Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine

Abstract

Background: A high percentage of patients with vestibular migraine (VM) were reported to have central ocular motor dysfunctions (COMD) in the symptom-free interval. Since VM is a chronic disorder, it is of interest if COMD worsen over time. Methods: Thirty VM patients and 11 control patients participated in an 8-year-long observational study with follow-up. All patients underwent standardized neuro-ophthalmological and neuro-otological examinations at the initial presentation and at follow-up. The primary outcome measure was change in COMD at follow-up. Results: In general, COMD in the symptom-free interval were subtle, consisting of a saccadic horizontal and/or vertical pursuit. At follow-up, significantly more patients with VM had COMD (p = 0.015). The prevalence of COMD increased from 20 to 63% in VM patients. Further, the presence of COMD at follow-up had a positive predictive value of 90.5% for the diagnosis of VM. Successful treatment with prophylactic migraine medication seems to prevent the development and worsening of COMD (p = 0.008). Conclusion: Mild COMD occur in a large percentage of VM patients during the course of the disease. The presence of COMD is predictive of VM in patients with recurrent attacks of vertigo. Prophylactic migraine medication seems to attenuate the development and progression of COMD.

Assessment of Vestibular and Oculomotor Function in Patients with Vestibular Migraine: A Preliminary Study

“…In addition, we furtherfound thatpositional nystagmus and smooth pursuit are common in oculomotorabnormalities. It similar to previous studies [20,28]. These results related to mechanisms of VM.…”

Isolated Vestibular Suppression Impairment With Vestibular Migraine

“…Although it is possible that VM is an independent and coincidental disorder, we speculate that it is also part of this CANVAS phenotype, noting that the eye movement abnormalities described here are similar to those of longstanding VM (23). A role for cerebellar dysfunction in VM has also recently been proposed on the basis of observed abnormalities of canal-otolith interaction (24).…”

The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings

“…A range of neuro‐otologic abnormalities were found in the interictal phase. Uncommon findings include spontaneous nystagmus (with and without fixation), and gaze‐evoked nystagmus, as well as abnormal head‐impulse testing . The incidence of saccadic pursuit varies widely among reported studies (between 3% and 57%), perhaps due to use of eye‐movement recordings (more sensitive method compared to bedside assessment of pursuit), as well as variations in patient cooperation …”

“…Uncommon findings include spontaneous nystagmus (with and without fixation), and gaze-evoked nystagmus, 10,11,21,22,[54][55][56][57][58] as well as abnormal head-impulse testing. 27,31,54,59 The incidence of saccadic pursuit varies widely among reported studies (between 3% and 57%), 21,22,27,[54][55][56]58 perhaps due to use of eye-movement recordings (more sensitive method compared to bedside assessment of pursuit), as well as variations in patient cooperation. 7 The application of vibratory stimuli to the mastoids, forehead, or neck muscles can generate nystagmus in vestibular disorders, usually indicating asymmetric peripheral vestibular input.…”