Motor neuronopathy with dropped hands and downbeat nystagmus: A distinctive disorder? A case report

Background  

Eye movements are clinically normal in most patients with motor neuron disorders until late in the disease course. Rare patients are reported to show slow vertical saccades, impaired smooth pursuit, and gaze-evoked nystagmus. We report clinical and oculomotor findings in three patients with motor neuronopathy and downbeat nystagmus, a classic sign of vestibulocerebellar disease.     

Effect of dopamine deficiency on the preparation of visually guided saccadic eye movements

Parameters of saccadic eye movements were studied in patients with Parkinson's disease and control subjects. In parkinsonian patients, the number of slow regular saccades was shown to be increased, and the number of express saccades was shown to be decreased. As a result the mean of saccade latency in patients was longer than in the control group. Moreover, the percentage of multistep saccades in patients with Parkinson's disease. In this case, not one but two or three saccades were performed with smaller amplitude to the target. We point, that the multistep saccades occurred mainly among the express saccades. Obviously, the dopamine deficiency distinguishing parkinsonian patients takes the primary part in the development of saccadic disorders. Degeneration of the nigrostriatal dopamine pathway results in imbalance in activity of the direct and indirect output pathways of the striatum. We suppose that this leads to inhibition of neurons activity in the superior colliculus during the saccade performance, which results in the early saccade interruption. In support of this reasoning, the mean of saccade latency and the percentage of the multistep saccades decreased in patients with Parkinson's disease after dopamine D2/D3 agonist (piribedil) treatment, due to activity restoration of the indirect pathway.     

Saccades during Attempted Fixation in Parkinsonian Disorders and Recessive Ataxia: From Microsaccades to Square-Wave Jerks

During attempted visual fixation, saccades of a range of sizes occur. These “fixational saccades” include microsaccades, which are not apparent in regular clinical tests, and “saccadic intrusions”, predominantly horizontal saccades that interrupt accurate fixation. Square-wave jerks (SWJs), the most common type of saccadic intrusion, consist of an initial saccade away from the target followed, after a short delay, by a “return saccade” that brings the eye back onto target. SWJs are present in most human subjects, but are prominent by their increased frequency and size in certain parkinsonian disorders and in recessive, hereditary spinocerebellar ataxias. Here we asked whether fixational saccades showed distinctive features in various parkinsonian disorders and in recessive ataxia. Although some saccadic properties differed between patient groups, in all conditions larger saccades were more likely to form SWJs, and the intervals between the first and second saccade of SWJs were similar. These findings support the proposal of a common oculomotor mechanism that generates all fixational saccades, including microsaccades and SWJs. The same mechanism also explains how the return saccade in SWJs is triggered by the position error that occurs when the first saccadic component is large, both in the healthy brain and in neurological disease.     

The saccadic and neurological deficits in type 3 Gaucher disease

Our objective was to characterize the saccadic eye movements in patients with type 3 Gaucher disease (chronic neuronopathic) in relationship to neurological and neurophysiological abnormalities. For approximately 4 years, we prospectively followed a cohort of 15 patients with Gaucher type 3, ages 8-28 years, by measuring saccadic eye movements using the scleral search coil method. We found that patients with type 3 Gaucher disease had a significantly higher regression slope of duration vs amplitude and peak duration vs amplitude compared to healthy controls for both horizontal and vertical saccades. Saccadic latency was significantly increased for horizontal saccades only. Downward saccades were more affected than upward saccades. Saccade abnormalities increased over time in some patients reflecting the slowly progressive nature of the disease. Phase plane plots showed individually characteristic patterns of abnormal saccade trajectories. Oculo-manual dexterity scores on the Purdue Pegboard test were low in virtually all patients, even in those with normal cognitive function. Vertical saccade peak duration vs amplitude slope significantly correlated with IQ and with the performance on the Purdue Pegboard but not with the brainstem and somatosensory evoked potentials. We conclude that, in patients with Gaucher disease type 3, saccadic eye movements and oculo-manual dexterity are representative neurological functions for longitudinal studies and can probably be used as endpoints for therapeutic clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT00001289.     

Saccades Improve Postural Control: A Developmental Study in Normal Children

Introduction

Dual-task performance is known to affect postural stability in children. This study focused on the effect of oculomotor tasks like saccadic eye movements on postural stability, studied in a large population of children by recording simultaneously their eye movements and posture.

Materials and Methods

Ninety-five healthy children from 5.8 to 17.6 years old were examined. All children were free of any vestibular, neurological, ophtalmologic and orthoptic abnormalities. Postural control was measured with a force platform TechnoConcept®, and eye movements with video oculography (MobilEBT®). Children performed two oculomotor tasks: fixation of a stable central target and horizontal saccades. We measured the saccade latency and the number of saccades during fixation as well as the surface, length and mean velocity of the center of pressure.

Results

During postural measurement, we observed a correlation between the age on the one hand and a decrease in saccade latency as well as an improvement in the quality of fixation on the other. Postural sway decreases with age and is reduced in the dual task (saccades) in comparison with a simple task of fixation.

Discussion - Conclusion

These results suggest a maturation of neural circuits controlling posture and eye movements during childhood. This study also shows the presence of an interaction between the oculomotor system and the postural system. Engaging in oculomotor tasks results in a reduction of postural sway.     

Age-related changes in saccadic eye movements in healthy subjects and patients with Parkinson's disease

Age-related changes in characteristics of saccadic eye movements (latency, duration and percentage of multistep saccades) in healthy subjects and patients with Parkinson's disease were evaluated. Healthy volunteers were divided into 6 age groups (17-20 years, 21-30 years, 31-40 years, 41-50 years, 51-60 years, 61-75 years), parkinsonian patients into 3 age groups (41-50 years, 51-60 years, 61-75 years). According to our data, saccade characteristics depend upon age in both healthy subjects and parkinsonian patients. In healthy volunteers the percentage of multistep saccades and the mean saccade latency increase significantly after the age of 60. Values of these characteristics in patients with Parkinson's disease significantly exceed the values in the corresponding age groups of healthy subjects. The "disease" factor (MANOVA) has a greater influence on saccade latency and percentage of multistep saccades then the "age" factor. The duration of single saccades depends on age to a smaller extent and does not change in patients with Parkinson's disease. The peculiarities of neurodegenerative processes during normal aging and aging with Parkinson's disease are discussed.     

Characteristics of Spontaneous Square-Wave Jerks in the Healthy Macaque Monkey during Visual Fixation

Saccadic intrusions (SIs), predominantly horizontal saccades that interrupt accurate fixation, include square-wave jerks (SWJs; the most common type of SI), which consist of an initial saccade away from the fixation target followed, after a short delay, by a return saccade that brings the eye back onto target. SWJs are present in most human subjects, but are prominent by their increased frequency and size in certain parkinsonian disorders and in recessive, hereditary spinocerebellar ataxias. SWJs have been also documented in monkeys with tectal and cerebellar etiologies, but no studies to date have investigated the occurrence of SWJs in healthy nonhuman primates. Here we set out to determine the characteristics of SWJs in healthy rhesus macaques (Macaca mulatta) during attempted fixation of a small visual target. Our results indicate that SWJs are common in healthy nonhuman primates. We moreover found primate SWJs to share many characteristics with human SWJs, including the relationship between the size of a saccade and its likelihood to be part of a SWJ. One main discrepancy between monkey and human SWJs was that monkey SWJs tended to be more vertical than horizontal, whereas human SWJs have a strong horizontal preference. Yet, our combined data indicate that primate and human SWJs play a similar role in fixation correction, suggesting that they share a comparable coupling mechanism at the oculomotor generation level. These findings constrain the potential brain areas and mechanisms underlying the generation of fixational saccades in human and nonhuman primates.     

A functional and structural investigation of the human fronto-basal volitional saccade network

Almost all cortical areas are connected to the subcortical basal ganglia (BG) through parallel recurrent inhibitory and excitatory loops, exerting volitional control over automatic behavior. As this model is largely based on non-human primate research, we used high resolution functional MRI and diffusion tensor imaging (DTI) to investigate the functional and structural organization of the human (pre)frontal cortico-basal network controlling eye movements. Participants performed saccades in darkness, pro- and antisaccades and observed stimuli during fixation. We observed several bilateral functional subdivisions along the precentral sulcus around the human frontal eye fields (FEF): a medial and lateral zone activating for saccades in darkness, a more fronto-medial zone preferentially active for ipsilateral antisaccades, and a large anterior strip along the precentral sulcus activating for visual stimulus presentation during fixation. The supplementary eye fields (SEF) were identified along the medial wall containing all aforementioned functions. In the striatum, the BG area receiving almost all cortical input, all saccade related activation was observed in the putamen, previously considered a skeletomotor striatal subdivision. Activation elicited by the cue instructing pro or antisaccade trials was clearest in the medial FEF and right putamen. DTI fiber tracking revealed that the subdivisions of the human FEF complex are mainly connected to the putamen, in agreement with the fMRI findings. The present findings demonstrate that the human FEF has functional subdivisions somewhat comparable to non-human primates. However, the connections to and activation in the human striatum preferentially involve the putamen, not the caudate nucleus as is reported for monkeys. This could imply that fronto-striatal projections for the oculomotor system are fundamentally different between humans and monkeys. Alternatively, there could be a bias in published reports of monkey studies favoring the caudate nucleus over the putamen in the search for oculomotor functions.     

Age-related changes in saccadic eye movements in healthy subjects and patients with Parkinson’s disease

The age-related changes in saccadic eye movements (the latency, the duration of single saccades and the percentage of multistep saccades) were compared in healthy subjects and patients with Parkinson’s disease. Healthy volunteers without neurological symptoms were divided into six age groups: (17–20, 21–30, 31–40, 41–50, 51–60, and 61–75 years of age); and parkinsonian patients, into three groups (41–50, 51–60, and 61–75 years of age). According to the data obtained, the saccade characteristics depend on the age in both the subjects without neurological symptoms and parkinsonian patients. In healthy volunteers, the percentage of multistep saccades and the mean saccade latency increase significantly after the age of 60 years. These parameters in patients with Parkinson’s disease significantly exceed the values in healthy subjects from the age-matched groups. The “disease” factor has a greater influence on the saccade latency and the percentage of multistep saccades than the “age” factor. The duration of single saccades depends on age to a lesser degree and does not change in patients with Parkinson’s disease. The peculiarities of the development of neurodegenerative processes in cases of normal aging and in idiopathic parkinsonism are discussed.     

Two types of eye movements during electrical stimulation of the rostral and caudal parts of the medial frontal "oculomotor" area in cats

The character of eye movements during electrical stimulation of the medial wall of the brain beneath the cruciate sulcus and of the inferior wall of the cruciate sulcus itself in the frontal cortex was investigated in waking cats. Stimulation of this part of the brain evoked two types of eye movements: unidirectional concomitant saccades, whose direction and amplitude were independent of the original position of the eyes in the orbits, and saccades into the central position (so-called centering saccades). Unidirectional saccades appeared in response to stimulation of the caudal part of the investigated zone, centering saccades in response to stimulation of its rostral part. Analysis of the directions and amplitudes of unidirectional saccades suggested the retinotopic organization of the caudal zone. Systematic changes in the magnitude and direction of vertical saccades during stimulation of the deep parts of the cruciate sulcus indicated previsely the projection of the vertical meridian of the retina. Reappearance of vertical saccades evoked by stimulation of certain parts of the medial wall of the brain suggests the existence of more than one retinotopically organized zone in this region. Inconstancy of stereotaxic coordinates of the oculomotor area, studied in different animals, was noted.Institute for Problems in Information Transmission, Academy of Sciences of the USSR, Moscow. Translated from Neirofiziologiya, Vol. 16, No. 6, pp. 761–766, November–December, 1984.     

Potential of the human cerebral cortex prior to antisaccades

Latencies and other parameters of presaccadic potentials preceding antisaccades and normal saccades to visual stimuli were studied in 10 right-handed healthy subjects. The EEG was recorded in F3, F4, Fz, C3, C4, Cz, P3, P4, O1 and O2 derivation. EEG records preceding saccades and antisaccades with mean latencies were selected and averaged. The latencies of the leftward antisaccades were shorter than of the rightward antisaccades. The slow presaccadic negativity (in the period of central eye fixations) and fast N -2 and P -1 potentials within the latent period were more prominent before antisaccades than normal saccades. Spatiotemporal analyses of presaccadic potentials showed that the right frontal cortex was activated to a greater extent before antisaccades than before saccades. These findings suggest that right-hemispheric dominance in the spatial attention and inhibition of automatic saccades to visual stimuli in the period of antisaccades preparation.     

Basal Ganglia Neuronal Activity during Scanning Eye Movements in Parkinson’s Disease

The oculomotor role of the basal ganglia has been supported by extensive evidence, although their role in scanning eye movements is poorly understood. Nineteen Parkinsońs disease patients, which underwent implantation of deep brain stimulation electrodes, were investigated with simultaneous intraoperative microelectrode recordings and single channel electrooculography in a scanning eye movement task by viewing a series of colored pictures selected from the International Affective Picture System. Four patients additionally underwent a visually guided saccade task. Microelectrode recordings were analyzed selectively from the subthalamic nucleus, substantia nigra pars reticulata and from the globus pallidus by the WaveClus program which allowed for detection and sorting of individual neurons. The relationship between neuronal firing rate and eye movements was studied by crosscorrelation analysis. Out of 183 neurons that were detected, 130 were found in the subthalamic nucleus, 30 in the substantia nigra and 23 in the globus pallidus. Twenty percent of the neurons in each of these structures showed eye movement-related activity. Neurons related to scanning eye movements were mostly unrelated to the visually guided saccades. We conclude that a relatively large number of basal ganglia neurons are involved in eye motion control. Surprisingly, neurons related to scanning eye movements differed from neurons activated during saccades suggesting functional specialization and segregation of both systems for eye movement control.     

Active oculography as a method of diagnosing the psychophysiologic condition of a man

The effect of stress factors on the oculomotor reactions of electric train drivers with various degrees of fatigue was studied in a modelled accidental situation. The spatio-temporal parameters of oculomotor reactions were shown to characterize not always correctly the state of a driver. More informative were found to be the values of asymmetry of saccades obtained by separate recordings of the right and left eye movements. A comparison between the character of the phase saccade disturbances of tired operators and that of patients with a deficiency in cerebral blood supply showed that the latter may be used as a model.     

Optical coherence tomography in parkinsonian syndromes

Background/Objective

Parkinson''s disease (PD) and the atypical parkinsonian syndromes multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) are movement disorders associated with degeneration of the central nervous system. Degeneration of the retina has not been systematically compared in these diseases.

Methods

This cross-sectional study used spectral-domain optical coherence tomography with manual segmentation to measure the peripapillar nerve fiber layer, the macular thickness, and the thickness of all retinal layers in foveal scans of 40 patients with PD, 19 with MSA, 10 with CBS, 15 with PSP, and 35 age- and sex-matched controls.

Results

The mean paramacular thickness and volume were reduced in PSP while the mean RNFL did not differ significantly between groups. In PSP patients, the complex of retinal ganglion cell- and inner plexiform layer and the outer nuclear layer was reduced. In PD, the inner nuclear layer was thicker than in controls, MSA and PSP. Using the ratio between the outer nuclear layer and the outer plexiform layer with a cut-off at 3.1 and the additional constraint that the inner nuclear layer be under 46 µm, we were able to differentiate PSP from PD in our patient sample with a sensitivity of 96% and a specificity of 70%.

Conclusion

Different parkinsonian syndromes are associated with distinct changes in retinal morphology. These findings may serve to facilitate the differential diagnosis of parkinsonian syndromes and give insight into the degenerative processes of patients with atypical parkinsonian syndromes.     

Latent period of antisaccades in various conditions of visual stimulation in man

The latent periods (LP) of normal saccades and antisaccades were studied in 10 right-handed healthy subjects in two series of experiments. Peripheral visual stimuli were located at an angle of 10 degrees with respect to the central fixation stimulus in the left and right visual semifields. Two standard schemes of visual stimulation: 1) SS (single step), i.e., switching the peripheral stimulus on immediately after switching the central stimulus of; 2) GAP, i.e., the same with the interstimulus interval in 200 ms. It was shown that in the GAP stimulation condition, the LP of both saccades and antisaccades was 30-50 shorter than in the SS condition. The LP of antisaccades was longer than that of saccades by 145-300 ms. The LP of the leftward antisaccades was by 10-100 ms shorter than that of the rightward ones. Probably, this phenomenon reflects the dominance of the right hemisphere in spatial attention.     

Significance of the potential role of pharmacological MRI (phMRI) in diagnosis of Parkinson’s disease

The initial diagnosis of Parkinson's disease (PD) is currently based on a clinical assessment.Many patients who receive an initial diagnosis of PD have parkinsonian features related to other diseases s...     

A model that integrates eye velocity commands to keep track of smooth eye displacements

Past results have reported conflicting findings on the oculomotor system’s ability to keep track of smooth eye movements in darkness. Whereas some results indicate that saccades cannot compensate for smooth eye displacements, others report that memory-guided saccades during smooth pursuit are spatially correct. Recently, it was shown that the amount of time before the saccade made a difference: short-latency saccades were retinotopically coded, whereas long-latency saccades were spatially coded. Here, we propose a model of the saccadic system that can explain the available experimental data. The novel part of this model consists of a delayed integration of efferent smooth eye velocity commands. Two alternative physiologically realistic neural mechanisms for this integration stage are proposed. Model simulations accurately reproduced prior findings. Thus, this model reconciles the earlier contradictory reports from the literature about compensation for smooth eye movements before saccades because it involves a slow integration process. Action Editor: Jonathan D. Victor     

A possible role of coenzyme Q10 in the etiology and treatment of Parkinson's disease.

Parkinson's disease (PD) is a degenerative neurological disorder. Recent studies have demonstrated reduced activity of complex I of the electron transport chain in brain and platelets from patients with PD. Platelet mitochondria from parkinsonian patients were found to have lower levels of coenzyme Q10 (CoQ10) than mitochondria from age/sex-matched controls. There was a strong correlation between the levels of CoQ10 and the activities of complexes I and II/III. Oral CoQ10 was found to protect the nigrostriatal dopaminergic system in one-year-old mice treated with MPTP, a toxin injurious to the nigrostriatal dopaminergic system. We further found that oral CoQ10 was well absorbed in parkinsonian patients and caused a trend toward increased complex I activity. These data suggest that CoQ10 may play a role in cellular dysfunction found in PD and may be a potential protective agent for parkinsonian patients.     

Blink Perturbation Effects on Saccades Evoked by Microstimulation of the Superior Colliculus

Current knowledge of saccade-blink interactions suggests that blinks have paradoxical effects on saccade generation. Blinks suppress saccade generation by attenuating the oculomotor drive command in structures like the superior colliculus (SC), but they also disinhibit the saccadic system by removing the potent inhibition of pontine omnipause neurons (OPNs). To better characterize these effects, we evoked the trigeminal blink reflex by delivering an air puff to one eye as saccades were evoked by sub-optimal stimulation of the SC. For every stimulation site, the peak and average velocities of stimulation with blink movements (SwBMs) were lower than stimulation-only saccades (SoMs), supporting the notion that the oculomotor drive is weakened in the presence of a blink. In contrast, the duration of the SwBMs was longer, consistent with the hypothesis that the blink-induced inhibition of the OPNs could prolong the window of time available for oculomotor commands to drive an eye movement. The amplitude of the SwBM could also be larger than the SoM amplitude obtained from the same site, particularly for cases in which blink-associated eye movements exhibited the slowest kinematics. The results are interpreted in terms of neural signatures of saccade-blink interactions.