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Berkman O, Raveh E, Harpaz E, Kreitman R, Ben-Ami E, Nechushtan E, Birman N, Drory VE. Changes in saccadic intrusions over time as an objective biomarker to follow ALS disease progression. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-7. [PMID: 38975625 DOI: 10.1080/21678421.2024.2376732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/30/2024] [Indexed: 07/09/2024]
Abstract
Objective: Saccadic Intrusions (SIs) are abnormal eye movements during gaze fixation. Studies have indicated the clinical relevance of SIs, especially of square wave jerks (SWJ) in ALS. We used a software-based platform to extract SIs as a part of an interventional drug trial. The objective was to examine SIs' change over time as a potential biomarker of ALS disease progression. Methods: 28 ALS patients (61.95 ± 8.6 years) were assessed with the revised ALS Functional Rating Scale (ALSFRS-R) and with an oculometric test. Changes of SIs over time and correlations with ALSFRS-R and its bulbar subscale were calculated. A power calculation was conducted to understand the practical implications of results. Results: A significant increase of SWJ over trial duration was observed, with an increase in frequency (mean rise of 0.14 ± 0.28, p < 0.01), amplitude (0.001 ± 0.0016 degrees, p < 0.005), overall duration of SWJ (0.13 ± 0.25, in %, p < 0.01), and in their relative part out of all intrusions (0.18 ± 0.32, in %, p < 0.005). Negative correlations were found with the bulbar subscale (R=-0.43, -0.41, -0.39 and -0.47, respectively, p < 0.001). The required sample size for observing a 40% reduction in bulbar aspects when using the oculometric test (α = 0.05 and β = 0.8), was found to be 150 patients per arm, compared with 200 patients using the bulbar subscale. Conclusions: Evaluation of saccadic intrusions during fixation was able to detect disease progression over time, correlated with ALSFRS-R bulbar subscale. Eye movements can potentially serve as an objective biomarker in ALS clinical trials and reduce the required sample size to show clinical effect of therapies.
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Affiliation(s)
| | | | | | | | | | - Elisheva Nechushtan
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and
| | - Nurit Birman
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, and Tel-Aviv Faculty of Medical Sciences, Tel-Aviv University, Tel Aviv, Israel
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Nakamagoe K, Matsumoto S, Touno N, Tateno I, Koganezawa T. Saccadic oscillations as a biomarker of clinical symptoms in amyotrophic lateral sclerosis. Neurol Sci 2023; 44:2787-2793. [PMID: 36872386 DOI: 10.1007/s10072-023-06719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Among eye movements in amyotrophic lateral sclerosis (ALS), we identified the characteristics of square-wave jerks (SWJs) seen during times without visual fixation (VF) and analyzed their relationships with clinical parameters. MATERIALS AND METHODS Clinical symptoms were evaluated and eye movements were tested using electronystagmography in 15 patients with ALS (10 men, 5 women; mean age, 66.9 ± 10.5 years). SWJs with and without VF were recorded, and their characteristics were identified. Relationships between each SWJ parameter and clinical symptoms were evaluated. Results were compared with eye movement data from 18 healthy individuals. RESULTS The frequency of SWJs without VF was significantly higher in the ALS group than in the healthy group (P < 0.001). When the condition was changed from VF to no-VF in the ALS group, the frequency of SWJs was significantly higher in healthy subjects (P = 0.004). A positive correlation was seen between frequency of SWJs and percentage predicted forced vital capacity (%FVC) (R = 0.546, P = 0.035). CONCLUSION The frequency of SWJs was higher with VF in healthy people, and was suppressed without VF. In contrast, the frequency of SWJs was not suppressed without VF in ALS patients. This suggests that SWJs without VF have some clinical significance in ALS patients. Moreover, a relationship was noted between the parameters of SWJs without VF in ALS patients and results of pulmonary function tests, suggesting that SWJs during times without VF may offer a clinical parameter of ALS.
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Affiliation(s)
- Kiyotaka Nakamagoe
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Shunya Matsumoto
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nozomi Touno
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ikumi Tateno
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tadachika Koganezawa
- Department of Physiology, Division of Biomedical Science, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Ionescu A, Ștefănescu E, Strilciuc Ș, Rafila A, Mureșanu D. Correlating Eye-Tracking Fixation Metrics and Neuropsychological Assessment after Ischemic Stroke. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1361. [PMID: 37629651 PMCID: PMC10456465 DOI: 10.3390/medicina59081361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Stroke survivors commonly experience cognitive deficits, which significantly impact their quality of life. Integrating modern technologies like eye tracking into cognitive assessments can provide objective and non-intrusive measurements. Materials and Methods: This study aimed to evaluate the cognitive and visual processing capabilities of stroke patients using eye-tracking metrics and psychological evaluations. A cohort of 84 ischemic stroke patients from the N-PEP-12 clinical study was selected for secondary analysis, based on the availability of eye-tracking data collected during a visual search task using an adapted Trail Making Test. Standardized cognitive assessments, including the Montreal Cognitive Assessment (MoCA) and digit span tasks, were also conducted. Results: Correlation analyses revealed some notable relationships between eye-tracking metrics and cognitive measures, such as a positive correlation between Symbol Search performance and the number of fixations. Anxiety levels were found to be positively correlated with first fixation duration, while longer first fixation durations were associated with poorer cognitive performance. However, most correlations were not statistically significant. Nonparametric ANOVA showed no significant differences in fixation metrics across the visits. Conclusions: These findings suggest a complex relationship between cognitive status, gaze fixation behavior, and psychological well-being in stroke patients. Further research with larger sample sizes and analysis of saccadic eye movements is needed to better understand these relationships and inform effective interventions for stroke rehabilitation.
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Affiliation(s)
- Alec Ionescu
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania
| | - Emanuel Ștefănescu
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania
| | - Ștefan Strilciuc
- Research Center for Functional Genomics, Biomedicine, and Translational Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Rafila
- Carol Davila University of Medicine and Pharmacy, Dionisie Lupu Street, 050474 Bucharest, Romania
| | - Dafin Mureșanu
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania
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Becker W, Behler A, Vintonyak O, Kassubek J. Patterns of small involuntary fixation saccades (SIFSs) in different neurodegenerative diseases: the role of noise. Exp Brain Res 2023:10.1007/s00221-023-06633-6. [PMID: 37247026 DOI: 10.1007/s00221-023-06633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
During the attempt to steadily fixate at a single spot, sequences of small involuntary fixation saccades (SIFSs, known also as microsaccades οr intrusions) occur which form spatio-temporal patterns such as square wave jerks (SWJs), a pattern characterised by alternating centrifugal and centripetal movements of similar magnitude. In many neurodegenerative disorders, SIFSs exhibit elevated amplitudes and frequencies. Elevated SIFS amplitudes have been shown to favour the occurrence of SWJs ("SWJ coupling"). We analysed SIFSs in different subject groups comprising both healthy controls (CTR) and patients with amyotrophic lateral sclerosis (ALS) and progressive supranuclear palsy (PSP), i.e. two neurodegenerative diseases with completely different neuropathological basis and different clinical phenotypes. We show that, across these groups, the relations between SIFS amplitude and the relative frequency of SWJ-like patterns and other SIFS characteristics follow a common law. As an explanation, we propose that physiological and technical noise comprises a small, amplitude-independent component that has little effect on large SIFSs, but causes considerable deviations from the intended amplitude and direction of small ones. Therefore, in contrast to large SIFSs, successive small SIFSs have a lower chance to meet the SWJ similarity criteria. In principle, every measurement of SIFSs is affected by an amplitude-independent noise background. Therefore, the dependence of SWJ coupling on SIFS amplitude will probably be encountered in almost any group of subjects. In addition, we find a positive correlation between SIFS amplitude and frequency in ALS, but none in PSP, suggesting that the elevated amplitudes might arise at different sites in the two disorders.
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Affiliation(s)
- Wolfgang Becker
- Section of Neurophysiology, Department of Neurology, University of Ulm, Ulm, Germany.
| | - Anna Behler
- Section of Neurophysiology, Department of Neurology, University of Ulm, Ulm, Germany
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Olga Vintonyak
- Section of Neurophysiology, Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Section of Neurophysiology, Department of Neurology, University of Ulm, Ulm, Germany
- Department of Neurology, University of Ulm, Ulm, Germany
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Youn CE, Lu C, Cauchi J, MacGowan D, Morgenstern R, Scelsa S. Oculomotor Dysfunction in Motor Neuron Disease. J Neuromuscul Dis 2023; 10:405-410. [PMID: 36872786 DOI: 10.3233/jnd-221579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Though eye movements are relatively spared in motor neuron disease (MND), recent literature suggests patients may exhibit oculomotor dysfunction (OD). Frontal lobe involvement has been postulated based on oculomotor pathway anatomy and clinical overlap of amyotrophic lateral sclerosis (ALS) with frontotemporal dementia. We examined oculomotor characteristics in patients with MND presenting to an ALS Center, hypothesizing that patients with prominent upper motor neuron involvement or pseudobulbar affect (PBA) may demonstrate greater OD. METHODS This was a single-center prospective observational study. Patients with diagnosis of MND were examined at bedside. Center for Neurologic Study-Liability Scale (CNS-LS) was administered to screen for pseudobulbar affect. Primary outcome was OD and the secondary outcome was the association between presence of OD in patients with MND experiencing symptoms of PBA or upper motor neuron dysfunction. Wilcoxon rank-sum scores and Fisher's exact tests were used to perform statistical analyses. RESULTS 53 patients with MND underwent the clinical ophthalmic evaluation. On bedside examination, 34 patients (64.2%) presented with OD. There were no significant associations between locations of MND at presentation and the presence or type of OD. OD was associated with increased disease severity as measured by reduced FVC (p = 0.02). There was no significant association between OD and CNS-LS (p = 0.2). DISCUSSION Though our study did not find a significant association between OD and upper versus lower MND at presentation, OD may be useful as an additional clinical marker for advanced disease.
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Affiliation(s)
- Clover E Youn
- Icahn School of Medicine at Mount Sinai Downtown, Department of Neurology, New York, New York, USA
| | - Christine Lu
- Icahn School of Medicine at Mount Sinai Downtown, Department of Neurology, New York, New York, USA
| | - Jonathan Cauchi
- Icahn School of Medicine at Mount Sinai Downtown, Department of Neurology, New York, New York, USA
| | - Daniel MacGowan
- Icahn School of Medicine at Mount Sinai Downtown, Department of Neurology, New York, New York, USA
| | - Rachelle Morgenstern
- Icahn School of Medicine at Mount Sinai Downtown, Department of Neurology, New York, New York, USA
| | - Stephen Scelsa
- Icahn School of Medicine at Mount Sinai Downtown, Department of Neurology, New York, New York, USA
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Yae Y, Yuge K, Maeda T, Ichinose F, Matsuo M, Kobayashi O, Okanari K, Baba Y, Yonee C, Maruyama S, Shibata M, Fujii T, Chinen M, Yamashita Y. Exploratory evaluation of an eye-tracking system in patients with advanced spinal muscular atrophy type I receiving nusinersen. Front Neurol 2022; 13:918255. [PMID: 36247789 PMCID: PMC9563313 DOI: 10.3389/fneur.2022.918255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study evaluated the feasibility of a matching-pair test using eye-tracking technology to assess nusinersen effectiveness in patients with advanced spinal muscular atrophy (SMA) type I.MethodsThis prospective, observational study enrolled patients with 5q-SMA type I who had lost gross motor function. Three different levels of matching-pair tests were conducted using the eye-gaze system (My Tobii; TobiiDynavox Inc.) at baseline, and after 9 and 24 weeks of nusinersen treatment. The primary endpoint was the change from baseline in matching-pair test scores and response times (i.e., the time to answer matching-pair test) at 24 weeks from baseline. Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND), Pediatric Quality of Life inventory for patients with Neuromuscular Disease (PedsQL-NM) and Numerical Rating Scale (NRS) scores were also assessed as secondary endpoints. Analysis of ocular fixation was performed as an additional analysis. This study was registered at https://www.umin.ac.jp/ctr/ (UMIN000033935).ResultsSeven patients (one male, six female) aged 5–21 years (median 11 years) were enrolled; all patients were bedridden and six patients were ventilated. All seven patients were able to conduct level 1 matching-pair tests at each assessment; five patients were also able to conduct levels 2 and 3. Two patients (those with the highest CHOP-INTEND scores) were able to complete all tests correctly within 60 s. There was a non-significant trend toward improvement in CHOP-INTEND, PedsQL-NM, and NRS scores over the 6-month period. There were no significant differences in the number of actions, errors, correct answers, or response times between baseline and Week 9 or 24 at any level. However, the result of an additional analysis suggests that detection of eye movement would be useful to evaluate for advanced SMA.ConclusionsEye-tracking systems are possibly feasible for the assessment of treatment efficacy in patients with advanced SMA type I.
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Affiliation(s)
- Yukako Yae
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kotaro Yuge
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- *Correspondence: Kotaro Yuge
| | - Toshiyuki Maeda
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Fumio Ichinose
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Osamu Kobayashi
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kazuo Okanari
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yusei Baba
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Chihiro Yonee
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shinsuke Maruyama
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Minoru Shibata
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan
| | - Tatsuya Fujii
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan
| | | | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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van Esch BF, van der Zaag-Loonen H, Bruintjes T, Kuijpers T, van Benthem PPG. Interventions for Menière's disease: an umbrella systematic review. BMJ Evid Based Med 2022; 27:235-245. [PMID: 34750154 DOI: 10.1136/bmjebm-2020-111410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To systematically review the efficacy of interventions for Menière's disease (MD) to report clinical implications of the results and to identify areas for future valuable research. METHODS In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Abstracts (PRISMA-A) guideline, a systematic online database search was conducted in which MEDLINE (PubMed), Embase (Ovid) and CENTRAL (Cochrane Library) were searched until May 2021 in order to search for the efficacy of treatment was analysed in a systematic review. Systematic reviews (SRs) on treatments for MD were screened for eligible interventions. From these SRs, we included placebo randomised controlled trials (RCTs). A separate search was conducted to identify RCTs on treatment modalities that were systematically reviewed yet published after the conduction of these SRs. The primary outcome was control of vertigo as defined by the American guideline as published in 1995. The PRISMA-A and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to appraise and evaluate the certainty of evidence. RESULTS We found five SRs from which 19 RCTs were extracted. Five RCTs were added by the separate search resulting in a total of 25 RCTs (n=1248) which evaluated the efficacy of betahistine dihydrochloride, intratympanic injections with gentamicin or steroids, endolymphatic sac surgery and pressure pulse therapy. Evidence on the efficacy of interventions for patients with MD is generally of low certainty. Betahistine (48 mg per day and 144 mg per day) and positive pressure therapy probably do not reduce MD symptoms when compared with placebo. Intratympanic injection with gentamicin or steroids, or treatment with endolymphatic surgery may reduce symptoms in MD when compared with placebo. CONCLUSIONS A definite effective and well-tolerated therapy for MD has yet to be discovered and information on the natural course of disease is one of the biggest flaws in current research. PROSPERO REGISTRATION NUMBER CRD4201502424.
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Affiliation(s)
- Babette Fiebke van Esch
- Apeldoorn Dizziness Centre, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
- Otorhinolaryngology, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | | | - Tjasse Bruintjes
- Apeldoorn Dizziness Centre, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
| | - Ton Kuijpers
- Guideline Development and Research, Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Peter Paul G van Benthem
- Otorhinolaryngology - Head and Neck Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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Carelli L, Solca F, Tagini S, Torre S, Verde F, Ticozzi N, Ferrucci R, Pravettoni G, Aiello EN, Silani V, Poletti B. Gaze-Contingent Eye-Tracking Training in Brain Disorders: A Systematic Review. Brain Sci 2022; 12:brainsci12070931. [PMID: 35884737 PMCID: PMC9313363 DOI: 10.3390/brainsci12070931] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 06/30/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Eye movement abnormalities in association with cognitive and emotional deficits have been described in neurological, neurodevelopmental, and psychiatric disorders. Eye-Tracking (ET) techniques could therefore enhance cognitive interventions by contingently providing feedback to patients. Since no consensus has been reached thus far on this approach, this study aimed at systematically reviewing the current evidence. This review was performed and reported according to PRISMA guidelines. Records were searched for in PubMed, Web of Science, and Scopus (1990–2021) through the following string: (‘Eye Tracking’ OR ‘Eye-Tracking’ OR ‘Oculomotor’) AND (‘Neuropsychol*’ OR ‘Cognitive’) AND (‘Rehabilitation’ OR ‘Training’ OR ‘Stimulation’). Study outcomes were thematically classified and qualitatively synthesized. A structured quality assessment was performed. A total of 24 articles were included, addressing neurodevelopmental (preterm infants and children with autism spectrum disorder, Rett syndrome, or ADHD; N = 14), psychiatric (mood and anxiety disorders or alcohol dependence; N = 7), and neurological conditions (stroke; N = 3). Overall, ET gaze-contingent training proved to be effective in improving cognitive and emotional alterations. However, population heterogeneity limits the generalizability of results. ET gaze-contingent protocols allow researchers to directly and dynamically train attentional functions; together with the recruitment of implicit, “bottom-up” strategies, these protocols are promising and possibly integrable with traditional cognitive approaches.
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Affiliation(s)
- Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, I.R.C.C.S., 20149 Milan, Italy; (F.S.); (S.T.); (F.V.); (N.T.); (E.N.A.); (V.S.); (B.P.)
- Correspondence:
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, I.R.C.C.S., 20149 Milan, Italy; (F.S.); (S.T.); (F.V.); (N.T.); (E.N.A.); (V.S.); (B.P.)
| | - Sofia Tagini
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, 10126 Turin, Italy;
- Istituto Auxologico Italiano, I.R.C.C.S., U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, 28824 Piancavallo, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, I.R.C.C.S., 20149 Milan, Italy; (F.S.); (S.T.); (F.V.); (N.T.); (E.N.A.); (V.S.); (B.P.)
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, I.R.C.C.S., 20149 Milan, Italy; (F.S.); (S.T.); (F.V.); (N.T.); (E.N.A.); (V.S.); (B.P.)
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, 20122 Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, I.R.C.C.S., 20149 Milan, Italy; (F.S.); (S.T.); (F.V.); (N.T.); (E.N.A.); (V.S.); (B.P.)
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, 20122 Milan, Italy
| | - Roberta Ferrucci
- Department of Health Sciences, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, International Medical School, University of Milan, 20122 Milan, Italy;
- Neurology Clinic III, ASST Santi Paolo e Carlo, 20142 Milan, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Foundation Maggiore Policlinico Hospital, 20162 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, I.R.C.C.S., 20149 Milan, Italy; (F.S.); (S.T.); (F.V.); (N.T.); (E.N.A.); (V.S.); (B.P.)
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, I.R.C.C.S., 20149 Milan, Italy; (F.S.); (S.T.); (F.V.); (N.T.); (E.N.A.); (V.S.); (B.P.)
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, 20122 Milan, Italy
- Department of Health Sciences, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, International Medical School, University of Milan, 20122 Milan, Italy;
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, I.R.C.C.S., 20149 Milan, Italy; (F.S.); (S.T.); (F.V.); (N.T.); (E.N.A.); (V.S.); (B.P.)
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Eye Movement Abnormalities in Amyotrophic Lateral Sclerosis. Brain Sci 2022; 12:brainsci12040489. [PMID: 35448020 PMCID: PMC9026966 DOI: 10.3390/brainsci12040489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022] Open
Abstract
It is generally believed that eye movements are completely spared in amyotrophic lateral sclerosis (ALS). Although a series of eye movement abnormalities has been recognized in recent years, the findings are highly controversial, and bulbar disabilities should be considered in relation to eye movement abnormalities. The present study aimed to determine whether eye movement abnormalities are present in ALS and, if so, to investigate their characteristics and their association with bulbar disability in ALS patients. A total of 60 patients and 30 controls were recruited and underwent the standardized evaluations of the oculomotor system using videonystagmography. Square-wave jerks (OR: 16.20, 95% CI: 3.50−74.95, p < 0.001) and abnormal cogwheeling during smooth pursuit (OR: 14.04, 95% CI: 3.00−65.75, p = 0.001) were more frequently observed in ALS patients than in the control subjects. In subgroup analyses, square-wave jerks (OR: 26.51, 95% CI: 2.83−248.05, p = 0.004) and abnormal cogwheeling during smooth pursuit (OR: 6.56, 95% CI: 1.19−36.16, p = 0.031) were found to be more common in ALS patients with bulbar involvement (n = 44) than in those without bulbar involvement (n = 16). There were no significant differences in the investigated eye movement parameters between bulbar-onset (n = 12) and spinal-onset patients (n = 48). ALS patients showed a range of eye movement abnormalities, affecting mainly the ocular fixation and smooth pursuit systems. Our pioneering study indicates that the region of involvement could better indicate the pathophysiological essence of the abnormalities than the type of onset pattern in ALS. Eye movement abnormalities may be potential clinical markers for objectively evaluating upper brainstem or supratentorial cerebral lesion neurodegeneration in ALS.
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Poletti B, Solca F, Carelli L, Diena A, Colombo E, Torre S, Maranzano A, Greco L, Cozza F, Lizio A, Ferrucci R, Girotti F, Verde F, Morelli C, Lunetta C, Silani V, Ticozzi N. Association of Clinically Evident Eye Movement Abnormalities With Motor and Cognitive Features in Patients With Motor Neuron Disorders. Neurology 2021; 97:e1835-e1846. [PMID: 34504031 DOI: 10.1212/wnl.0000000000012774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although oculomotor abnormalities (OMAs) are not usually considered prominent features of amyotrophic lateral sclerosis (ALS), they may represent potential clinical markers of neurodegeneration, especially when investigated together with cognitive and behavioral alterations. The aim of our study was to identify patterns of clinically evident OMAs in patients with ALS and to correlate such findings with cognitive-behavioral data. METHODS Three consecutive inpatient cohorts of Italian patients with ALS and controls were retrospectively evaluated to assess the frequency of OMAs and cognitive-behavioral alterations. The ALS population was divided into a discovery cohort and a replication cohort. Controls included a cohort of cognitively impaired individuals and patients with Alzheimer disease (AD). Participants underwent bedside eye movement evaluation to determine the presence and pattern of OMAs. Cognitive assessment was performed with a standard neuropsychological battery (discovery ALS cohort and AD cohort) and the Italian Edinburgh Cognitive and Behavioural ALS Screen (ECAS) (replication ALS cohort). RESULTS We recruited 864 individuals with ALS (635 discovery, 229 replication), 798 who were cognitively unimpaired and 171 with AD. OMAs were detected in 10.5% of our ALS cohort vs 1.6% of cognitively unimpaired controls (p = 1.2 × 10-14) and 11.4% of patients with AD (p = NS). The most frequent deficits were smooth pursuit and saccadic abnormalities. OMA frequency was higher in patients with bulbar onset, prominent upper motor neuron signs, and advanced disease stages. Cognitive dysfunction was significantly more frequent in patients with OMAs in both ALS cohorts (p = 1.1 × 10-25). Furthermore, OMAs significantly correlated with the severity of cognitive impairment and with pathologic scores at the ECAS ALS-specific domains. Last, OMAs could be observed in 35.0% of cognitively impaired patients with ALS vs 11.4% of patients with AD (p = 6.4 × 10-7), suggesting a possible involvement of frontal oculomotor areas in ALS. CONCLUSION Patients with ALS showed a range of clinically evident OMAs, and these alterations were significantly correlated with cognitive, but not behavioral, changes. OMAs may be a marker of neurodegeneration, and bedside assessment represents a rapid, highly specific tool for detecting cognitive impairment in ALS.
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Affiliation(s)
- Barbara Poletti
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federica Solca
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Laura Carelli
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Alberto Diena
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Eleonora Colombo
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Silvia Torre
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Alessio Maranzano
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Lucia Greco
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federica Cozza
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Andrea Lizio
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Roberta Ferrucci
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Floriano Girotti
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Federico Verde
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Claudia Morelli
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Christian Lunetta
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Vincenzo Silani
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy
| | - Nicola Ticozzi
- From the Department of Neurology (B.P., L.C., A.D., E.C., S.T., A.M., F.G., F.V., C.M., V.S., N.T.), Istituto Auxologico Italiano IRCCS; Department of Pathophysiology and Transplantation (F.S., F.V., V.S., N.T.), Dino Ferrari Center and Department of Health Sciences (R.F.), Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Universitá degli Studi di Milano; Neuromuscular Omnicenter (L.G., F.C., A.L., C.L.), Fondazione Serena Onlus; Department of Materials Science and COMiB Research Center (F.C.), Università degli Studi di Milano-Bicocca; ASST Santi Paolo e Carlo (R.F.), Neurology Clinic III; and IRCCS Ca Granda Foundation Maggiore Policlinico Hospital (R.F.), Milan, Italy.
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11
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Liu Z, Yang Z, Gu Y, Liu H, Wang P. The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis. PLoS One 2021; 16:e0254059. [PMID: 34252113 PMCID: PMC8274929 DOI: 10.1371/journal.pone.0254059] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
Background Eye tracking (ET) is a viable marker for the recognition of cognitive disorders. We assessed the accuracy and clinical value of ET for the diagnosis of cognitive disorders in patients. Methods We searched the Medline, Embase, Web of Science, Cochrane Library, and Pubmed databases from inception to March 2, 2021, as well as the reference lists of identified primary studies. We included articles written in English that investigated ET for cognitive disorder patients—Mild cognitive impairment (MCI), Alzheimer’s disease (AD), Amyotrophic lateral sclerosis (ALS), and dementia. Two independent researchers extracted the data and the characteristics of each study; We calculated pooled sensitivities and specificities. A hierarchical summary of receiver performance characteristics (HSROC) model was used to test the diagnostic accuracy of ET for cognitive impairment (CI). Findings 11 studies met the inclusion criteria and were included in qualitative comprehensive analysis. Meta-analysis was performed on 9 trials using Neuropsychological Cognitive Testing (NCT) as the reference standard. The comprehensive sensitivity and specificity of ET for detecting cognitive disorders were 0.75 (95% CI 0.72–0.79) and 0.73 (95% CI 0.70 to 0.76), respectively. The combined positive likelihood ratio (LR+) was 2.74 (95%CI 2.32–3.24) and the negative likelihood ratio (LR−) was 0.27 (95%CI 0.18–0.42). Conclusions This review showed that ET technology could be used to detect the decline in CI, clinical use of ET techniques in combination with other tools to assess CI can be encouraged.
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Affiliation(s)
- Zicai Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Zhen Yang
- Histology and Imaging platform, Core Facilities of West China Hospital, Sichuan University, China
| | - Yueming Gu
- Rehabilitation College of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The 7th Affiliated Hospital of Sun Yat-Sen University (Shenzhen), Shenzhen, Guangdong, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
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12
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Rojas P, Ramírez AI, Fernández-Albarral JA, López-Cuenca I, Salobrar-García E, Cadena M, Elvira-Hurtado L, Salazar JJ, de Hoz R, Ramírez JM. Amyotrophic Lateral Sclerosis: A Neurodegenerative Motor Neuron Disease With Ocular Involvement. Front Neurosci 2020; 14:566858. [PMID: 33071739 PMCID: PMC7544921 DOI: 10.3389/fnins.2020.566858] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that causes degeneration of the lower and upper motor neurons and is the most prevalent motor neuron disease. This disease is characterized by muscle weakness, stiffness, and hyperreflexia. Patients survive for a short period from the onset of the disease. Most cases are sporadic, with only 10% of the cases being genetic. Many genes are now known to be involved in familial ALS cases, including some of the sporadic cases. It has also been observed that, in addition to genetic factors, there are numerous molecular mechanisms involved in these pathologies, such as excitotoxicity, mitochondrial disorders, alterations in axonal transport, oxidative stress, accumulation of misfolded proteins, and neuroinflammation. This pathology affects the motor neurons, the spinal cord, the cerebellum, and the brain, but recently, it has been shown that it also affects the visual system. This impact occurs not only at the level of the oculomotor system but also at the retinal level, which is why the retina is being proposed as a possible biomarker of this pathology. The current review discusses the main aspects mentioned above related to ALS, such as the main genes involved, the most important molecular mechanisms that affect this pathology, its ocular involvement, and the possible usefulness of the retina as a biomarker.
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Affiliation(s)
- Pilar Rojas
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,Hospital General Universitario Gregorio Marañón, Instituto Oftálmico de Madrid, Madrid, Spain
| | - Ana I Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - José A Fernández-Albarral
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Inés López-Cuenca
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Elena Salobrar-García
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Cadena
- Hospital General Universitario Gregorio Marañón, Instituto Oftálmico de Madrid, Madrid, Spain
| | - Lorena Elvira-Hurtado
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan J Salazar
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa de Hoz
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.,OFTARED, ISCIII, Madrid, Spain.,Departamento de Inmunología Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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13
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Becker W, Gorges M, Lulé D, Pinkhardt E, Ludolph AC, Kassubek J. Saccadic intrusions in amyotrophic lateral sclerosis (ALS). J Eye Mov Res 2019; 12:10.16910/jemr.12.6.8. [PMID: 33828758 PMCID: PMC7962685 DOI: 10.16910/jemr.12.6.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The attempt to quietly fixate at a small visual object is continuously interrupted by a variety of fixational eye movements comprising, among others, a continuum of saccadic intrusions (SI) which range in size from microsaccades with amplitudes ≤0.25° to larger refixation saccades of up to about 2°. The size and frequency of SI varies considerably among individuals and is known to increase in neurodegenerative diseases such as progressive supranuclear palsy (PSP), and amyotrophic lateral sclerosis (ALS). However, studies of ALS disagree whether also the frequency of SI increases. We undertook an analysis of SI in 119 ALS patients and 47 age-matched healthy controls whose eye movements during fixation and tests of executive functions (e.g antisaccades) had been recorded by video-oculography according to standardised procedures. SI were categorised according to their spatio-temporal patterns as stair case, back-and-forth and square wave jerks (a subcategory of back-and-forth). The SI of patients and controls were qualitatively similar (same direction preferences, similar differences between patterns), but were enlarged in ALS. Notably however, no increase of SI frequency could be demonstrated. Yet, there were clear correlations with parameters such as eye blink rate or errors in a delayed saccade task that suggest an impairment of inhibitory mechanisms, in keeping with the notion of a frontal dysfunction in ALS. However, it remains unclear how the impairment of inhibitory mechanisms in ALS could selectively increase the amplitude of intrusions without changing their frequency of occurrence.
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14
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Bueno APA, Sato JR, Hornberger M. Eye tracking - The overlooked method to measure cognition in neurodegeneration? Neuropsychologia 2019; 133:107191. [PMID: 31521634 DOI: 10.1016/j.neuropsychologia.2019.107191] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/26/2019] [Accepted: 09/08/2019] [Indexed: 12/11/2022]
Abstract
Eye tracking (ET) studies are becoming increasingly popular due to rapid methodological and technological advances as well as the development of cost efficient and portable eye trackers. Although historically ET has been mostly employed in psychophysics or developmental cognition studies, there is also promising scope to use ET for movement disorders and measuring cognitive processes in neurodegeneration. Particularly, ET can be a powerful tool for cognitive and neuropsychological assessments of patients with pathologies affecting motor and verbal abilities, as tasks can be adapted without requiring motor (except eye movements) or verbal responses. In this review, we will examine the existing evidence of ET methods in neurodegenerative conditions and its potential clinical impact for cognitive assessment. We highlight that current evidence for ET is mostly focused on diagnostics of cognitive impairments in neurodegenerative disorders, where it is debatable whether it has any more sensitivity or specificity than existing cognitive assessments. By contrast, there is currently a lack of ET studies in more advanced disease stages, when patients' motor and verbal functions can be significantly affected, and standard cognitive assessments are challenging or often not possible. We conclude that ET is a promising method not only for cognitive diagnostics but more importantly, for potential cognitive disease tracking in progressive neurodegenerative conditions.
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Affiliation(s)
- A P A Bueno
- - Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil; - Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - J R Sato
- - Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - M Hornberger
- - Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK; - Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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15
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Bradshaw MJ, Gilden D, Lavin P, Sriram S. Clinical Reasoning: A 57-year-old woman with ataxia and oscillopsia: Varicella-zoster encephalitis. Neurology 2018; 87:e61-4. [PMID: 27527543 DOI: 10.1212/wnl.0000000000002981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Michael J Bradshaw
- From the Department of Neurology (M.J.B., P.L., S.S.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology and Immunology & Microbiology (D.G.), University of Colorado School of Medicine, Aurora.
| | - Don Gilden
- From the Department of Neurology (M.J.B., P.L., S.S.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology and Immunology & Microbiology (D.G.), University of Colorado School of Medicine, Aurora
| | - Patrick Lavin
- From the Department of Neurology (M.J.B., P.L., S.S.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology and Immunology & Microbiology (D.G.), University of Colorado School of Medicine, Aurora
| | - Subramaniam Sriram
- From the Department of Neurology (M.J.B., P.L., S.S.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology and Immunology & Microbiology (D.G.), University of Colorado School of Medicine, Aurora
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16
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Poletti B, Carelli L, Faini A, Solca F, Meriggi P, Lafronza A, Ciringione L, Pedroli E, Ticozzi N, Ciammola A, Cipresso P, Riva G, Silani V. The Arrows and Colors Cognitive Test (ACCT): A new verbal-motor free cognitive measure for executive functions in ALS. PLoS One 2018; 13:e0200953. [PMID: 30091987 PMCID: PMC6084851 DOI: 10.1371/journal.pone.0200953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background and objective The presence of executive deficits in patients with Amyotrophic Lateral Sclerosis is well established, even if standardized measures are difficult to obtain due to progressive physical disability of the patients. We present clinical data concerning a newly developed measure of cognitive flexibility, administered by means of Eye-Tracking (ET) technology in order to bypass verbal-motor limitations. Methods 21 ALS patients and 21 age-and education-matched healthy subjects participated in an ET-based cognitive assessment, including a newly developed test of cognitive flexibility (Arrows and Colors Cognitive Test–ACCT) and other oculomotor-driven measures of cognitive functions. A standard screening of frontal and working memory abilities and global cognitive efficiency was administered to all subjects, in addition to a psychological self-rated assessment. For ALS patients, a clinical examination was also performed. Results ACCT successfully discriminated between patients and healthy controls, mainly concerning execution times obtained at different subtests. A qualitative analysis performed on error distributions in patients highlighted a lower prevalence of perseverative errors, with respect to other type of errors. Correlations between ACCT and other ET-based frontal-executive measures were significant and involved different frontal sub-domains. Limited correlations were observed between ACCT and standard ‘paper and pencil’ cognitive tests. Conclusions The newly developed ET-based measure of cognitive flexibility could be a useful tool to detect slight frontal impairments in non-demented ALS patients by bypassing verbal-motor limitations through the oculomotor-driven administration. The findings reported in the present study represent the first contribution towards the development of a full verbal-motor free executive test for ALS patients.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
- * E-mail:
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences—IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
| | - Paolo Meriggi
- ICT & Biomedical Technology Integration Unit, Centre for Innovation and Technology Transfer (CITT), Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luciana Ciringione
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience—IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
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17
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Kang BH, Kim JI, Lim YM, Kim KK. Abnormal Oculomotor Functions in Amyotrophic Lateral Sclerosis. J Clin Neurol 2018; 14:464-471. [PMID: 30198218 PMCID: PMC6172508 DOI: 10.3988/jcn.2018.14.4.464] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/25/2018] [Accepted: 03/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Although traditionally regarded as spared, a range of oculomotor dysfunction has been recognized in amyotrophic lateral sclerosis (ALS) patients. ALS is nowadays considered as a neurodegenerative disorder of a third compartment comprising widespread areas of extra-motor brain including cerebellum. Our objective was to perform an observational study to examine for ocular motor dysfunction in patients with ALS and for any differences between bulbar-onset and spinal-onset patients. METHODS Thirty two ALS patients (bulbar onset: 10, spinal onset: 22) underwent the standardized systemic evaluations using video-oculography. RESULTS Oculomotor dysfunctions such as square wave jerks, saccadic dysmetria, abnormal cogwheeling smooth pursuits and head shaking and positional nystagmus of central origin have been observed in the ALS patients at a relatively early stage. Abnormal smooth pursuits and saccadic dysmetria were increased in the bulbar-onset compared to the spinal-onset (p<0.05). CONCLUSIONS These oculomotor abnormalities may be a marker of neuro-degeneration beyond motor neurons in ALS, especially in bulbar-onset disease. Future longitudinal studies of eye movement abnormalities have provided insights into the distribution and nature of the disease process.
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Affiliation(s)
- Bong Hui Kang
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,Department of Neurology, Dankook University College of Medicine, Dankook University Hospital, Cheonan, Korea
| | - Jae Il Kim
- Department of Neurology, Dankook University College of Medicine, Dankook University Hospital, Cheonan, Korea
| | - Young Min Lim
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kwang Kuk Kim
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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18
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Woolley SC, Rush BK. Considerations for Clinical Neuropsychological Evaluation in Amyotrophic Lateral Sclerosis. Arch Clin Neuropsychol 2018; 32:906-916. [PMID: 29028904 DOI: 10.1093/arclin/acx089] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/14/2017] [Indexed: 12/11/2022] Open
Abstract
The clinical neuropsychologist has the opportunity to be uniquely involved in the evaluation and treatment of individuals with amyotrophic lateral sclerosis (ALS). We review the current literature that defines cognitive and behavioral symptoms in ALS, including current knowledge of the neuropathological and genetic underpinning for these symptoms. There are unique considerations for clinical neuropsychological evaluation and clinical research in ALS and we highlight these in this review. Specifically, we shed light on special factors that contribute to our understanding of cognitive and behavioral impairment in ALS, including co-morbid symptoms, differential diagnosis, and considerations for longitudinal tracking of phenotypes. We discuss the rationale for proposing a specific approach to such as cognitive screening, test selection, response modality consideration, and test-retest intervals. With this didactic overview, the clinical neuropsychologist has the potential to learn more about the heterogeneous presentation of motor and neuropsychological symptoms in ALS. Furthermore, the reader has the opportunity to understand what it takes to develop a valid assessment approach particularly when the phenotype of ALS remains undefined in some regards. This clinical practice review sets the stage for the clinical neuropsychologist to further contribute to our clinical and scientific understanding of ALS and cognition.
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Affiliation(s)
| | - Beth K Rush
- Mayo Clinic Florida, Department of Psychiatry and Psychology, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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19
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Turner MR, Eisen A, Kiernan MC, Ravits J, Swash M. Kinnier Wilson's puzzling features of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:657-666. [PMID: 29122933 DOI: 10.1136/jnnp-2017-317217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Andrew Eisen
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney; Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Ravits
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
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20
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Pinto-Grau M, Hardiman O, Pender N. The Study of Language in the Amyotrophic Lateral Sclerosis - Frontotemporal Spectrum Disorder: a Systematic Review of Findings and New Perspectives. Neuropsychol Rev 2018; 28:251-268. [DOI: 10.1007/s11065-018-9375-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/01/2018] [Indexed: 12/11/2022]
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21
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Puri S, Shaikh AG. Basic and translational neuro-ophthalmology of visually guided saccades: disorders of velocity. EXPERT REVIEW OF OPHTHALMOLOGY 2017; 12:457-473. [PMID: 30774705 PMCID: PMC6377082 DOI: 10.1080/17469899.2017.1395695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Saccades are rapid, yoked eye movements in an effort to direct a target over fovea. The complex circuitry of saccadic eye movements has been exhaustively described. As a result clinicians can elegantly localize the pathology if it falls on the neuraxis responsible for saccades. Traditionally saccades are studied with their quantitative characteristics such as amplitude, velocity, duration, direction, latency and accuracy. AREAS COVERED Amongst all subtypes, the physiology of the visually guided saccades is most extensively studied. Here we will review the basic and pertinent neuro-anatomy and physiology of visually guided saccade and then discuss common or classic disorders affecting the velocity of visually guided saccades. We will then discuss the basic mechanism for saccade slowing in these disorders. EXPERT COMMENTARY Prompt appreciation of disorders of saccade velocity is critical to reach appropriate diagnosis. Disorders of midbrain, cerebellum, or basal ganglia can lead to prolonged transition time during gaze shift and decreased saccade velocity.
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Affiliation(s)
- Sushant Puri
- Dept. of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, United States
| | - Aasef G. Shaikh
- Dept. of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, United States
- Daroff-DelOsso Ocular Motility Laboratory, Cleveland VA Medical Center, Cleveland, Ohio, United States
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22
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Delva A, Thakore N, Pioro EP, Poesen K, Saunders-Pullman R, Meijer IA, Rucker JC, Kissel JT, Van Damme P. Finger extension weakness and downbeat nystagmus motor neuron disease syndrome: A novel motor neuron disorder? Muscle Nerve 2017; 56:1164-1168. [PMID: 28440863 PMCID: PMC5656559 DOI: 10.1002/mus.25669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/26/2017] [Accepted: 04/17/2017] [Indexed: 12/11/2022]
Abstract
Introduction: Disturbances of eye movements are infrequently encountered in motor neuron diseases (MNDs) or motor neuropathies, and there is no known syndrome that combines progressive muscle weakness with downbeat nystagmus. Methods: To describe the core clinical features of a syndrome of MND associated with downbeat nystagmus, clinical features were collected from 6 patients. Results: All patients had slowly progressive muscle weakness and wasting in combination with downbeat nystagmus, which was clinically most obvious in downward and lateral gaze. Onset was in the second to fourth decade with finger extension weakness, progressing to other distal and sometimes more proximal muscles. Visual complaints were not always present. Electrodiagnostic testing showed signs of regional motor axonal loss in all patients. Discussion: The etiology of this syndrome remains elusive. Because finger extension weakness and downbeat nystagmus are the discriminating clinical features of this MND, we propose the name FEWDON‐MND syndrome. Muscle Nerve56: 1164–1168, 2017
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Affiliation(s)
- Aline Delva
- Department of Neurology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium
| | - Nimish Thakore
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Erik P Pioro
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Koen Poesen
- Laboratory for Molecular Neurobiomarker Research, University of Leuven (KU Leuven), Leuven, Belgium.,Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel and Icahn School of Medicine at Mount Sinai, New York, USA
| | - Inge A Meijer
- Department of Neurology, Mount Sinai Beth Israel and Icahn School of Medicine at Mount Sinai, New York, USA
| | - Janet C Rucker
- Department of Neurology, Mount Sinai Beth Israel and Icahn School of Medicine at Mount Sinai, New York, USA
| | - John T Kissel
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Philip Van Damme
- Department of Neurology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosciences, University of Leuven (KU Leuven), Leuven, Belgium.,Laboratory of Neurobiology, VIB Center for Brain & Disease Research, VIB, Leuven, Belgium
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23
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Strong MJ, Abrahams S, Goldstein LH, Woolley S, Mclaughlin P, Snowden J, Mioshi E, Roberts-South A, Benatar M, HortobáGyi T, Rosenfeld J, Silani V, Ince PG, Turner MR. Amyotrophic lateral sclerosis - frontotemporal spectrum disorder (ALS-FTSD): Revised diagnostic criteria. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:153-174. [PMID: 28054827 PMCID: PMC7409990 DOI: 10.1080/21678421.2016.1267768] [Citation(s) in RCA: 557] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
This article presents the revised consensus criteria for the diagnosis of frontotemporal dysfunction in amyotrophic lateral sclerosis (ALS) based on an international research workshop on frontotemporal dementia (FTD) and ALS held in London, Canada in June 2015. Since the publication of the Strong criteria, there have been considerable advances in the understanding of the neuropsychological profile of patients with ALS. Not only is the breadth and depth of neuropsychological findings broader than previously recognised - - including deficits in social cognition and language - but mixed deficits may also occur. Evidence now shows that the neuropsychological deficits in ALS are extremely heterogeneous, affecting over 50% of persons with ALS. When present, these deficits significantly and adversely impact patient survival. It is the recognition of this clinical heterogeneity in association with neuroimaging, genetic and neuropathological advances that has led to the current re-conceptualisation that neuropsychological deficits in ALS fall along a spectrum. These revised consensus criteria expand upon those of 2009 and embrace the concept of the frontotemporal spectrum disorder of ALS (ALS-FTSD).
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Affiliation(s)
- Michael J Strong
- a Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry , London , Ontario , Canada
| | - Sharon Abrahams
- b Department of Psychology, School of Philosophy, Psychology & Language Sciences , Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh , Edinburgh , UK
| | - Laura H Goldstein
- c King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience , London , UK
| | - Susan Woolley
- d Forbes Norris MDA/ALS Research Centre, California Pacific Medical Centre , San Francisco , CA , USA
| | - Paula Mclaughlin
- e Western University , Schulich School of Medicine & Dentistry , London , ON , Canada
| | - Julie Snowden
- f Greater Manchester Neuroscience Centre , Salford Royal NHS Trust and University of Manchester , Manchester , UK
| | - Eneida Mioshi
- g Faculty of Medicine and Health Sciences , University of East Anglia , Norwich , UK
| | - Angie Roberts-South
- h Northwestern University , Roxelyn and Richard Pepper Department of Communication Sciences and Disorders , Evanston , IL , USA
| | - Michael Benatar
- i Department of Neurology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Tibor HortobáGyi
- j Department of Neuropathology , Institute of Pathology, University of Debrecen , Debrecen , Hungary
| | - Jeffrey Rosenfeld
- k Department of Neurology , Loma Linda University School of Medicine , Loma Linda , CA , USA
| | - Vincenzo Silani
- l Department of Neurology and Laboratory Neuroscience - IRCCS Istituto Auxologico Italiano, Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy
| | - Paul G Ince
- m Sheffield Institute for Translational Neuroscience, Department of Neuroscience , The University of Sheffield , Sheffield , UK , and
| | - Martin R Turner
- n Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
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24
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Poletti B, Carelli L, Solca F, Lafronza A, Pedroli E, Faini A, Zago S, Ticozzi N, Ciammola A, Morelli C, Meriggi P, Cipresso P, Lulé D, Ludolph AC, Riva G, Silani V. An eye-tracking controlled neuropsychological battery for cognitive assessment in neurological diseases. Neurol Sci 2017; 38:595-603. [PMID: 28078566 DOI: 10.1007/s10072-016-2807-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/23/2016] [Indexed: 12/11/2022]
Abstract
Traditional cognitive assessment in neurological conditions involving physical disability is often prevented by the presence of verbal-motor impairment; to date, an extensive motor-verbal-free neuropsychological battery is not available for such purposes. We adapted a set of neuropsychological tests, assessing language, attentional abilities, executive functions and social cognition, for eye-tracking (ET) control, and explored its feasibility in a sample of healthy participants. Thirty healthy subjects performed a neuropsychological assessment, using an ET-based neuropsychological battery, together with standard "paper and pencil" cognitive measures for frontal (Frontal Assessment Battery-FAB) and working memory abilities (Digit Sequencing Task) and for global cognitive efficiency (Montreal Cognitive Assessment-MoCA). Psychological measures of anxiety (State-Trait Anxiety Inventory-Y-STAI-Y) and depression (Beck Depression Inventory-BDI) were also collected, and a usability questionnaire was administered. Significant correlations were observed between the "paper and pencil" screening of working memory abilities and the ET-based neuropsychological measures. The ET-based battery also correlated with the MoCA, while poor correlations were observed with the FAB. Usability aspects were found to be influenced by both working memory abilities and psychological components. The ET-based neuropsychological battery developed could provide an extensive assessment of cognitive functions, allowing participants to perform tasks independently from the integrity of motor or verbal channels. Further studies will be aimed at investigating validity and usability components in neurological populations with motor-verbal impairments.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Zago
- Department of Neuroscience and Mental Health, Università degli Studi di Milano, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Meriggi
- ICT and Biomedical Technology Integration Unit, Centre for Innovation and Technology Transfer (CITT), Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
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Proudfoot M, Menke RAL, Sharma R, Berna CM, Hicks SL, Kennard C, Talbot K, Turner MR. Eye-tracking in amyotrophic lateral sclerosis: A longitudinal study of saccadic and cognitive tasks. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:101-11. [PMID: 26312652 DOI: 10.3109/21678421.2015.1054292] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A relative preservation of eye movements is notable in ALS, but saccadic functions have not been studied longitudinally. ALS overlaps with FTD, typically involving executive dysfunction, and eye-tracking offers additional potential for the assessment of extramotor pathology where writing and speaking are both impaired. Eye-tracking measures (including anti-saccade, trail-making and visual search tasks) were assessed at six-monthly intervals for up to two years in a group of ALS (n = 61) and primary lateral sclerosis (n = 7) patients, compared to healthy age-matched controls (n = 39) assessed on a single occasion. Task performance was explored speculatively in relation to resting-state functional MRI (R-FMRI) network connectivity. Results showed that ALS patients were impaired on executive and visual search tasks despite normal basic saccadic function, and impairments in the PLS patients were unexpectedly often more severe. No significant progression was detected longitudinally in either group. No changes in R-FMRI network connectivity were identified in relation to patient performance. In conclusion, eye-tracking offers an objective means to assess extramotor cerebral involvement in ALS. The relative resistance of pure oculomotor function is confirmed, and higher-level executive impairments do not follow the same rate of decline as physical disability. PLS patients may have more cortical dysfunction than has been previously appreciated.
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Affiliation(s)
- Malcolm Proudfoot
- a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Ricarda A L Menke
- a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Rakesh Sharma
- a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Claire M Berna
- a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Stephen L Hicks
- a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Christopher Kennard
- a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Kevin Talbot
- a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Martin R Turner
- a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
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26
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Burrell JR, Carpenter RHS, Hodges JR, Kiernan MC. Early saccades in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:294-301. [PMID: 23586894 DOI: 10.3109/21678421.2013.783077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Our objective was to correlate saccadic abnormalities, including early saccades, in patients with amyotrophic lateral sclerosis (ALS) with measures of motor and functional impairment. A portable saccadometer was used to record saccades in ALS patients and control subjects. The linear approach to threshold with ergodic rate model was used to characterize saccades, including sub-populations of early saccades. Patients with established cognitive impairment or frontotemporal dementia were excluded. Limb-onset (Limb ALS) and bulbar-onset (Bulbar ALS) patient groups were compared and saccadic abnormalities were correlated with measures of motor and functional impairment. In total, 48 participants were included in the study; 24 patients with ALS (15 males, 9 females; mean age 57.0 +/- 13.9 years; mean symptom duration 22.4 +/- 16.3 months, of whom 62.5% had Limb ALS) and 24 age-matched controls. Early saccades were increased in both Limb ALS and Bulbar ALS patients, but other saccadic parameters were normal in ALS. Saccadic abnormalities did not correlate with motor or functional impairment. In conclusion, ALS patients show increased early saccades, but exhibit no significant differences across ALS phenotypes.
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27
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Goldstein LH, Abrahams S. Changes in cognition and behaviour in amyotrophic lateral sclerosis: nature of impairment and implications for assessment. Lancet Neurol 2013; 12:368-80. [DOI: 10.1016/s1474-4422(13)70026-7] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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28
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Anderson TJ, MacAskill MR. Eye movements in patients with neurodegenerative disorders. Nat Rev Neurol 2013; 9:74-85. [DOI: 10.1038/nrneurol.2012.273] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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29
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Byrne S, Pradhan F, Ni Dhubhghaill S, Treacy M, Cassidy L, Hardiman O. Blink rate in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2012; 14:291-3. [PMID: 23151260 DOI: 10.3109/21678421.2012.729217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Susan Byrne
- Beaumont Hospital and Trinity College, Dublin.
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Moss HE, McCluskey L, Elman L, Hoskins K, Talman L, Grossman M, Balcer LJ, Galetta SL, Liu GT. Cross-sectional evaluation of clinical neuro-ophthalmic abnormalities in an amyotrophic lateral sclerosis population. J Neurol Sci 2011; 314:97-101. [PMID: 22192877 DOI: 10.1016/j.jns.2011.10.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/12/2011] [Accepted: 10/12/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Ocular motility abnormalities may be a marker of neuro-degeneration beyond motor neurons in amyotrophic lateral sclerosis (ALS). We formally compared clinical neuro-ophthalmic abnormalities in ALS patients and a control population. METHODS Patients attending a multidisciplinary ALS clinic (n=63, age 60.8+/-16.4 years) and their caregivers serving as controls (n=37, ages 55.0+/-12.7 years) participated in this cross-sectional study. Visual acuity was assessed. Video recordings of a standardized ocular motility exam including gaze fixation, voluntary saccades, reflex saccades, smooth pursuit, eyelid opening and Bell's phenomenon were rated by two senior neuro-ophthalmologists who were masked to subject group. RESULTS Visual acuity was lower in ALS patients versus control subjects (OR 0.81 (0.71-0.93), p=0.003, logistic regression). Inter- and intra-rater reliability for ocular motility examination ratings were good (Cohen's Kappa>0.6). Findings observed only in ALS subjects included gaze impersistence (14%, p=0.01), moderately or severely restricted voluntary upgaze (13%, p=0.01), and moderate or severe eyelid opening apraxia (27%, p=0.0002). Accounting for age, moderately or severely saccadic horizontal smooth pursuits distinguished ALS from control subjects (OR 3.6 (1.2-10.9), p=0.02, logistic regression). CONCLUSIONS Clinical findings of decreased visual acuity, gaze impersistence, voluntary upgaze restriction, eyelid opening apraxia, and saccadic horizontal smooth pursuits are more frequent in patients with ALS than in similar-aged controls. These findings are potential clinical markers of neurodegeneration beyond upper and lower motor neuron disease in ALS. Further study is warranted regarding their application to disease categorization and outcomes assessment.
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Affiliation(s)
- Heather E Moss
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Hardiman O, van den Berg LH, Kiernan MC. Clinical diagnosis and management of amyotrophic lateral sclerosis. Nat Rev Neurol 2011; 7:639-49. [PMID: 21989247 DOI: 10.1038/nrneurol.2011.153] [Citation(s) in RCA: 402] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that results in progressive loss of bulbar and limb function. Patients typically die from respiratory failure within 3 years of symptom onset. The incidence of ALS in Europe is 2-3 cases per 100,000 individuals in the general population, and the overall lifetime risk of developing the disease is 1:400. ALS is familial in 5% of cases, and shows a Mendelian pattern of inheritance. ALS is recognized to overlap with frontotemporal dementia. Diagnosis is made on clinical grounds, using internationally recognized consensus criteria, after exclusion of conditions that can mimic ALS. The Revised ALS Functional Rating Scale is currently the most widely used assessment tool; scores are used to predict survival, and have been employed extensively in clinical trials. Riluzole remains the only effective drug, and extends the average survival of patients by 3-6 months. Optimal treatment is based on symptom management and preservation of quality of life, provided in a multidisciplinary setting. The discovery of further effective disease-modifying therapies remains a critical need for patients with this devastating condition.
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Affiliation(s)
- Orla Hardiman
- Department of Neurology, School of Medicine, Room 5.41, 5th Floor, Biomedical Science Building, Trinity College Dublin, Dublin 2, Ireland.
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Abstract
SUMMARY There is an overlap between amyotrophic lateral sclerosis and frontotemporal dementia. Approximately 15% of amyotrophic lateral sclerosis patients suffer from frontotemporal dementia characterized by behavioral change while a further third experience subtle executive dysfunction (typically letter fluency deficits) and corresponding prefrontal changes. Behavior change appears prevalent with apathy being the most prominent feature. Reports of social and emotional cognition deficits are increasing. Deficits have been described on theory of mind tasks including interpretation of stories and cartoons, faux pas detection and in the judgment of preference based on direction of eye-gaze. Impairments in emotional face and prosody perception and emotional enhancement of memory have been reported, and decision making (with and without risk) appears affected. The role of executive dysfunction in this social cognition deficit remains unresolved and more direct evidence of oribitofrontal involvement has yet to be found. Implications for healthcare provision are discussed with deterioration of social interaction with carers predicted.
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Affiliation(s)
- Sharon Abrahams
- Centre for Cognitive Aging & Epidemiology, Euan MacDonald Centre, University of Edinburgh, UK
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Andersen PM, Abrahams S, Borasio GD, de Carvalho M, Chio A, Van Damme P, Hardiman O, Kollewe K, Morrison KE, Petri S, Pradat PF, Silani V, Tomik B, Wasner M, Weber M. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)--revised report of an EFNS task force. Eur J Neurol 2011; 19:360-75. [PMID: 21914052 DOI: 10.1111/j.1468-1331.2011.03501.x] [Citation(s) in RCA: 702] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The evidence base for the diagnosis and management of amyotrophic lateral sclerosis (ALS) is weak. OBJECTIVES To provide evidence-based or expert recommendations for the diagnosis and management of ALS based on a literature search and the consensus of an expert panel. METHODS All available medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in February 2011. Recommendations were reached by consensus. RECOMMENDATIONS Patients with symptoms suggestive of ALS should be assessed as soon as possible by an experienced neurologist. Early diagnosis should be pursued, and investigations, including neurophysiology, performed with a high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives/carers should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. Control of symptoms such as sialorrhoea, thick mucus, emotional lability, cramps, spasticity and pain should be attempted. Percutaneous endoscopic gastrostomy feeding improves nutrition and quality of life, and gastrostomy tubes should be placed before respiratory insufficiency develops. Non-invasive positive-pressure ventilation also improves survival and quality of life. Maintaining the patient's ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end-of-life care should be discussed early with the patient and carers, respecting the patient's social and cultural background.
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Affiliation(s)
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- Umeå University, Umeå, Sweden.
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Slow saccades in bulbar-onset motor neurone disease. J Neurol 2010; 257:1134-40. [PMID: 20146069 DOI: 10.1007/s00415-010-5478-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/03/2009] [Accepted: 01/15/2010] [Indexed: 10/19/2022]
Abstract
Historical studies of eye movements in motor neurone disease (MND) have been conflicting although current findings suggest that eye movement abnormalities relate to frontal lobe impairment. Numerous case reports, however, describe slow saccades and supranuclear gaze palsies in patients with MND often associated with bulbar-onset disease. We performed a study of saccades and smooth pursuit in a large group of patients with MND to examine for any differences between bulbar-onset and spinal-onset patients. Forty-four patients (14 bulbar-onset and 30 spinal-onset patients) and 45 controls were recruited. Reflexive saccades, antisaccades and smooth pursuit were examined using infra-red oculography and all subjects then underwent neuropsychological evaluation. Reflexive saccades were found to be slower in bulbar-onset compared to spinal-onset patients and controls (p = 0.03, p = 0.05). Antisaccade latency (p = 0.01) and antisaccade type 1 errors (p = 0.03, p = 0.04) were increased in patients compared to controls. 'Proportion of time spent in smooth pursuit' and smooth pursuit 'velocity gain' were reduced in patients compared to controls (p = 0.000, p = 0.001). Antisaccade errors and velocity gain correlated with neuropsychological measures sensitive to lesions of the frontal lobes. This is the first study to highlight the presence of slow saccades in bulbar-onset MND. These findings suggest that slow saccades may be due to increased brainstem pathology in bulbar-onset disease that involves burst cell neurons. Furthermore these observations highlight the potential for overlap between bulbar-onset MND and progressive supranuclear palsy (PSP) as both can have a bulbar palsy and slowed saccades.
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