Break in Binocular Fusion During Head Turning in MS Patients With Ino

Abstract

patients with MS were APL. This provides a cumulative incidence higher than currently expected (reported incidences between 0.07% 4 and 0.80% 6 when considering only series of more than 100 patients with MS). The complete references of reported cases of t-AL in patients with MS treated with MTZ are provided in the e-references on the Neurology ® Web site at www.neurology.org.Considering the MTZ regimen administrated, there was no relation between the treatment scheme and the occurrence of t-AL. There was no t-AL in the low-dose regimen, which was used in special cases to enable tolerance, but the low number of patients in that regimen does not enable us to draw significant conclusions. Nowadays, the real risk of t-AL is not known, as the total number of patients with MS who have received MTZ is unknown and leukemia cases might be underreported. The results of this prospective observational study stress the necessity of re-evaluating this risk.

Axonal conduction in multiple sclerosis: A combined magnetic resonance imaging and electrophysiological study of the medial longitudinal fasciculus

“…13 Disruption of this tract can cause internuclear ophthalmoplegia (INO), characterized by slowing or limitation of ipsilateral adducting eye relative to abducting eye saccades. INO is common in MS and can lead to a break in binocular fusion, 14 diplopia, loss of depth perception, and reduction in quality of life. [15][16][17] Since vestibular afferents travel through the MLF, 18,19 quantitative analysis of the vestibular-ocular reflex (VOR) can be used to probe alteration in the latency and fidelity of MLF axonal conduction in vivo.…”

The Neuro-Ophthalmology of Multiple Sclerosis

“…In most cases of INO, the eyes are orthotropic in primary position although there may be a mild exophoria detectable on alternate cover testing [112]. Patients may be asymptomatic or may have transient blurred vision or diplopia with head turning or gaze-direction changes, which result from dysconjugate saccades and breaks in binocular fusion [112,113].…”

Modeling the mechanisms of Uhthoff's phenomenon in MS patients with internuclear ophthalmoparesis

“…A break in binocular fusion can produce a loss of stereopsis and depth perception, transient diplopia (perceived as a double image or visual blur), oscillopsia, and disorientation 19 . The maximum degree of fusional break is directly related to the severity of INO 20 . A break in binocular fusion may have safety implications for MS patients while driving and walking, especially in hot climates, which can exacerbate INO‐related dysconjugacy 21 …”

“…19 The maximum degree of fusional break is directly related to the severity of INO. 20 A break in binocular fusion may have safety implications for MS patients while driving and walking, especially in hot climates, which can exacerbate INO-related dysconjugacy. 21 Using a head turning protocol where the head turned to two visual targets placed 60 • on either side of center, we have unpublished pilot data collected on three MS patients at baseline and during wholebody heating to determine the effects of increase internal temperature on binocular fusion.…”