Abstract
BackgroundReliable detection of slowed vertical saccades may help discriminate progressive supranuclear palsy (PSP) from the subset of Parkinson’s disease patients who lack tremor (akinetic-rigid or PD-postural instability and gait disorder PIGD subtype), and from age-related oculomotor changes. We investigated the feasibility of a camera-less computerized behavioral saccade latency paradigm previously validated in PD to discriminate probable PSP-Richardson syndrome (PSP-RS) from PD-PIGD and age-matched controls.MethodsIn this proof-of-concept case-control study, reflexive saccade latencies were measured in 5 subjects with probable PSP-RS, 5 subjects with PD-PIGD subtype, and 5 age-matched controls using the behavioral paradigm. The battery was repeated approximately one month later. All subjects were examined off levodopa by a movement disorders neurologist and by an ophthalmologist, who also performed a dilated eye exam.ResultsVertical prosaccade latencies were longer in the PSP group (median = 903 ms) relative to PD (median = 268 ms) and control groups (median = 235 ms), with no overlap between groups (100% accuracy). PSP subjects also had larger vertical-horizontal discrepancies than comparison groups. Test-retest reliability for the behavioral saccade measures was good (interclass correlation coefficient = 0.948; 95% confidence interval [0.856, 0.982]), and the measures strongly correlated with clinical ratings.ConclusionsComputerized behavioral measurement of reflexive saccade latency is feasible in PSP, and potentially discriminates probable PSP-RS from the PD-PIGD subtype. Findings from this proof-of-concept study support utility of the approach for obtaining objective saccade metrics in clinical evaluations and for tracking change in future, larger trials of moderately advanced PSP. Future studies should also examine the behavioral paradigm in earlier presentations of PSP and other subtypes of PSP.
Highlights
Reliable detection of slowed vertical saccades may help discriminate progressive supranuclear palsy (PSP) from the subset of Parkinson’s disease patients who lack tremor, and from age-related oculomotor changes
Linder found that video-oculography could not discriminate early PSP from early Parkinson’s disease (PD) when subjects were tested off dopaminergic medication [4]
The purpose of the present study was to determine whether reflexive vertical saccade latency measured by the behavioral method could feasibly and reliably distinguish subjects with PSP-Richardson syndrome (PSP-RS) from subjects with akinetic-rigid Parkinson’s disease (PD-postural instability gait disturbance (PIGD)) and age-matched healthy controls, and to assess agreement between behavioral measures and existing clinical rating measures
Summary
Reliable detection of slowed vertical saccades may help discriminate progressive supranuclear palsy (PSP) from the subset of Parkinson’s disease patients who lack tremor (akinetic-rigid or PD-postural instability and gait disorder PIGD subtype), and from age-related oculomotor changes. Using video-oculography with Eyelink (Ontario, CA), Gorges showed reduced peak eye velocities in PSP (mixed PSP-RS and PSPparkinsonism) compared to Parkinson’s disease, MSA and healthy controls [3]. The Parkinson’s subjects had mixed akinetic-rigid and tremor-predominant phenotypes and were tested on dopaminergic medication. Linder found that video-oculography could not discriminate early PSP from early PD when subjects were tested off dopaminergic medication [4]. In moderately-advanced PSP oculomotor abnormalities beyond vertical palsy and paresis can impact feasibility of video-oculography. Blepharospasm, apraxia of eyelid opening, saccadic intrusions, and square wave jerks can encumber calibration and invalidate trials
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