Eye Movement Disorders in Multiple Sclerosis and Optic Neuritis

Abstract

Horizontal saccadic and smooth pursuit eye movements were studied in 84 patients with multiple sclerosis (MS) and 21 patients with optic neuritis (ON). The MS patients were clinically classified as 'definite', 'probable', or 'possible'; subclinical eye movement disorder was found in 80 per cent of the definite, 74 per cent of the probable and 60 per cent of the possible category. Five of the ON patients (25 per cent) showed a subclinical eye movement deficit; these 5 were young patients with a recent history of ON. In a group of 27 MS patients with symptoms of spinal cord involvement only, 14 showed subclinical oculomotor disorder indicating the involvement of cerebral structures in the demyelination process. A study of the correlation between specific eye movement parameters and results of visual evoked response (VER) tests revealed that saccadic latency or smooth pursuit abnormalities are not correlated with prolonged VER latencies (P-100 peak latency). This indicates that lesions beyond the primary visual pathway contribute substantially to both parameters of oculomotor dysfunction. A significant correlation was found between prolonged saccadic latency and smooth pursuit deficit. An explanation for this finding based on functional aspects of the saccadic and smooth pursuit systems and their mutual interaction is presented. The occurrence of internuclear ophthalmoplegia (INO) is significantly related to an increase of saccadic latency. This finding indicates that demyelination in the patients manifesting INO may not be restricted exclusively to one or both medial longitudinal fasciculi, but may extend to other brainstem structures which are functionally involved in the programming of saccades. The findings confirm the value of standardized objective examination of eye movements in the detection and clarification of subclinical lesions in the central nervous system of patients with an early diagnosis of MS or ON.

Bedside Tested Ocular Motor Disorders in Multiple Sclerosis Patients

“…However, our findings seem to confirm earlier reported data by Reulen et al who described the presence of subclinical eye movement disorders in 80% of definite MS patients [19]; Knezevic et al who reported the presence of one or more, often subclinical, abnormal saccade parameters in 67% of patients with clinically definite, probable or suspected MS [23]; Muri and Meienberg who observed one or more OMDs in 76% of systematically examined patients with definite MS, using simple clinical tests verified on healthy controls [24]. Lower prevalence of OMDs was reported by other studies.…”

“…Data on the exact prevalence of OMDs in MS patients are rare, resulting from few small sample size studies reporting prevalence varying from 80% [19] to 32% [13] in clinically definite MS.…”

Cortical thickness and surface area relate to specific symptoms in early relapsing–remitting multiple sclerosis

“…Early features of RRMS may include eye motor disturbances (Reulen et al 1983;Frohman et al 2005;Graves and Balcer 2010), fine motor control of the hand (Cutter et al 1999) or cognitive dysfunction (Amato and Ponziani 2001;Amato et al 2010 (Benedict et al 2002;Langdon et al 2011) and is suggested for use in clinical trials (Benedict et al 2012b). Because of the wide use of the SDMT (Benedict et al 2004;Drake et al 2010;Langdon et al 2011), it is important to identify whether decrements in motor function could lead to input or output level problems related to the procedure of the test.…”

Der Einfluß von Kontaktlinsen und Sehschärfe auf die Registrierung sakkadischer Augenbewegungen mit der Infrarot-Reflexionsmethode

“…Aus diesen Gründen und da bei verschiedenen neurologischen Erkrankungen Störungen der sakkadischen Augenbewegungen beschrieben wurden, findet die Untersuchung der Sakkaden ein zunehmendes klinisches Interesse (l9, 20,23). Vor d e m bei der multiplen Sklerose (21,25), der Myasthenia gravis (1 5,30) und der endokrinen Ophthalmopathie (22) ergaben sich Hinweise, daß die Untersuchung der Sakkaden einen relevanten diagnostischen Beitrag leisten kann. In der klinischen Diagnostik werden heute vor allem zwei Methoden zur Registrierung sakkadischer Augenbewegungen angewandt: die Gleichstrom-Elektrookulographie (7, und 3cSakkaden mit und ohne Kontaktlinsen registriert.…”