Pediatric Oculomotor Findings during Monocular Videonystagmography: A Developmental Study

Abstract

Significant differences were noted between the pediatric and adult participants for saccade latency, smooth pursuit gain, and OPK asymmetry. Saccade latency was significantly longer for the pediatric participants compared to the adult participants. Smooth pursuit gain was significantly less for the pediatric participants compared to the adult participants. The pediatric participants also demonstrated increased OPK asymmetry compared to the adult participants. Caution should be exercised when comparing pediatric test results to adult normative values to avoid "false positive" diagnoses of central vestibular involvement.

Oculomotor Assessment in Children

“…Standard error bars are noted. 17 greater for the pediatric participants than adult participants. Development of the vestibular nuclei, nucleus of the optic track, accessory optic system, cerebral cortex, parietal lobes, and temporal lobes are related to OPK function, specifically decreased variability, with an increase in age.…”

“…[8][9][10][11][12][13][14][15][16] These documented age effects pose several questions with regard to the clinical vestibular evaluation of oculomotor function in children. To answer these questions, Doettl et al 17 completed oculomotor testing using videonystagmography (VNG) consisting of saccades and smooth pursuit, and OPK using standard clinical equipment and protocols in pediatric and adult populations to investigate for age affects with regard to saccade latency, accuracy, speed, smooth pursuit gain, OPK nystagmus gain, speed, and asymmetry ratio.…”

Oculomotor Test Changes in Patients with Peripheral Vestibular Dysfunction

“…Among the oculomotor tests, saccade maintains the position of an image of a target over the fovea in the case of quick eye movement (10). Saccade functions, especially latency and velocity, improve with age via development of the prefrontal function and brain myelination, visual maturation and development of the cerebral cortex (9). Saccade can be impaired in cases of intoxication such as anticonvulsive or benzodiazepine use and in neurodegenerative disorders such as brainstem lesions, midbrain lesion, progressive supranuclear palsy, cerebellum or cerebellar pathways (17 peripheral vestibular disorder and claimed that vestibulo oculomotor dysfunction may be a sign of peripheral dysfunction as well as central nervous system impairment (10).…”

“…Optokinetic nystagmus occurs rhythmically, involuntarily, unconsciously and automatically (10). Optokinetic function is related to vestibular nuclei, nucleus of the optic track, accessory optic system, cerebral cortex, temporal lobes, and parietal lobes (9). Tuma et al demonstrated that optokinetic nystagmus gain was altered in 5.0% of patients with…”

“…VNG tests include oculomotor, spontaneous nystagmus, positional and caloric tests. Gaze, saccade, smooth pursuit, and optokinetic (OPK) tests can be evaluated with an oculomotor test (9).…”