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Gerardo F, Bárbara E, Cecilia G, Aldana M, Natalia C, Lucia B, Silva B, Leila C, Cecilia P, Orlando G, Magdalena C, Luciana L, Gabriel P, Ricardo A. Abnormal eye movements increase as motor disabilities and cognitive impairments become more evident in Multiple Sclerosis: A novel eye-tracking study. Mult Scler J Exp Transl Clin 2024; 10:20552173241255008. [PMID: 38817553 PMCID: PMC11138185 DOI: 10.1177/20552173241255008] [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: 01/04/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Background Eye movements can reflect brain alterations and inform on the presence of motor disabilities and cognitive impairments in people with multiple sclerosis (pwMS). Objective The aim of the study was to determine the correlation between motor and cognitive measurements and eye movement parameters when performing the n-back task (NBKT). Methods This was a cross-sectional study carried out at Ramos Mejía Hospital, a center specialized in demyelinating diseases in Buenos Aires, Argentina. The study population consisted of 66 patients with relapsing-remitting multiple sclerosis (RRMS) and 5 patients with secondary progressive multiple sclerosis (SPMS). pwMS performed the n-back test while using a device head mounted display (HMD) with eyetracking capabilities in order to capture eye movement. Clinical motor and cognitive measures were assessed with Expanded Disability Status Scale (EDSS), Nine Hole Peg Test (NHPT), Timed 25-Foot Walk (T25FW), and Symbol Digit Modalities Test (SDMT). Results pwMS showed strong and statistically significant correlations between gaze duration; number of fixations, saccade amplitude and motor disabilities and cognitive impairments as measured by EDSS, NHPT, T25FW, and SDMT. Conclusion This study found significant correlations between eye movement behavior and motor and cognitive disability in pwMS. These findings suggest that eye movements have the potential to be used as a surrogate biomarker in MS progression.
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Affiliation(s)
| | - Eizaguirre Bárbara
- Multiple Sclerosis University Center CUEM, Ramos Mejia Hospital, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | - Lazaro Luciana
- Centro Universitario de Esclerosis Múltiple y enfermedades desmielinizantes (CUEM), Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Pardo Gabriel
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Alonso Ricardo
- Multiple Sclerosis University Center CUEM, Ramos Mejia Hospital, Buenos Aires, Argentina
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2
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Riboni-Verri G, Chen BS, McMurran CE, Halliwell GJ, Brown JWL, Coles AJ, Cunniffe NG. Visual outcome measures in clinical trials of remyelinating drugs. BMJ Neurol Open 2024; 6:e000560. [PMID: 38389586 PMCID: PMC10882304 DOI: 10.1136/bmjno-2023-000560] [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: 10/16/2023] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Abstract
One of the most promising approaches to delay, prevent or reverse disability progression in multiple sclerosis (MS) is to enhance endogenous remyelination and limit axonal degeneration. In clinical trials of remyelinating drugs, there is a need for reliable, sensitive and clinically relevant outcome measures. The visual pathway, which is frequently affected by MS, provides a unique model system to evaluate remyelination of acute and chronic MS lesions in vivo and non-invasively. In this review, we discuss the different measures that have been used and scrutinise visual outcome measure selection in current and future remyelination trials.
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Affiliation(s)
- Gioia Riboni-Verri
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Benson S Chen
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Christopher E McMurran
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gregory J Halliwell
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Clinical Outcomes Research Unit (CORe), University of Melbourne, Melborune, Melborune, Australia
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
| | - Nick G Cunniffe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Clinical Vision Laboratory, University of Cambridge, Cambridge, UK
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3
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de Villers-Sidani É, Voss P, Bastien N, Cisneros-Franco JM, Hussein S, Mayo NE, Koch NA, Drouin-Picaro A, Blanchette F, Guitton D, Giacomini PS. Oculomotor analysis to assess brain health: preliminary findings from a longitudinal study of multiple sclerosis using novel tablet-based eye-tracking software. Front Neurol 2023; 14:1243594. [PMID: 37745656 PMCID: PMC10516298 DOI: 10.3389/fneur.2023.1243594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
A growing body of evidence supports the link between eye movement anomalies and brain health. Indeed, the oculomotor system is composed of a diverse network of cortical and subcortical structures and circuits that are susceptible to a variety of degenerative processes. Here we show preliminary findings from the baseline measurements of an ongoing longitudinal cohort study in MS participants, designed to determine if disease and cognitive status can be estimated and tracked with high accuracy based on eye movement parameters alone. Using a novel gaze-tracking technology that can reliably and accurately track eye movements with good precision without the need for infrared cameras, using only an iPad Pro embedded camera, we show in this cross-sectional study that several eye movement parameters significantly correlated with clinical outcome measures of interest. Eye movement parameters were extracted from fixation, pro-saccade, anti-saccade, and smooth pursuit visual tasks, whereas the clinical outcome measures were the scores of several disease assessment tools and standard cognitive tests such as the Expanded Disability Status Scale (EDSS), Brief International Cognitive Assessment for MS (BICAMS), the Multiple Sclerosis Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT). Furthermore, partial least squares regression analyses show that a small set of oculomotor parameters can explain up to 84% of the variance of the clinical outcome measures. Taken together, these findings not only replicate previously known associations between eye movement parameters and clinical scores, this time using a novel mobile-based technology, but also the notion that interrogating the oculomotor system with a novel eye-tracking technology can inform us of disease severity, as well as the cognitive status of MS participants.
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Affiliation(s)
- Étienne de Villers-Sidani
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrice Voss
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - J. Miguel Cisneros-Franco
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Nancy E. Mayo
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Nils A. Koch
- Innodem Neurosciences, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | | | | | - Daniel Guitton
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Paul S. Giacomini
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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4
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de Villers-Sidani É, Voss P, Guitton D, Cisneros-Franco JM, Koch NA, Ducharme S. A novel tablet-based software for the acquisition and analysis of gaze and eye movement parameters: a preliminary validation study in Parkinson's disease. Front Neurol 2023; 14:1204733. [PMID: 37396780 PMCID: PMC10310943 DOI: 10.3389/fneur.2023.1204733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
The idea that eye movements can reflect certain aspects of brain function and inform on the presence of neurodegeneration is not a new one. Indeed, a growing body of research has shown that several neurodegenerative disorders, such as Alzheimer's and Parkinson's Disease, present characteristic eye movement anomalies and that specific gaze and eye movement parameters correlate with disease severity. The use of detailed eye movement recordings in research and clinical settings, however, has been limited due to the expensive nature and limited scalability of the required equipment. Here we test a novel technology that can track and measure eye movement parameters using the embedded camera of a mobile tablet. We show that using this technology can replicate several well-known findings regarding oculomotor anomalies in Parkinson's disease (PD), and furthermore show that several parameters significantly correlate with disease severity as assessed with the MDS-UPDRS motor subscale. A logistic regression classifier was able to accurately distinguish PD patients from healthy controls on the basis of six eye movement parameters with a sensitivity of 0.93 and specificity of 0.86. This tablet-based tool has the potential to accelerate eye movement research via affordable and scalable eye-tracking and aid with the identification of disease status and monitoring of disease progression in clinical settings.
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Affiliation(s)
- Étienne de Villers-Sidani
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrice Voss
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Daniel Guitton
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - J. Miguel Cisneros-Franco
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Nils A. Koch
- Innodem Neurosciences, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Simon Ducharme
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
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5
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Au Yong HM, Clough M, Perucca P, Malpas CB, Kwan P, O'Brien TJ, Fielding J. Ocular motility as a measure of cerebral dysfunction in adults with focal epilepsy. Epilepsy Behav 2023; 141:109140. [PMID: 36812874 DOI: 10.1016/j.yebeh.2023.109140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Using objective oculomotor measures, we aimed to: (1) compare oculomotor performance in patients with drug-resistant focal epilepsy to healthy controls, and (2) investigate the differential impact of epileptogenic focus laterality and location on oculomotor performance. METHODS We recruited 51 adults with drug-resistant focal epilepsy from the Comprehensive Epilepsy Programs of two tertiary hospitals and 31 healthy controls to perform prosaccade and antisaccade tasks. Oculomotor variables of interest were latency, visuospatial accuracy, and antisaccade error rate. Linear mixed models were performed to compare interactions between groups (epilepsy, control) and oculomotor tasks, and between epilepsy subgroups and oculomotor tasks for each oculomotor variable. RESULTS Compared to healthy controls, patients with drug-resistant focal epilepsy exhibited longer antisaccade latencies (mean difference = 42.8 ms, P = 0.001), poorer spatial accuracy for both prosaccade (mean difference = 0.4°, P = 0.002), and antisaccade tasks (mean difference = 2.1°, P < 0.001), and more antisaccade errors (mean difference = 12.6%, P < 0.001). In the epilepsy subgroup analysis, left-hemispheric epilepsy patients exhibited longer antisaccade latencies compared to controls (mean difference = 52.2 ms, P = 0.003), while right-hemispheric epilepsy was the most spatially inaccurate compared to controls (mean difference = 2.5°, P = 0.003). The temporal lobe epilepsy subgroup displayed longer antisaccade latencies compared to controls (mean difference = 47.6 ms, P = 0.005). SIGNIFICANCE Patients with drug-resistant focal epilepsy exhibit poor inhibitory control as evidenced by a high percentage of antisaccade errors, slower cognitive processing speed, and impaired visuospatial accuracy on oculomotor tasks. Patients with left-hemispheric epilepsy and temporal lobe epilepsy have markedly impaired processing speed. Overall, oculomotor tasks can be a useful tool to objectively quantify cerebral dysfunction in drug-resistant focal epilepsy.
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Affiliation(s)
- Hue Mun Au Yong
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Meaghan Clough
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Piero Perucca
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, Victoria, Australia.
| | - Charles B Malpas
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
| | - Patrick Kwan
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
| | - Terence J O'Brien
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
| | - Joanne Fielding
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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García Cena CE, Gómez-Andrés D, Pulido-Valdeolivas I, Sánchez-Seco VG, Domingo-Santos A, Moreno-García S, Benito-León J. Toward an Automatic Assessment of Cognitive Dysfunction in Relapsing-Remitting Multiple Sclerosis Patients Using Eye Movement Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:8220. [PMID: 36365918 PMCID: PMC9657913 DOI: 10.3390/s22218220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Despite the importance of cognitive function in multiple sclerosis, it is poorly represented in the Expanded Disability Status Scale (EDSS), the commonly used clinical measure to assess disability, suggesting that an analysis of eye movement, which is generated by an extensive and well-coordinated functional network that is engaged in cognitive function, could have the potential to extend and complement this more conventional measure. We aimed to measure the eye movement of a case series of MS patients with relapsing−remitting MS to assess their cognitive status using a conventional gaze tracker. A total of 41 relapsing−remitting MS patients and 43 age-matched healthy controls were recruited for this study. Overall, we could not find a clear common pattern in the eye motor abnormalities. Vertical eye movement was more impaired in MS patients than horizontal movement. Increased latencies were found in the prosaccades and reflexive saccades of antisaccade tests. The smooth pursuit was impaired with more corrections (backup and catchup movements, p<0.01). No correlation was found between eye movement variables and EDSS or disease duration. Despite significant alterations in the behavior of the eye movements in MS patients, which are compatible with altered cognitive status, there is no common pattern of these alterations. We interpret this as a consequence of the patchy, heterogeneous distribution of white matter involvement in MS that provokes multiple combinations of impairment at different points in the different networks involved in eye motor control. Further studies are therefore required.
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Affiliation(s)
- Cecilia E. García Cena
- Escuela Técnica Superior de Ingeniería y Diseño Industrial, Centre for Automation and Robotics, ETSIDI-CAR, Universidad Politécnica de Madrid, 28012 Madrid, Spain
| | - David Gómez-Andrés
- Child Neurology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Euro-NMD and ERN-RND, 08035 Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Anatomy, Histology and Neuroscience Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | | | - Angela Domingo-Santos
- Department of Neurology, “La Mancha Centro” General Hospital, Alcázar de San Juan, 13600 Ciudad Real, Spain
| | - Sara Moreno-García
- Department of Neurology, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Department of Medicine, Complutense University, 28040 Madrid, Spain
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7
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Hof S, Loonstra F, de Ruiter L, van Rijn L, Petzold A, Uitdehaag B, Bijvank JN. The prevalence of internuclear ophthalmoparesis in a population-based cohort of individuals with multiple sclerosis. Mult Scler Relat Disord 2022; 63:103824. [DOI: 10.1016/j.msard.2022.103824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
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Wang W, Clough M, White O, Shuey N, Van Der Walt A, Fielding J. Detecting Cognitive Impairment in Idiopathic Intracranial Hypertension Using Ocular Motor and Neuropsychological Testing. Front Neurol 2021; 12:772513. [PMID: 34867761 PMCID: PMC8635089 DOI: 10.3389/fneur.2021.772513] [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: 09/08/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: To determine whether cognitive impairments in patients with Idiopathic Intracranial Hypertension (IIH) are correlated with changes in visual processing, weight, waist circumference, mood or headache, and whether they change over time. Methods: Twenty-two newly diagnosed IIH patients participated, with a subset assessed longitudinally at 3 and 6 months. Both conventional and novel ocular motor tests of cognition were included: Symbol Digit Modalities Test (SDMT), Stroop Colour and Word Test (SCWT), Digit Span, California Verbal Learning Test (CVLT), prosaccade (PS) task, antisaccade (AS) task, interleaved antisaccade-prosaccade (AS-PS) task. Patients also completed headache, mood, and visual functioning questionnaires. Results: IIH patients performed more poorly than controls on the SDMT (p< 0.001), SCWT (p = 0.021), Digit Span test (p< 0.001) and CVLT (p = 0.004) at baseline, and generated a higher proportion of AS errors in both the AS (p< 0.001) and AS-PS tasks (p = 0.007). Further, IIH patients exhibited prolonged latencies on the cognitively complex AS-PS task (p = 0.034). While weight, waist circumference, headache and mood did not predict performance on any experimental measure, increased retinal nerve fibre layer (RNFL) was associated with AS error rate on both the block [F(3, 19)=3.22, B = 0.30, p = 0.022] and AS-PS task [F(3, 20) = 2.65, B = 0.363, p = 0.013]. Unlike ocular motor changes, impairments revealed on conventional tests of cognition persisted up to 6 months. Conclusion: We found multi-domain cognitive impairments in IIH patients that were unrelated to clinical characteristics. Marked ocular motor inhibitory control deficits were predicted by RNFL thickness but remained distinct from other cognitive changes, underscoring the significance of visual processing changes in IIH.
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Affiliation(s)
- Wendy Wang
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Owen White
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Neil Shuey
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Anneke Van Der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Nij Bijvank JA, Strijbis EMM, Nauta IM, Kulik SD, Balk LJ, Stam CJ, Hillebrand A, Geurts JJG, Uitdehaag BMJ, van Rijn LJ, Petzold A, Schoonheim MM. Impaired saccadic eye movements in multiple sclerosis are related to altered functional connectivity of the oculomotor brain network. Neuroimage Clin 2021; 32:102848. [PMID: 34624635 PMCID: PMC8503580 DOI: 10.1016/j.nicl.2021.102848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Impaired eye movements in multiple sclerosis (MS) and functional connectivity (FC) Eye movements related to altered FC of the oculomotor brain network. Lower (beta band) and higher (theta/delta band) FC related to abnormal eye movements. Regional changes were more informative than whole-network measures. Eye movement parameters also related to disability and cognitive dysfunction.
Background Impaired eye movements in multiple sclerosis (MS) are common and could represent a non-invasive and accurate measure of (dys)functioning of interconnected areas within the complex brain network. The aim of this study was to test whether altered saccadic eye movements are related to changes in functional connectivity (FC) in patients with MS. Methods Cross-sectional eye movement (pro-saccades and anti-saccades) and magnetoencephalography (MEG) data from the Amsterdam MS cohort were included from 176 MS patients and 33 healthy controls. FC was calculated between all regions of the Brainnetome atlas in six conventional frequency bands. Cognitive function and disability were evaluated by previously validated measures. The relationships between saccadic parameters and both FC and clinical scores in MS patients were analysed using multivariate linear regression models. Results In MS pro- and anti-saccades were abnormal compared to healthy controls A relationship of saccadic eye movements was found with FC of the oculomotor network, which was stronger for regional than global FC. In general, abnormal eye movements were related to higher delta and theta FC but lower beta FC. Strongest associations were found for pro-saccadic latency and FC of the precuneus (beta band β = -0.23, p = .006), peak velocity and FC of the parietal eye field (theta band β = -0.25, p = .005) and gain and FC of the inferior frontal eye field (theta band β = -0.25, p = .003). Pro-saccadic latency was also strongly associated with disability scores and cognitive dysfunction. Conclusions Impaired saccadic eye movements were related to functional connectivity of the oculomotor network and clinical performance in MS. This study also showed that, in addition to global network connectivity, studying regional changes in MEG studies could yield stronger correlations.
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Affiliation(s)
- J A Nij Bijvank
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - E M M Strijbis
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - I M Nauta
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - S D Kulik
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, the Netherlands
| | - L J Balk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - C J Stam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - A Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - J J G Geurts
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, the Netherlands
| | - B M J Uitdehaag
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - L J van Rijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands; Onze Lieve Vrouwe Gasthuis, Department of Ophthalmology, Amsterdam, the Netherlands
| | - A Petzold
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam, the Netherlands; Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the UCL Queen Square Institute of Neurology, London, United Kingdom
| | - M M Schoonheim
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, the Netherlands
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10
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Cunniffe N, Coles A. Promoting remyelination in multiple sclerosis. J Neurol 2021; 268:30-44. [PMID: 31190170 PMCID: PMC7815564 DOI: 10.1007/s00415-019-09421-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
The greatest unmet need in multiple sclerosis (MS) are treatments that delay, prevent or reverse progression. One of the most tractable strategies to achieve this is to therapeutically enhance endogenous remyelination; doing so restores nerve conduction and prevents neurodegeneration. The biology of remyelination-centred on the activation, migration, proliferation and differentiation of oligodendrocyte progenitors-has been increasingly clearly defined and druggable targets have now been identified in preclinical work leading to early phase clinical trials. With some phase 2 studies reporting efficacy, the prospect of licensed remyelinating treatments in MS looks increasingly likely. However, there remain many unanswered questions and recent research has revealed a further dimension of complexity to this process that has refined our view of the barriers to remyelination in humans. In this review, we describe the process of remyelination, why this fails in MS, and the latest research that has given new insights into this process. We also discuss the translation of this research into clinical trials, highlighting the treatments that have been tested to date, and the different methods of detecting remyelination in people.
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Affiliation(s)
- Nick Cunniffe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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11
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Solly EJ, Clough M, McKendrick AM, Foletta P, White OB, Fielding J. Ocular motor measures of visual processing changes in visual snow syndrome. Neurology 2020; 95:e1784-e1791. [PMID: 32675081 DOI: 10.1212/wnl.0000000000010372] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether changes to cortical processing of visual information can be evaluated objectively using 3 simple ocular motor tasks to measure performance in patients with visual snow syndrome (VSS). METHODS Sixty-four patients with VSS (32 with migraine and 32 with no migraine) and 23 controls participated. Three ocular motor tasks were included: prosaccade (PS), antisaccade (AS), and interleaved AS-PS tasks. All these tasks have been used extensively in both neurologically healthy and diseased states. RESULTS We demonstrated that, compared to controls, the VSS group generated significantly shortened PS latencies (p = 0.029) and an increased rate of AS errors (p = 0.001), irrespective of the demands placed on visual processing (i.e., task context). Switch costs, a feature of the AS-PS task, were comparable across groups, and a significant correlation was found between shortened PS latencies and increased AS error rates for patients with VSS (r = 0.404). CONCLUSION We identified objective and quantifiable measures of visual processing changes in patients with VSS. The absence of any additional switch cost on the AS-PS task in VSS suggests that the PS latency and AS error differences are attributable to a speeded PS response rather than to impaired executive processes more commonly implicated in poorer AS performance. We propose that this combination of latency and error deficits, in conjunction with intact switching performance, will provide a VS behavioral signature that contributes to our understanding of VSS and may assist in determining the efficacy of therapeutic interventions.
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Affiliation(s)
- Emma J Solly
- From the Department of Neuroscience (E.J.S., M.C., P.F., O.B.W., J.F.), Central Clinical School, Monash University, Melbourne; and Department of Optometry & Vision Sciences (A.M.M.) and Department of Medicine, Royal Melbourne Hospital (O.B.W.), The University of Melbourne, Australia
| | - Meaghan Clough
- From the Department of Neuroscience (E.J.S., M.C., P.F., O.B.W., J.F.), Central Clinical School, Monash University, Melbourne; and Department of Optometry & Vision Sciences (A.M.M.) and Department of Medicine, Royal Melbourne Hospital (O.B.W.), The University of Melbourne, Australia
| | - Allison M McKendrick
- From the Department of Neuroscience (E.J.S., M.C., P.F., O.B.W., J.F.), Central Clinical School, Monash University, Melbourne; and Department of Optometry & Vision Sciences (A.M.M.) and Department of Medicine, Royal Melbourne Hospital (O.B.W.), The University of Melbourne, Australia
| | - Paige Foletta
- From the Department of Neuroscience (E.J.S., M.C., P.F., O.B.W., J.F.), Central Clinical School, Monash University, Melbourne; and Department of Optometry & Vision Sciences (A.M.M.) and Department of Medicine, Royal Melbourne Hospital (O.B.W.), The University of Melbourne, Australia
| | - Owen B White
- From the Department of Neuroscience (E.J.S., M.C., P.F., O.B.W., J.F.), Central Clinical School, Monash University, Melbourne; and Department of Optometry & Vision Sciences (A.M.M.) and Department of Medicine, Royal Melbourne Hospital (O.B.W.), The University of Melbourne, Australia
| | - Joanne Fielding
- From the Department of Neuroscience (E.J.S., M.C., P.F., O.B.W., J.F.), Central Clinical School, Monash University, Melbourne; and Department of Optometry & Vision Sciences (A.M.M.) and Department of Medicine, Royal Melbourne Hospital (O.B.W.), The University of Melbourne, Australia.
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12
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Gajamange S, Shelton A, Clough M, White O, Fielding J, Kolbe S. Functional correlates of cognitive dysfunction in clinically isolated syndromes. PLoS One 2019; 14:e0219590. [PMID: 31314815 PMCID: PMC6636738 DOI: 10.1371/journal.pone.0219590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 06/27/2019] [Indexed: 12/04/2022] Open
Abstract
Cognitive dysfunction can be identified in patients with clinically isolated syndromes suggestive of multiple sclerosis using ocular motor testing. This study aimed to identify the functional neural correlates of cognitive dysfunction in patients with clinically isolated syndrome using MRI. Eighteen patients with clinically isolated syndrome and 17 healthy controls were recruited. Subjects underwent standard neurological and neuropsychological testing. Subjects also underwent functional MRI (fMRI) during a cognitive ocular motor task, involving pro-saccade (direct gaze towards target) and anti-saccade (direct gaze away from target) trials. Ocular motor performance variables (averaged response time and error rate) were calculated for each subject. Patients showed a trend towards a greater rate of anti-saccade errors (p = 0.09) compared to controls. Compared to controls, patients exhibited increased activation in the right postcentral, right supramarginal gyrus, and the right parietal operculum during the anti-saccade>pro-saccade contrast. This study demonstrated that changes in functional organisation of cognitive brain networks is associated with subtle cognitive changes in patients with clinically isolated syndrome.
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Affiliation(s)
- Sanuji Gajamange
- Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Annie Shelton
- Department of Psychology, MIND Institute, and Center for Mind and Brain, University of California, Davis, Davis, California, United States of America
| | - Meaghan Clough
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Owen White
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Joanne Fielding
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Scott Kolbe
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
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13
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Fischer M, Köhler W, Faiss JH, Hoffmann F, Kunkel A, Sailer M, Schwab M, Zettl UK, Bublak P. A smart peek: Processing of rapid visual displays is disturbed in newly diagnosed, cognitively intact MS patients and refers to cognitive performance and disease progression in late stages. J Neurol Sci 2019; 401:118-124. [DOI: 10.1016/j.jns.2019.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 10/27/2022]
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14
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Ternes AM, Clough M, Foletta P, White O, Fielding J. Executive control deficits correlate with reduced frontal white matter volume in multiple sclerosis. J Clin Exp Neuropsychol 2019; 41:723-729. [DOI: 10.1080/13803395.2019.1614536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Anne-Marie Ternes
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Meaghan Clough
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Australia
| | - Paige Foletta
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Australia
| | - Owen White
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Australia
| | - Joanne Fielding
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Australia
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15
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Villoslada P, Green AJ, Galetta S. Personalizing medical care for patients with MS. Neurology 2019; 92:929-930. [DOI: 10.1212/wnl.0000000000007493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Kanhai KMS, Nij Bijvank JA, Wagenaar YL, Klaassen ES, Lim K, Bergheanu SC, Petzold A, Verma A, Hesterman J, Wattjes MP, Uitdehaag BMJ, van Rijn LJ, Groeneveld GJ. Treatment of internuclear ophthalmoparesis in multiple sclerosis with fampridine: A randomized double-blind, placebo-controlled cross-over trial. CNS Neurosci Ther 2019; 25:697-703. [PMID: 30756475 PMCID: PMC6515699 DOI: 10.1111/cns.13096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/08/2018] [Indexed: 01/08/2023] Open
Abstract
Aim To examine whether the velocity of saccadic eye movements in internuclear ophthalmoparesis (INO) improves with fampridine treatment in patients with multiple sclerosis (MS). Methods Randomized, double‐blind, placebo‐controlled, cross‐over trial with fampridine in patients with MS and INO. Horizontal saccades were recorded at baseline and at multiple time points post‐dose. Main outcome measures were the change of peak velocity versional dysconjugacy index (PV‐VDI) and first‐pass amplitude VDI (FPA‐VDI). Both parameters were compared between fampridine and placebo using a mixed model analysis of variance taking patients as their own control. Pharmacokinetics was determined by serial blood sampling. Results Thirteen patients had a bilateral and 10 had a unilateral INO. One patient had an INO of abduction (posterior INO of Lutz) and was excluded. Fampridine significantly reduced both PV‐VDI (−17.4%, 95% CI: −22.4%, −12.1%; P < 0.0001) and FPA‐VDI (−12.5%, 95% CI: −18.9%, −5.5%; P < 0.01). Pharmacokinetics demonstrated that testing coincided with the average tmax at 2.08 hours (SD 45 minutes). The main adverse event reported after administration of fampridine was dizziness (61%). Conclusion Fampridine improves saccadic eye movements due to INO in MS. Treatment response to fampridine may gauge patient selection for inclusion to remyelination strategies in MS using saccadic eye movements as primary outcome measure.
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Affiliation(s)
| | - Jenny A Nij Bijvank
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - KyoungSoo Lim
- Centre for Human Drug Research, Leiden, the Netherlands.,KCRN Research, Germantown, Maryland
| | | | - Axel Petzold
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam UMC, Amsterdam, the Netherlands.,The National Hospital for Neurology and Neurosurgery, Queen Square and Moorfields Eye Hospital, London, UK
| | - Ajay Verma
- Experimental Medicine, Biogen, Cambridge, Massachusetts
| | | | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Laurentius J van Rijn
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Geert Jan Groeneveld
- Centre for Human Drug Research, Leiden, the Netherlands.,Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam UMC, Amsterdam, the Netherlands
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17
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Ternes AM, Clough M, Foletta P, White O, Fielding J. Characterization of inhibitory failure in Multiple Sclerosis: Evidence of impaired conflict resolution. J Clin Exp Neuropsychol 2018; 41:320-329. [PMID: 30526274 DOI: 10.1080/13803395.2018.1552756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Inhibitory control deficits are frequently reported in Multiple Sclerosis (MS), although it is unclear whether these deficits represent a global or process-specific failure. Notably, most models of inhibitory control recognize at least two dissociable processes, the most consistent being: (a) the inhibition of a dominant response: response suppression, and (b) the inhibition of a dominant response and initiation of a nondominant response: executive control. This study aimed to ascertain the processes underlying inhibitory failure in MS. METHOD Twenty-three MS patients and 25 healthy controls completed a battery of commonly used inhibitory tasks, with measures from each task entered into a principal components analysis with orthogonal (varimax) rotation. RESULTS As anticipated, two components emerged, with tasks evaluating response suppression (stop signal, go/no go) loading on a common component, and tasks evaluating executive control (Stroop, antisaccade, endogenously-cued saccade) loading on a separate common component. Composite scores were generated for each component and compared between groups. Unlike response suppression scores, executive control scores were significantly poorer for MS patients. CONCLUSIONS Inhibitory control deficits in MS may reflect poor resolution in the context of competing processes, rather than difficulty in preventing the execution of an inappropriate response.
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Affiliation(s)
- Anne-Marie Ternes
- a School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences , Monash University , Clayton , Victoria , Australia
| | - Meaghan Clough
- b Department of Neurosciences , Central Clinical School, Monash University, Alfred Hospital , South Yarra , Victoria , Australia
| | - Paige Foletta
- b Department of Neurosciences , Central Clinical School, Monash University, Alfred Hospital , South Yarra , Victoria , Australia
| | - Owen White
- b Department of Neurosciences , Central Clinical School, Monash University, Alfred Hospital , South Yarra , Victoria , Australia
| | - Joanne Fielding
- a School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences , Monash University , Clayton , Victoria , Australia.,b Department of Neurosciences , Central Clinical School, Monash University, Alfred Hospital , South Yarra , Victoria , Australia
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18
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Nij Bijvank JA, Petzold A, Balk LJ, Tan HS, Uitdehaag BMJ, Theodorou M, van Rijn LJ. A standardized protocol for quantification of saccadic eye movements: DEMoNS. PLoS One 2018; 13:e0200695. [PMID: 30011322 PMCID: PMC6047815 DOI: 10.1371/journal.pone.0200695] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Quantitative saccadic testing is a non-invasive method of evaluating the neural networks involved in the control of eye movements. The aim of this study is to provide a standardized and reproducible protocol for infrared oculography measurements of eye movements and analysis, which can be applied for various diseases in a multicenter setting. METHODS Development of a protocol to Demonstrate Eye Movement Networks with Saccades (DEMoNS) using infrared oculography. Automated analysis methods were used to calculate parameters describing the characteristics of the saccadic eye movements. The two measurements of the subjects were compared with descriptive and reproducibility statistics. RESULTS Infrared oculography measurements of all subjects were performed using the DEMoNS protocol and various saccadic parameters were calculated automatically from 28 subjects. Saccadic parameters such as: peak velocity, latency and saccade pair ratios showed excellent reproducibility (intra-class correlation coefficients > 0.9). Parameters describing performance of more complex tasks showed moderate to good reproducibility (intra-class correlation coefficients 0.63-0.78). CONCLUSIONS This study provides a standardized and transparent protocol for measuring and analyzing saccadic eye movements in a multicenter setting. The DEMoNS protocol details outcome measures for treatment trial which are of excellent reproducibility. The DEMoNS protocol can be applied to the study of saccadic eye movements in various neurodegenerative and motor diseases.
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Affiliation(s)
- J. A. Nij Bijvank
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
- * E-mail:
| | - A. Petzold
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
- Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - L. J. Balk
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
| | - H. S. Tan
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
| | - B. M. J. Uitdehaag
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
| | - M. Theodorou
- Moorfields Eye Hospital and The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - L. J. van Rijn
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam UMC - VUmc, Amsterdam, The Netherlands
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Serra A, Chisari CG, Matta M. Eye Movement Abnormalities in Multiple Sclerosis: Pathogenesis, Modeling, and Treatment. Front Neurol 2018; 9:31. [PMID: 29467711 PMCID: PMC5807658 DOI: 10.3389/fneur.2018.00031] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/15/2018] [Indexed: 01/13/2023] Open
Abstract
Multiple sclerosis (MS) commonly causes eye movement abnormalities that may have a significant impact on patients’ disability. Inflammatory demyelinating lesions, especially occurring in the posterior fossa, result in a wide range of disorders, spanning from acquired pendular nystagmus (APN) to internuclear ophthalmoplegia (INO), among the most common. As the control of eye movements is well understood in terms of anatomical substrate and underlying physiological network, studying ocular motor abnormalities in MS provides a unique opportunity to gain insights into mechanisms of disease. Quantitative measurement and modeling of eye movement disorders, such as INO, may lead to a better understanding of common symptoms encountered in MS, such as Uhthoff’s phenomenon and fatigue. In turn, the pathophysiology of a range of eye movement abnormalities, such as APN, has been clarified based on correlation of experimental model with lesion localization by neuroimaging in MS. Eye movement disorders have the potential of being utilized as structural and functional biomarkers of early cognitive deficit, and possibly help in assessing disease status and progression, and to serve as platform and functional outcome to test novel therapeutic agents for MS. Knowledge of neuropharmacology applied to eye movement dysfunction has guided testing and use of a number of pharmacological agents to treat some eye movement disorders found in MS, such as APN and other forms of central nystagmus.
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Affiliation(s)
- Alessandro Serra
- Neurology, Louis Stokes VA Medical Center, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH, United States
| | | | - Manuela Matta
- Neurology, Ospedale San Luigi Gonzaga, Orbassano, Italy
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20
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Moroso A, Ruet A, Lamargue-Hamel D, Munsch F, Deloire M, Ouallet JC, Cubizolle S, Charré-Morin J, Saubusse A, Tourdias T, Dousset V, Brochet B. Preliminary evidence of the cerebellar role on cognitive performances in clinically isolated syndrome. J Neurol Sci 2017; 385:1-6. [PMID: 29406885 DOI: 10.1016/j.jns.2017.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 11/02/2017] [Accepted: 11/29/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cerebellar and cognitive dysfunction can occur early in clinically isolated syndrome (CIS). Eye tracking is a reliable tool for the evaluation of both subtle cerebellar symptoms and cognitive impairment. OBJECTIVES To investigate the early cognitive profile using neuropsychological and ocular motor (OM) testing in CIS with and without cerebellar dysfunction with OM testing compared to healthy subjects (HS). METHODS Twenty-eight patients and 12 HC underwent OM and neuropsychological testing. Cerebellar impairment was defined by the registration of saccadic intrusions and/or at least 10% of dysmetria during ocular motor recording. Visually guided saccade (VGS), memory-guided saccade (MGS) and antisaccade (AS) paradigms were compared to neuropsychological assessments. RESULTS The group of patients with cerebellar dysfunction (n=16) performed worse on MGS latencies and error rates, and had worse working memory, executive function and information processing speed (IPS) z scores than patients without cerebellar dysfunction. IPS was correlated with the AS error rate in all patients and with the VGS error rate and the MGS final eye position ratio in cerebellar patients. CONCLUSION Eye tracking is a sensitive tool to assess cognitive and cerebellar dysfunctions in CIS. In CIS patients, cerebellar impairment is associated with working memory, executive functions and IPS slowness.
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Affiliation(s)
- Amandine Moroso
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Aurélie Ruet
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Delphine Lamargue-Hamel
- Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Fanny Munsch
- Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Mathilde Deloire
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France
| | | | - Stéphanie Cubizolle
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France
| | - Julie Charré-Morin
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France
| | - Aurore Saubusse
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France
| | - Thomas Tourdias
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Vincent Dousset
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France
| | - Bruno Brochet
- CHU de Bordeaux, INSERM-CHU CIC-P 0005, Service de Neurologie, Bordeaux F-33076, France; Université de Bordeaux, Bordeaux F-33076, France; Neurocentre Magendie, INSERM U1215, Team Glia-neuron Interactions, Bordeaux F-33077, France.
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21
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Lizak N, Clough M, Millist L, Kalincik T, White OB, Fielding J. Impairment of Smooth Pursuit as a Marker of Early Multiple Sclerosis. Front Neurol 2016; 7:206. [PMID: 27917151 PMCID: PMC5116770 DOI: 10.3389/fneur.2016.00206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/02/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a diffuse disease that disrupts wide-ranging cerebral networks. The control of saccades and smooth pursuit are similarly dependent upon widespread networks, with the assessment of pursuit offering an opportunity to examine feedback regulation. We sought to characterize pursuit deficits in MS and to examine their relationship with disease duration. METHODS Twenty healthy controls, 20 patients with a clinically isolated syndrome (CIS), and 40 patients with clinically definite MS (CDMS) participated. Thirty-six trials of Rashbass' step-ramp paradigm of smooth pursuit, evenly split by velocity (8.65°, 17.1°, and 25.9°/s) and ramp direction (left/right), were performed. Four parameters were measured: latency of pursuit onset, closed-loop pursuit gain, number of saccades, and summed saccade amplitudes during pursuit. For CDMS patients, these were correlated with disease duration and Expanded Disability Status Scale (EDSS) score. RESULTS Closed-loop pursuit gain was significantly lower in CIS than controls at all speeds. CDMS gain was lower than controls at medium pursuit velocity. CDMS patients also displayed longer pursuit latency than controls at all velocities. All patients accumulated increased summed saccade amplitudes at slow and medium pursuit speeds, and infrequent high-amplitude saccades at the fast speed. No pursuit variable significantly correlated with EDSS or disease duration in CDMS patients. CONCLUSION Smooth pursuit is significantly compromised in MS from onset. Low pursuit gain and increased saccadic amplitudes may be robust markers of disseminated pathology in CIS and in more advanced MS. Pursuit may be useful in measuring early disease.
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Affiliation(s)
- Nathaniel Lizak
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Monash School of Medicine, Monash University, Melbourne, VIC, Australia; School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Lynette Millist
- Department of Neurology, Royal Melbourne Hospital , Melbourne, VIC , Australia
| | - Tomas Kalincik
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Owen B White
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
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