Ocular Tilt Reaction as a Delayed Complication of Deep Brain Stimulation for Parkinson Disease

Ortiz-Pérez, Santiago; Sánchez-Dalmau, Bernardo; Molina, J.A. Ruiz; Adán, Alfredo; Candela, Santiago; Rumià, Jordi

doi:10.1097/wno.0b013e3181b2822d

Cited by 10 publications

(12 citation statements)

References 23 publications

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“…24,25 Hence, skew deviation can occur at a variety of sites where damages cause an imbalance in the utriculo-ocular pathway. These damages include lesions in the peripheral vestibular organ or its nerve 2,[26][27][28] and central lesions within the posterior fossa that involve the vestibular nuclei (eg, in the lateral medullary syndrome), 17,29 pons, 13,30 midbrain, 15,[31][32][33][34] diencephalon, 35,36 or cerebellum. 7,37 Normally, with the head upright, the utricles lie roughly in an earth-horizontal plane.…”

Section: Commentmentioning

confidence: 99%

Ability of an Upright-Supine Test to Differentiate Skew Deviation From Other Vertical Strabismus Causes

Wong

Colpa²,

Chandrakumar³

2011

Arch Ophthalmol

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Objective: To determine the sensitivity and specificity of a new upright-supine test to differentiate skew deviation from trochlear nerve palsy and other causes of vertical strabismus in a large number of patients. Methods: The study consisted of 125 consecutive patients who sought treatment from January 1, 2008, through December 31, 2010, for vertical strabismus of various causes: skew deviation (25 patients), trochlear nerve palsy (58 patients), restrictive causes (14 patients), and other causes (eg, myasthenia gravis and childhood strabismus) (28 patients). Twenty healthy participants served as controls. The deviation was measured by the prism and alternate cover test using a near target at 1 ⁄3 m in both the upright and supine positions. A vertical strabismus that decreased by 50% or more from the upright to supine position constituted a positive test result. Results: The upright-supine test result was positive in 20 of 25 patients with skew deviation (sensitivity,80%) but negative in all patients with trochlear nerve palsy, restrictive, or other causes (specificity,100%). Conclusions: The upright-supine test is highly specific for differentiating skew deviation from other causes of vertical strabismus. This test could be added as a fourth step after the 3-step test, and if the result is positive, neuroimaging should be considered if indicated clinically.

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Section: Commentmentioning

confidence: 99%

Ability of an Upright-Supine Test to Differentiate Skew Deviation From Other Vertical Strabismus Causes

Wong

Colpa²,

Chandrakumar³

2011

Arch Ophthalmol

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“…A patient with electrodes in both subthalamic nuclei for advanced Parkinson disease developed a brainstem hemorrhage [13]. The hemorrhage caused vertical diplopia from skew deviation, ipsiversive binocular torsion and a head tilt.…”

Section: Brainstem Tegmentunmentioning

confidence: 99%

Ocular torsion and vertical misalignment

Sharpe

Kumar

Sundaram

2011

Current Opinion in Neurology

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“…A case of hypertropia resulting in vertical diplopia was reported in a Parkinson’s disease patient following DBS implantation, although this was due to hemorrhage at the site of implantation and not the stimulation itself ( 64 ). Strabismus has also been reported as a side effect of DBS of the medial forebrain bundle as a treatment for depression; this strabismus was only present at high currents and could be rapidly resolved by adjusting the stimulation parameters ( 65 , 66 ).…”

Section: Saccades Vergence and Strabismus In Parkinson’s Diseasementioning

confidence: 99%

Vergence and Strabismus in Neurodegenerative Disorders

2018

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Maintaining proper eye alignment is necessary to generate a cohesive visual image. This involves the coordination of complex neural networks, which can become impaired by various neurodegenerative diseases. When the vergence system is affected, this can result in strabismus and disorienting diplopia. While previous studies have detailed the effect of these disorders on other eye movements, such as saccades, relatively little is known about strabismus. Here, we focus on the prevalence, clinical characteristics, and treatment of strabismus and disorders of vergence in Parkinson’s disease, spinocerebellar ataxia, Huntington disease, and multiple system atrophy. We find that vergence abnormalities may be more common in these disorders than previously thought. In Parkinson’s disease, the evidence suggests that strabismus is related to convergence insufficiency; however, it is responsive to dopamine replacement therapy and can, therefore, fluctuate with medication “on” and “off” periods throughout the day. Diplopia is also established as a side effect of deep brain stimulation and is thought to be related to stimulation of the subthalamic nucleus and extraocular motor nucleus among other structures. In regards to the spinocerebellar ataxias, oculomotor symptoms are common in many subtypes, but diplopia is most common in SCA3 also known as Machado–Joseph disease. Ophthalmoplegia and vergence insufficiency have both been implicated in strabismus in these patients, but cannot fully explain the properties of the strabismus, suggesting the involvement of other structures as well. Strabismus has not been reported as a common finding in Huntington disease or atypical parkinsonian syndromes and more studies are needed to determine how these disorders affect binocular alignment.

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Ocular Tilt Reaction as a Delayed Complication of Deep Brain Stimulation for Parkinson Disease

Cited by 10 publications

References 23 publications

Ability of an Upright-Supine Test to Differentiate Skew Deviation From Other Vertical Strabismus Causes

Ability of an Upright-Supine Test to Differentiate Skew Deviation From Other Vertical Strabismus Causes

Ocular torsion and vertical misalignment

Vergence and Strabismus in Neurodegenerative Disorders

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