-vestibular examination (VVE) are associated with concussion history (first vs. repeat) or age of first concussion in acutely concussed adolescents.

DESIGN

Cross-sectional.

METHODS

Data were queried from the Children's Hospital of Philadelphia Minds Matter concussion registry. Patients aged 14-18 years old presenting for their initial visit to the specialty care concussion program within 28 days of injury were included. Demographics, including age, sex, concussion history, and age of first concussion, were collected before the exam. The VVE consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and vestibulo-ocular reflex (VOR), binocular convergence, left/right monocular accommodation, and complex tandem gait. Primary outcomes included VVE subtests (normal/abnormal), and total VVE score (abnormal = 2+ abnormal subtests).

RESULTS

Among 1051 patients included (female = 604(57.5 %); age = 15.6 ± 1.2; median lifetime concussions = 1 [IQR = 1,3]), 518 had repeat concussion. Controlling for age and sex, first vs. repeat concussion was not associated with any VVE subtest or total score (Total VVE Score RR = 1.35, 99.5%CI = 0.70,2.61). Of those with repeat concussion, 190 had valid age of first concussion data. Controlling for age, sex, and number of lifetime concussions, age of first concussion was not significantly associated with any VVE subtest or total score (Total VVE Score RR = 1.11, 99.5%CI = 0.78,1.57).

CONCLUSIONS

Adolescents with concussion history present with similar visio-vestibular function to those with no concussion history. Additionally, clinical effects of early age of first concussion may not be evident in children. This study provides foundational data regarding potential cumulative effects of concussion in younger athletes.

Oculomotor abnormalities and its association with sleep stages in progressive supranuclear palsy

BACKGROUND

Oculomotor abnormalities are one of the cardinal clinical features of progressive supranuclear palsy (PSP). Vertical saccadic slowing is an early sign of PSP. The association between oculomotor abnormalities and sleep architecture has not been studied so far.

OBJECTIVES

To study the association of oculomotor abnormalities of PSP with the sleep stages by using video polysomnography (vPSG).

METHODS

This was a cross-sectional single-center study. Twenty-two patients with PSP and 15 age and gender-matched controls were recruited. Saccades, vestibulo-ocular reflex, and optokinetic nystagmus were assessed and graded clinically in all patients and one overnight vPSG was done in all cases.

RESULTS

Vertical saccades, upward more than downwards, were affected in all cases. While horizontal saccades were normal only in 41% of cases. Vertical optokinetic nystagmus (OKN) was affected in all cases. Horizontal OKN was normal in 36% of patients. The vertical upward saccades had a negative correlation with N1% and duration (r = -0.418; p = 0.05, r = -0.457; p = 0.03), N3% and duration (r = -0.486; p = 0.02, r = -0.510; p = 0.01), REM% (r = -0.449; p = 0.04), total sleep time (r = -0.487; p = 0.02) and sleep efficiency (r = -0.444; p = 0.04). There was a positive correlation between horizontal OKN and sleep onset latency (r = 0.432; p = 0.05).

CONCLUSIONS

Vertical saccadic restriction in PSP has significant negative correlation with total sleep time and sleep efficiency. The oculomotor and sleep abnormalities in PSP are probably interlinked and their assessment is useful in determining the characteristics of the disease.

Isolated oculomotor nerve palsy secondary to non-aneurysmal subarachnoid hemorrhage

We present a case series of two patients who developed unilateral cranial nerve III (CNIII) palsy following non-aneurysmal SAH (NASAH). Subarachnoid hemorrhage (SAH) can present with various signs and symptoms. Early diagnosis is paramount to determine treatment course. Thus, clinicians must be aware of the variable clinical presentations of this condition. Two patients were admitted to a single institution for SAH. Patient 1, 52-year-old male, presented with headache, left eye ptosis, and painless diplopia. A non-contrast head computed tomography (CT) demonstrated a SAH within the left sylvian fissure and blood surrounding the mesencephalon and falx. Patient 2, 70-year-old male, presented with mild headache, acute onset of blurry vision, and right eye ptosis. A non-contrast head CT demonstrated a diffuse SAH predominantly in the Sylvian and suprasellar cisterns. Patients were admitted to the neuro intensive care unit and underwent diagnostic angiograms to identify possible aneurysms. Magnetic resonance imaging and angiograms for both patients were negative. Patients were managed with best medical therapy and followed up in the outpatient setting. Unilateral CNIII palsy in the setting of NASAH was identified in both patients. Diagnostic angiograms were negative for aneurysms; therefore, SAH were determined to be spontaneous. We propose that unilateral CNIII palsy is a possible sign of NASAH.

Oculomotor deficits in attention deficit hyperactivity disorder (ADHD): A systematic review and comprehensive meta-analysis

Atypical motor coordination and cognitive processes, such as response inhibition and working memory, have been extensively researched in individuals with attention deficit hyperactivity disorder (ADHD). Oculomotor neural circuits overlap extensively with regions involved in motor planning and cognition, therefore studies of oculomotor function may offer unique insights into motor and cognitive control in ADHD. We performed a series of pairwise meta-analyses based on data from 26 oculomotor studies in ADHD to examine whether there were differences in performance on visually-guided saccade, gap, antisaccade, memory-guided, pursuit eye movements and fixation tasks. These analyses revealed oculomotor disturbances in ADHD, particularly for difficulties relating to saccade inhibition, memorizing visual target locations and initiating antisaccades. There was no evidence for pursuit eye movement disturbances or saccade dysmetria. Investigating oculomotor abnormalities in ADHD may provide insight into top-down cognitive control processes and motor control, and may serve as a promising biomarker in ADHD research and clinical practice.

Neuromyelitis optica with brain stem involvement in a middle-aged Ethiopian woman: a case report and review of literature

Introduction

Neuromyelitis optica is a demyelinating disease of the central nervous system that predominantly affects the optic nerves and spinal cord. In neuromyelitis optica, white blood cells and antibodies primarily attack the optic nerves and the spinal cord, but may also attack the brain. Brainstem manifestation has been described recently. So far, neuromyelitis optica is very rare in Ethiopia and there were only two case reports, but this is the first case report of neuromyelitis optica with brainstem involvement.

Case presentation

A 47-year-old Addis Ababa woman presented to Saint Paul’s Hospital Millennium Medical College with a history of visual loss of 7 years and bilateral lower limb weakness of 4 days duration. She had bilateral oculomotor nerve palsy. Her past medical history showed systemic hypertension for 18 years and dyslipidemia for 1 year. The objective evaluation of the patient revealed right optic nerve atrophy suggesting optic neuritis and flaccid paraplegia with sensory level at the fourth thoracic vertebra. Diagnostic work-up using electromyography and spinal magnetic resonance imaging revealed demyelinating anterior visual pathway dysfunction and signs of extensive cervicothoracic transverse myelitis from the third cervical to lower thoracic vertebrae, respectively. Then a diagnosis of neuromyelitis optica was established. After treatment with high-dose systemic steroid followed by azathioprine, the patient was stable for several months with significant improvement of vision and lower-extremity weakness with no relapse of symptoms.

Conclusion

The case described here is a rare inflammatory demyelinating disorder of the central nervous system occurring in East Africa. It reminds clinicians to suspect neuromyelitis optica in a patient who presented with unexplained recurrent optic neuritis to make a timely diagnosis and prevention of permanent neuronal damage. Neuromyelitis optica can also be associated with oculomotor nerve involvement.

Random and Short-Term Excessive Eye Movement in Children with Autism During Face-to-Face Conversation

This study investigated the oculomotor performance in children with autism spectrum disorder (ASD) during a face-to-face conversation. A head mounted eye tracker recorded the eye movements in 20 children with ASD and 23 children with typical development (TD). Group comparisons were conducted on the randomness and the quantity of eye movement. The amount of time needed to reveal group difference was also examined. Results showed that the randomness of eye movement was significantly higher at all examined time durations, and the amount of eye movement was significantly greater within 3 s in the ASD group. These findings demonstrated an atypical pattern of oculomotor dynamics in children ASD, which might facilitate the objective identification of ASD during daily social interaction.

Spatio-temporal properties of oculomotor activation by multiple, simultaneous peripheral stimuli

Oculomotor research shows that eye movements are primed toward the midpoint of an array of visual stimuli, such that an eye movement to a visual target is executed most rapidly when it appears near the midpoint of an earlier array. At longer intervals between the prime and target, this facilitatory effect can reverse to become inhibitory - such that eye movements are slower when made toward the midpoint - but the source of this inhibition is unclear. One of our prior studies suggests a global source: target proximity to the midpoint determines inhibition, consistent with the notion that oculomotor activation is responsible for the effect and the original definition of inhibition of return. A later study suggests a local source: target proximity to the nearest array element determines inhibition, consistent with the notion that repeat stimulation of an input pathway is responsible. To resolve the ambiguity we systematically test whether timing differences between studies altered the source of the inhibition. We find that both previously observed patterns are reproducible depending on the prime offset - target onset asynchrony. We also resolve the discrepancy by showing that when this asynchrony is less than 200 ms, target proximity to the array's midpoint and its proximity to any given array element can jointly determine inhibition, whereas when the asynchrony is approximately 200 ms, inhibition is robust at the midpoint of the array. At longer asynchronies, all inhibitory effects rapidly dissipate.

A potential new brainstem reflex: The oculoglossal phenomenon

BACKGROUND

A synchronized involuntary movement of the tongue to the same side as voluntary movements of the eyes, termed the oculoglossal phenomenon, has been observed. A description of the hypothesized pathway of this phenomenon could guide the development of a rapid clinical evaluation of the long segment of the brainstem and help facilitate further studies to establish a new reflex, if possible. The aim of this study is to describe and propose the simple concept of this pathway/phenomenon, the oculoglossal phenomenon.

METHODS

This is an observational study. Of a newly observe brainstem phenomenon evaluated on a subject at the National Neuroscience Institute in king Fahad Medical City (KFMC), Riyadh, Saudi Arabia. After being observed incidentally in a single patient, 60 participants were tested between January and March 2020 to confirm the presence of the phenomenon. Each subject was instructed to protrude the tongue and then move their eyes horizontally to the side. If the tongue simultaneously and involuntarily moved to the same side as the eyes, the test was deemed confirmatory. A literature review was performed, and possible anatomical pathway was proposed.

RESULTS

The oculoglossal reflex was present in most (50/60, 83.3%) of the subjects. Our proposed pathway begins at the frontal cortex, followed by a projection to the paramedian pontine reticular formation, then to the contralateral medial longitudinal fasciculus and bilaterally to the hypoglossal nuclei.

CONCLUSION

An accurate description of this phenomenon could lead to additional studies and possibly establishing it as a legitimate reflex, thus conceivably adding a new tool in the neurological examination to evaluate the brainstem's integrity.

Cavernous internal carotid artery aneurysm presenting with ipsilateral oculomotor nerve palsy: A case report

The oculomotor nerve palsy is a rare neurological deficit, it is associated with numerous underlying pathologies. Including stroke, neoplasms, trauma, post-surgical inflammation, and microvascular damage from chronic disease. It can cause a set of neurological deficits, including diplopia from oculomotor nerve involvement, decreased visual acuity from optic neuropathy, facial hypoesthesia from involvement of the trigeminal nerve, and less frequently facial pain. We present a case of 52 years old female patient who presented with a history of lateral divination of the left eye associated with ipsilateral drooping of upper eyelid, visual disturbance, and ‏pupil dysfunction. MRI and MRA were performed and in conventional sequences plus 3D FIESTA sequence and it shows a signal void structure, compressing the left oculomotor nerve after passing through left chiasmatic cistern and upon entrance to cavernous sinus. Reformatted images demonstrate that this structure arising from distal left internal carotid artery at lateral part of cavernous sinus represents a saccular aneurysm in the cavernous part of the internal carotid. Aneurysms can cause direct compression of the third cranial nerve either by the enlargement of an unruptured aneurysm or by rupture of the aneurysmal sac resulting in third cranial nerve palsy.

Semantically predictable input streams impede gaze-orientation to surprising locations

When available, people use prior knowledge to predict dimensions of future events such as their location and semantic features. However, few studies have examined how multi-dimensional predictions are implemented, and mechanistic accounts are absent. Using eye tracking, we evaluated whether predictions of target-location and target-category interact during the earliest stages of orientation. We presented stochastic series so that across four conditions, participants could predict either the location of the next target-image, its semantic category, both dimensions, or neither. Participants observed images in absence of any task involving their semantic content. We modeled saccade latencies using ELATER, a rise-to-threshold model that accounts for accumulation rate (AR), variance of AR over trials, and variance of decision baseline. The main findings were: 1) AR scaled with the degree of surprise associated with a target's location; 2) predictability of semantic-category hindered saccade latencies, suggesting a bottleneck in implementing joint predictions; 3) saccades to targets that satisfied semantic expectations were associated with greater AR-variance than saccades to semantically-surprising images, consistent with a richer repertoire of early evaluative processes for semantically-expected images. Predictability of target-category also impacted gaze pre-positioning prior to target presentation. The results indicate a strong interaction between foreknowledge of object location and semantics during stimulus-guided saccades, and suggest statistical regularities in an input stream can also impact anticipatory, non-stimulus-guided processes.

Reliance on visual feedback from ocular accommodation on motor skills in children with developmental coordination disorder and typically developing controls

Children with developmental coordination disorder (DCD) present with marked impairments in motor skills, including visual-motor integration. Oculomotor anomalies are more prevalent in children with DCD than typically developing children. Children with DCD further demonstrate altered use of visual feedback compared to typically developing controls. We investigated whether the accommodation system, a key component of the oculomotor system, contributes to visual feedback during fine and gross motor skills performance; and whether children with DCD demonstrate differences in reliance on visual feedback from accommodation. Minus dioptre lenses were used to maximally induce accommodation and impede accommodation dynamics. Children with DCD and typically developing controls performed motor skills tests assessing balance, upper limb coordination, visual-motor performance, gross and fine dexterity. Motor skills performance in controls was significantly affected by impeded accommodation in all tasks. Children with DCD demonstrated reliance on accommodation feedback in upper limb and visual-motor tasks only. Children with DCD may be less reliant on visual feedback obtained from accommodation due to adaptive mechanisms to overcome faulty information in the presence of oculomotor anomalies. These results strengthen our previous findings that accommodation anomalies contribute to motor skills impairment, and suggest that performance on these motor tasks is heavily reliant on visual feedback from accommodation.

Spatial attention and spatial short term memory in PSP and Parkinson's disease

Progressive Supranuclear Palsy (PSP) is a neurodegenerative disorder characterised by deterioration in motor, oculomotor and cognitive function. A key clinical feature of PSP is the progressive paralysis of eye movements, most notably for vertical saccades. These oculomotor signs can be subtle, however, and PSP is often misdiagnosed as Parkinson's disease (PD), in its early stages. Although some of the clinical features of PD and PSP overlap, they are distinct disorders with differing underlying pathological processes, responses to treatment and prognoses. One key difference lies in the effects the diseases have on cognition. The oculomotor system is tightly linked to cognitive processes such as spatial attention and spatial short-term memory (sSTM), and previous studies have suggested that PSP and PD experience different deficits in these domains. We therefore hypothesised that people with PSP (N = 15) would experience problems with attention (assessed with feature and conjunction visual search tasks) and sSTM (assessed with the Corsi blocks task) compared to people with PD (N = 16) and Age Matched Controls (N = 15). As predicted, feature and conjunction search were sgnificantly slower in the PSP group compared to the other groups, and this deficit was significantly worse for feature compared to conjunction search. The PD group did not differ from AMC on feature search but were significantly impaired on the conjunction search. The PSP group also had a pronounced vertical sSTM impairment that was not present in PD or AMC groups. It is argued that PSP is associated with specific impairment of visuospatial cognition which is caused by degeneration of the oculomotor structures that support exogenous spatial attention, consistent with oculomotor theories of spatial attention and memory.

Vestibular-ocular reflex dysfunction following mild traumatic brain injury: A narrative review

Mild traumatic brain injury (mTBI) is a prevalent injury which occurs across many populations, including children and adolescents, athletes, military personnel, and the elderly. mTBI can result in various subjective symptoms and clinical deficits, such as abnormalities to the vestibulo-ocular reflex (VOR). Over 50% of individuals with mTBI are reported to have VOR abnormalities, which strongly contribute to feelings of dizziness and unsteadiness. Dizziness is a strong predictor for prolonged recovery following mTBI and is additionally linked with mental health difficulties and functional limitations affecting likelihood of return to work. Early diagnosis, and subsequent treatment, of VOR deficits following mTBI may greatly improve recovery outcomes and a patient's quality of life, but a thorough comprehension of the related pathophysiology is necessary to understand the assessments used to diagnose VOR abnormalities. Therefore, the purpose of this article is i) provide readers with an introduction on the VOR physiology to facilitate understanding about mTBI-related abnormalities, and ii) to discuss current assessments that are commonly used to measure VOR function following mTBI. As the VOR and oculomotor (OM) systems are heavily linked and often work in tandem, discussion of the relevant aspects of the OM system is also provided.

Clinical Practice Guidelines for Occupational Therapists in the Evaluation and Treatment of Oculomotor Impairment Following Traumatic Brain Injury

Purpose of review

Currently, a lack of guidelines exists regarding best practices for occupational therapists (OTs) in the treatment and evaluation of oculomotor dysfunction following traumatic brain injury (TBI). Furthermore, individuals with TBI would benefit significantly from collaboration between OTs and optometrists during inpatient rehab.

Recent findings

Although few articles examine interdisciplinary models of inpatient rehab care that include optometry, a recent pilot study is explored. Emerging evidence from the field of optometry supports the use of restorative approaches for oculomotor impairment in mild TBI; however, cases with moderate to severe TBI are not addressed.

Summary

We describe an interdisciplinary approach involving collaboration between optometry and occupational therapy, yielding a comprehensive model to effectively evaluate and treat oculomotor impairments in those with TBI and facilitate improved performance in daily activities. We also provide guidelines useful for OTs working in settings where collaboration with optometry is not feasible.

Extradural minipterional approach for giant intracranial aneurysms

Background:

The clinical applicability of the minipterional (MPT) craniotomy is still limited to small and superficial anterior circulation aneurysms. We discuss the technical nuances of a modified MPT approach, the extradural MPT approach (eMPTa), for the treatment of a giant intracranial aneurysm (GIA) arising from the paraclinoid carotid artery.

Case Description:

A 44-year-old female presented with facial hypoesthesia and third cranial nerve palsy. Further investigations revealed the presence of a 27 mm aneurysm arising from the communicating segment of the internal carotid artery. The patient underwent surgical clipping through an extradural MPT craniotomy and combined anterior clinoidectomy. Postoperative angio-computed tomography demonstrated complete aneurysm occlusion and patency of the parent vessels. The patient recovered fully from her previous deficits.

Conclusion:

The skull base drilling, interdural dissection, and anterior clinoidectomy are key steps during the eMPTa that optimizes the use of the extradural corridor. Such adaptations are enough to improve the surgical maneuverability along the paraclinoid region and adapt the MPT suitability for the treatment of complex GIA.

Effects of blocked vs. interleaved administration mode on saccade preparatory set revealed using pupillometry

Eye movements have been used extensively to assess information processing and cognitive function. However, significant variability in saccade performance has been observed, which could arise from methodological variations across different studies. For example, prosaccades and antisaccades have been studied using either a blocked or interleaved design, which has a significant influence on error rates and latency. This is problematic as it makes it difficult to compare saccade performance across studies and may limit the ability to use saccades as a behavioural assay to assess neurocognitive function. Thus, the current study examined how administration mode influences saccade related preparatory activity by employing pupil size as a non-invasive proxy for neural activity related to saccade planning and execution. Saccade performance and pupil dynamics were examined in eleven participants as they completed pro- and antisaccades in blocked and interleaved paradigms. Results showed that administration mode significantly modulated saccade performance and preparatory activity. Reaction times were longer for both pro- and antisaccades in the interleaved condition, compared to the blocked condition (p < 0.05). Prosaccade pupil dilations were larger in the interleaved condition (p < 0.05), while antisaccade pupil dilations did not significantly differ between administration modes. Additionally, ROC analysis provided preliminary evidence that pupil size can effectively predict saccade directional errors prior to saccade onset. We propose that task-evoked pupil dilations reflect an increase in preparatory activity for prosaccades and the corresponding cognitive demands associated with interleaved administration mode. Overall, the results highlight the importance that administration mode plays in the design of neurocognitive tasks.

Visually guided saccades and acoustic distractors: no evidence for the remote distractor effect or global effect

A remote visual distractor increases saccade reaction time (RT) to a visual target and may reflect the time required to resolve conflict between target- and distractor-related information within a common retinotopic representation in the superior colliculus (SC) (i.e., the remote distractor effect: RDE). Notably, because the SC serves as a sensorimotor interface it is possible that the RDE may be associated with the pairing of an acoustic distractor with a visual target; that is, the conflict related to saccade generation signals may be sensory-independent. To address that issue, we employed a traditional RDE experiment involving a visual target and visual proximal and remote distractors (Experiment 1) and an experiment wherein a visual target was presented with acoustic proximal and remote distractors (Experiment 2). As well, Experiments 1 and 2 employed no-distractor trials. Experiment 1 RTs elicited a reliable RDE, whereas Experiment 2 RTs for proximal and remote distractors were shorter than their no distractor counterparts. Accordingly, findings demonstrate that the RDE is sensory specific and arises from conflicting visual signals within a common retinotopic map. As well, Experiment 2 findings indicate that an acoustic distractor supports an intersensory facilitation that optimizes oculomotor planning.

A single bout of moderate intensity exercise improves cognitive flexibility: evidence from task-switching

Executive function entails the core components of response  inhibition, working memory and cognitive flexibility. An accumulating literature has shown that a single bout of exercise improves the response inhibition  and working memory components of executive function; however, limited work has examined a putative exercise-related improvement to cognitive flexibility. To address this limitation, Experiment 1 entailed a 20-min session of moderate intensity aerobic exercise (via cycle ergometer), and pre- and post-exercise cognitive flexibility was examined via a task-switching paradigm involving alternating pro- and antisaccades (AABB: A = prosaccade, B = antisaccade). In Experiment 2, participants sat on the cycle ergometer without exercising (i.e., rest break) and the same AABB paradigm was examined pre- and post-break. We used an AABB pro- and antisaccade paradigm because previous work has shown that a prosaccade preceded by an antisaccade exhibits a reliable-and large magnitude-increase in reaction time, whereas the converse switch does not (i.e., the unidirectional prosaccade switch-cost). Experiment 1 showed a unidirectional prosaccade switch-cost pre-exercise (p = .012)-but not post-exercise (p = .30), and a two one-sided t test indicated that the latter comparison was within an equivalence boundary (p < .01). In contrast, Experiment 2 revealed a unidirectional prosaccade switch-cost at pre- and post-break assessments (ps < .01). Accordingly, our results indicate that a single bout of exercise improves cognitive flexibility and provides convergent evidence that exercise improves global components of executive function.

Utilization of video oculography to quantify oculomotor dysfunction in anti-DPPX encephalitis: A case study

Anti-DPPX encephalitis is an increasingly recognized cause of neurological disability. We describe a case of a 44 year-old woman who presented to our facility with the chief complaint of confusion, weight loss, and a visual disturbance. Multidirectional nystagmus was noted, and she underwent additional evaluation. Anti-DPPX antibodies returned positive, and she treated with immunotherapy with improvement in her symptoms and deficits. We describe the video-oculography findings in the case, and discuss the implications for localization.

Development and validation of a high-speed video system for measuring saccadic eye movement

Laboratory-based retroreflective and magnetic scleral search-coil technologies are the current standards for collecting saccadometric data, but such equipment is costly and cumbersome. We have validated a novel, portable, high-speed video camera-based system (Exilim EX-FH20, Casio, Tokyo, Japan) for measuring saccade reaction time (RT) and error rate in a well-lit environment. This system would enable measurements of pro- and antisaccades in athletes, which is important because antisaccade metrics provide a valid tool for concussion diagnosis and determining an athlete's safe return to play. A total of 529 trials collected from 15 participants were used to compare saccade RT and error rate measurements of the high-speed camera system to a retroreflective video-based eye tracker (Eye-Trac 6: Applied Sciences Laboratories, Bedford, MA). Bland-Altman analysis revealed that the RT measurements made by the high-speed video system were 11 ms slower than those made by the retroreflective system. Error rate measurements were identical between the two systems. An excellent degree of reliability was found between the system measurements and in the ratings of independent researchers examining the video data. A strong association (r = .97) between the RTs determined via the retroreflective and high-speed camera systems was observed across all trials. Our high-speed camera system is portable and easily set up, does not require extensive equipment calibration, and can be used in a well-lit environment. Accordingly, the camera-based capture of saccadometric data may provide a valuable tool for neurological assessment following a concussive event and for the continued monitoring of recovery.

Pro- and antisaccade task-switching: response suppression-and not vector inversion-contributes to a task-set inertia

Alternating between different tasks represents an executive function essential to activities of daily living. In the oculomotor literature, reaction times (RT) for a 'standard' and stimulus-driven (SD) prosaccade (i.e., saccade to target at target onset) are increased when preceded by a 'non-standard' antisaccade (i.e., saccade mirror-symmetrical to target at target onset), whereas the converse switch does not elicit an RT cost. The prosaccade switch-cost has been attributed to lingering neural activity-or task-set inertia-related to the antisaccade executive demands of response suppression and vector inversion. It is, however, unclear whether response suppression and/or vector inversion contribute to the prosaccade switch-cost. Experiment 1 of the present work had participants alternate (i.e., AABB paradigm) between minimally delayed (MD) pro- and antisaccades. MD saccades require a response after target extinction and necessitate response suppression for both pro- and antisaccades-a paradigm providing a framework to determine whether vector inversion contributes to a task-set inertia. In Experiment 2, participants alternated between SD pro- and MD antisaccades-a paradigm designed to determine if a switch-cost is selectively imparted when a SD and standard response is preceded by a non-standard response. Experiment 1 showed that RTs for MD pro- and antisaccades were refractory to the preceding trial-type; that is, vector inversion did not engender a switch-cost. Experiment 2 indicated that RTs for SD prosaccades were increased when preceded by an MD antisaccade. Accordingly, response suppression engenders a task-set inertia but only for a subsequent stimulus-driven and standard response (i.e., SD prosaccade). Such a result is in line with the view that response suppression is a hallmark feature of executive function.

Cortical control of eye movements in natural reading: Evidence from MVPA

Language comprehension during reading requires fine-grained management of saccadic eye movements. A critical question, therefore, is how the brain controls eye movements in reading. Neural correlates of simple eye movements have been found in multiple cortical regions, but little is known about how this network operates in reading. To investigate this question in the present study, participants were presented with normal text, pseudo-word text, and consonant string text in a magnetic resonance imaging (MRI) scanner with eyetracking. Participants read naturally in the normal text condition and moved their eyes "as if they were reading" in the other conditions. Multi-voxel pattern analysis was used to analyze the fMRI signal in the oculomotor network. We found that activation patterns in a subset of network regions differentiated between stimulus types. These results suggest that the oculomotor network reflects more than simple saccade generation and are consistent with the hypothesis that specific network areas interface with cognitive systems.

Short-term plasticity after partial deafferentation in the oculomotor system

Medial rectus motoneurons are innervated by two main pontine inputs. The specific function of each of these two inputs remains to be fully understood. Indeed, selective partial deafferentation of medial rectus motoneurons, performed by the lesion of either the vestibular or the abducens input, initially induces similar changes in motoneuronal discharge. However, at longer time periods, the responses to both lesions are dissimilar. Alterations on eye movements and motoneuronal discharge induced by vestibular input transection recover completely 2 months post-lesion, whereas changes induced by abducens internuclear lesion are more drastic and permanent. Functional recovery could be due to some kind of plastic process, such as reactive synaptogenesis, developed by the remaining intact input, which would occupy the vacant synaptic spaces left after lesion. Herein, by means of confocal microscopy, immunocytochemistry and retrograde labeling, we attempt to elucidate the possible plastic processes that take place after partial deafferentation of medial rectus motoneuron. 48 h post-injury, both vestibular and abducens internuclear lesions produced a reduced synaptic coverage on these motoneurons. However, 96 h after vestibular lesion, there was a partial recovery in the number of synaptic contacts. This suggests that there was reactive synaptogenesis. This recovery was preceded by an increase in somatic neurotrophin content, suggesting a role of these molecules in presynaptic axonal sprouting. The rise in synaptic coverage might be due to terminal sprouting performed by the remaining main input, i.e., abducens internuclear neurons. The present results may improve the understanding of this apparently redundant input system.

Oculomotor effects of medical and surgical treatments of Parkinson's disease

Oculomotor abnormalities are fast becoming a proxy for disease diagnosis and progression. Saccades-ballistic eye movements-are known to be affected by dopaminergic cell loss in the basal ganglia, caused by Parkinson's disease. Pharmaceutical and neurosurgical interventions such as deep brain stimulation and functional neurosurgery have both been noted to have an effect on saccades. Comparing and contrasting these effects may yield insights into Parkinson's disease pathophysiology, and the mechanisms of pharmacological and neurosurgical treatments. Computational models of saccadic control, such as the LATER model, can help to interpret the distribution of saccadic latencies, providing a framework for objectively comparing the effects of pharmaceutical interventions and deep brain stimulation.

Oculomotor Schwannomas: A Systematic Review and Report of Two Pediatric Cases Treated with Fractionated Cyberknife Stereotactic Radiotherapy

OBJECTIVE

Pediatric oculomotor nerve schwannomas are rare and challenging lesions due to the high morbidity associated with surgical intervention and their proximity to critical structures limiting the opportunity for stereotactic radiosurgery. We aim to report and review the novel use of fractionated Cyberknife (Accuray, Inc., Sunnyvale, California, USA) stereotactic radiotherapy in pediatric patients with oculomotor schwannomas.

METHODS

A systematic review of PubMed, Embase, and Cochrane was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two patients, ages 8 and 10 years, with tumor volumes of 0.1 cm³ and 0.2 cm³, respectively, were treated with fractionated Cyberknife radiotherapy at our institution. A total dose of 45-50 Gy was administered over 25 fractions (1.8-2.0 Gy per fraction) to the 82%-84% isodose line. Serial magnetic resonance imaging was obtained for long-term follow-up (56-58 months).

RESULTS

We found 14 articles published between 1982 and 2018 that reported a total of 18 pediatric patients with intracranial oculomotor schwannomas. No previously described cases of pediatric intracranial oculomotor schwannomas were treated with radiation therapy. In both of our patients, radiographic tumor control was achieved at a mean follow-up of 57 months, with 1 patient displaying a decrease in tumor volume. Neither patient exhibited any worsening of their presenting symptoms, nor did either patient develop any new neurocognitive deficits following treatment.

CONCLUSIONS

Fractionated Cyberknife radiotherapy is an effective and well-tolerated treatment option for intracranial oculomotor nerve schwannomas with excellent tumor control rates, similar to surgical and radiosurgical techniques, while sparing critical surrounding structures.

Towards dynamic modeling of visual-vestibular conflict detection

Visual-vestibular mismatch is a common occurrence, with causes ranging from vehicular travel, to vestibular dysfunction, to virtual reality displays. Behavioral and physiological consequences of this mismatch include adaptation of reflexive eye movements, oscillopsia, vertigo, and nausea. Despite this significance, we still do not have a good understanding of how the nervous system evaluates visual-vestibular conflict. Here we review research that quantifies perceptual sensitivity to visual-vestibular conflict and factors that mediate this sensitivity, such as noise on visual and vestibular sensory estimates. We emphasize that dynamic modeling methods are necessary to investigate how the nervous system monitors conflict between time-varying visual and vestibular signals, and we present a simple example of a drift-diffusion model for visual-vestibular conflict detection. The model makes predictions for detection of conflict arising from changes in both visual gain and latency. We conclude with discussion of topics for future research.

Vestibular and oculomotor function in children with CP: Descriptive study

OBJECTIVE

We aimed to describe vestibular/oculomotor function of 7-12-year-old children with CP, Gross Motor Function Classification System (GMFCS) levels (I-III), in comparison to an age-matched control group to understand the effect of the vestibular system on activities and participation of children with CP.

METHODS

Vestibular, oculomotor and balance function were tested in children with CP. Central and peripheral vestibular function was examined using an enclosed rotary chair and infrared video goggles (100 Hz) that measured eye movements. Oculomotor tests included smooth pursuit and optokinetic nystagmus (OKN). Vestibulo-Ocular Reflex (VOR) tests, done in complete darkness, included step rotation (STEP), sinusoidal harmonic acceleration (SHA) test, VOR cancellation and enhancement, and subjective visual vertical and horizontal (SVV/SVH). The integrity of the saccule was tested with the Cervical Vestibular Evoked Myogenic Potential. If able, the participants' balance abilities were examined using the Sensory Organization Test (SOT) to determine ability to maintain standing balance during six conditions that challenged the visual, somatosensory and vestibular systems. Independent t-tests and Mann-Whitney U tests were used to compare results between groups.

RESULTS

Forty-one children with CP (mean age = 9.44 years, SD = 1.66; 23F/18M; Gross Motor Function Classification System levels: I (n = 19), II (n = 7), III (n = 15) and thirty-three typically developing (TD) children (mean age = 10.16 years, SD = 1.6; 13F/20M) were recruited from the Birmingham, AL community. There was no significant difference between children with CP and TD children in saccular function (i.e. C-VEMP test), and peripheral vestibular end organ (i.e. SHA test and STEP test), VOR enhancement, or OKN gain. Velocity gain for horizontal smooth pursuit was significantly worse in children with CP (p = 0.009), compared to TD children. Poor mediation of central vestibular function were that evident with significantly higher VOR cancellation gain in children with CP (p < 0.0001), compared to TD children and significantly higher SVV variance (p = 0.002), SVH mean (p = 0.001), and SVH variance (p < 0.0001) in children with CP compared to TD children. Compromised balance abilities in children with CP was evident with significantly lower composite scores (p < 0.0001), vestibular ratio (p < 0.0001), and visual ratio (p = 0.021). The somatosensory ratio (p = 0.798) of children with CP was similar to children with TD.

CONCLUSIONS

Although peripheral vestibular function was intact, children with CP had difficulty coupling eye and head movement (VOR cancellation), using the vestibular system for postural control (SOT), demonstrated poor perception of upright (SVV/SVH), and had difficulty following a slow moving target (smooth pursuit eye movement). These results implicate a central vestibular and oculomotor function impairment the severity of which corresponded with severity of the level of CP.

Response suppression produces a switch-cost for spatially compatible saccades

Executive function supports the rapid alternation between tasks for online reconfiguration of attentional and motor goals. The oculomotor literature has found that a prosaccade (i.e., saccade to veridical target location) preceded by an antisaccade (i.e., saccade mirror symmetrical to a target) elicits an increase in reaction time (RT), whereas the converse switch does not. This switch-cost has been attributed to the antisaccade task's requirement of inhibiting a prosaccade (i.e., response suppression) and transforming a target's coordinate (i.e., vector inversion)-executive processes thought to contribute to a task-set inertia that proactively interferes with the planning of a subsequent prosaccade. It is, however, unclear whether response suppression and vector inversion contribute to a task-set inertia or whether the phenomenon relates to a unitary component (e.g., response suppression). Here, the same stimulus-driven (SD) prosaccades (i.e., respond at target onset) as used in previous work were used with minimally delayed (MD) prosaccades (i.e., respond at target offset) and arranged in an AABB paradigm (i.e., A = SD prosaccade, B = MD prosaccade). MD prosaccades provide the same response suppression as antisaccades without the need for vector inversion. RTs for SD task-switch trials were longer and more variable than their task-repeat counterparts, whereas values for MD task-switch and task-repeat trials did not reliably differ. Moreover, SD task-repeat and task-switch movement times and amplitudes did not vary and thus demonstrate that a switch-cost is unrelated to a speed accuracy trade-off. Accordingly, results suggest the executive demands of response suppression is sufficient to engender the persistent activation of a non-standard task-set that selectively delays the planning of a subsequent SD prosaccade.

Older adults elicit a single-bout post-exercise executive benefit across a continuum of aerobically supported metabolic intensities

Ten minutes of aerobic or resistance training can 'boost' executive function in older adults. Here, we examined whether the magnitude of the exercise benefit is influenced by exercise intensity. Older adults (N = 17: mean age = 73 years) completed a volitional test to exhaustion (VO_2peak) via treadmill to determine participant-specific moderate (80% of lactate threshold (LT)), heavy (15% of the difference between LT and VO_2peak) and very-heavy (50% of the difference between LT and VO_2peak) exercise intensities. Subsequently, in separate sessions all participants completed 10-min constant load single-bouts of exercise at each intensity. Pre- and post-exercise executive function were examined via the antisaccade task. Antisaccades require a saccade mirror-symmetrical to a target and extensive evidence has shown that antisaccades are supported via frontoparietal networks that demonstrate task-dependent changes following single-bout and chronic exercise. We also included a non-executive task (saccade to veridical target location; i.e., prosaccade) to determine whether a putative post-exercise benefit is specific to executive-related oculomotor control. Results showed that VO₂ and psychological ratings of perceived exertion concurrently increased with increasing exercise intensity. As well, antisaccade reaction times showed a 24 ms (i.e., 8%) reduction from pre- to post-exercise assessments (p < .001), whereas prosaccade values did not (p = .19). Most notably, the post-exercise change in antisaccade RTs did not reliably vary with exercise intensity. Further, for each exercise intensity participants' cardiorespiratory fitness level was unrelated to the magnitude of the post-exercise executive benefit (ps > .13). Accordingly, an exercise duration as brief as 10-min provides a selective benefit to executive function in older adults across the continuum of moderate to very-heavy intensities.

Ptosis and Elevation Paresis Due to Mesencephalic Infarction

Lesions located in the anterior cavernous sinus or posterior orbit are known to cause divisional oculomotor palsy. We herein report a patient with fascicular infarction causing superior division paresis of the nerve.

Vestibulo-ocular dysfunction in adolescent rugby union players with and without a history of concussion

OBJECTIVES

Sport-related concussions are common in adolescent contact sports. Vestibulo-ocular dysfunction has been reported in athletes post-concussion. There is a lack of research on vestibulo-ocular function in sporting adolescents, and the influence of previous concussions on the vestibular system in this population. The aim of this study was to investigate vestibulo-ocular function in a cohort of adolescent rugby players with and without a history of concussion during pre-season assessment.

DESIGN

Cross-sectional cohort.

METHODS

213 male adolescent (13-18 years old) rugby players were recruited from six schools in Queensland, Australia. Vestibulo-ocular assessments were conducted during the preseason and included clinical assessment of oculomotor function and the vestibulo-ocular reflex (VOR) using the clinical and video-Head Impulse Test (HIT). Players were allocated into two groups: no history of concussion in the last 12 months (n = 165); and concussion in the last 12 months (n = 48).

RESULTS

There were no between group differences in vestibulo-ocular function for players with and without a history of concussion (p = 0.65). However, vestibulo-ocular dysfunction was reported in 69 (32.7%) of the players tested, who had either abnormal oculomotor control or VOR function.

CONCLUSIONS

The high prevalence of vestibulo-ocular dysfunction in adolescent rugby players suggests that positive clinical findings post-concussion need to be interpreted carefully in the absence of baseline or pre-concussion assessments.

Eye Movements in Neuropsychological Tasks

This chapter reviews how recording and analysis of eye movements have been applied to understanding cognitive functioning in patients with neurological disease. Measures derived from the performance of instructed eye movement tests such as the anti-saccade and memory-guided saccade tasks have been shown to be associated with cognitive test performance and the early stages of neurodegenerative disorders including Alzheimer's and Parkinson's disease. Other researchers have taken an ecological approach and recorded the uninstructed pattern of saccades made by patients during performance of established neuropsychological tasks. Studies that have analysed the eye movement strategies used in a number of widely used tests are reviewed, including the Corsi blocks, Tower of London, 'CANTAB' Spatial Working Memory and Brixton Spatial Anticipation test. The findings illustrate that eye movements are not purely in the service of vision, but support visuospatial working memory and forward action planning. Eye movement tests and measures also have potential for application in the assessment and diagnosis of neurological disease and cognitive impairment. Establishing large-scale normative data sets in healthy older adults and use of machine learning multivariate classifier algorithms may be key to further developing eye tracking applications in neuropsychological assessment.