Slow Phase Eye Velocity Research Articles

Direction-Changing and Direction-Fixed Positional Nystagmus in Patients With Vestibular Neuritis and Meniere Disease.

ObjectivesDirection-changing positional nystagmus (PN) was considered to indicate the presence of benign paroxysmal positional vertigo involving lateral semicircular canal in most cases. We investigated the incidence of PN on the supine head-roll test and compared the characteristics of nystagmus in patients with vestibular neuritis (VN) and Meniere disease (MD).MethodsA retrospective review of patients, who were diagnosed with unilateral VN or unilateral definite MD between September 2005 and November 2011, was conducted. Sixty-five VN patients and 65 MD patients were enrolled. Eye movements were recorded for 30–60 seconds at the positions of sitting, head roll to the right, and head roll to the left, and maximum slow-phase eye velocity was calculated. PN was classified as direction-fixed (paretic or recovery) and direction-changing (geotropic or apogeotropic).ResultsSpontaneous nystagmus was observed in 57 patients (87%, the slow-phase eye velocity of 7°/sec±5°/sec) with acute VN, 39 (60%, 2°/sec±1°/sec) with follow-up VN, and 32 (49%, 2°/sec±2°/sec) with MD. Direction-fixed PN was the most common type. Direction-fixed paretic type was most common in acute VN (80%) and follow-up VN (42%), and direction-fixed recovery type was most common in MD (31%). Paretic type was significantly more common in acute VN (80%) than in follow-up VN (42%) and MD (26%), and the recovery type was significantly more common in MD (31%) than in acute VN (3%) and follow-up VN (14%). Direction-changing PN was more common in MD (22%), followed by follow-up VN (14%) and acute VN (9%).ConclusionThough direction-fixed paretic PN was most common in VN and MD patients, direction-changing PN could be observed in a few patients (9%–20%) with peripheral vestibular disorders regardless of the duration from the onset of dizziness, suggesting the presence of otolith-related dizziness.

Recovery of positional nystagmus after benign paroxysmal positional vertigo fatigue.

In benign paroxysmal positional vertigo (BPPV), positional nystagmus is generally weaker when the Dix-Hallpike test is repeated. This phenomenon is known as BPPV fatigue. The positional nystagmus induced by the Dix-Hallpike test can be observed again when time has passed. There has been no study regarding the length of time required to recover the positional nystagmus. The purpose of this study was to examine whether positional nystagmus recovers within 30min after the disappearance of the nystagmus by BPPV fatigue. This was a prospective observational study. Twenty patients with posterior canal type of BPPV (canalolithiasis of the posterior canal) were included. Dix-Hallpike tests were performed three times for each patient. A second Dix-Hallpike test was performed immediately after the first Dix-Hallpike test. A third Dix-Hallpike test was performed 30min after the second Dix-Hallpike test. We recorded positional nystagmus induced by the Dix-Hallpike tests and analyzed maximum slow-phase eye velocity (SPEV) of the positional nystagmus. The average maximum SPEV of positional nystagmus induced by the second Dix-Hallpike test (4.8°/s) was statistically lower than that induced by the first Dix-Hallpike test (48.0°/s); this decrease was caused by BPPV fatigue. There was no statistical difference between average maximum SPEV of positional nystagmus induced by the first Dix-Hallpike test and that induced by the third Dix-Hallpike test (41.6°/s); this indicates that the effect of BPPV fatigue disappeared. The effect of BPPV fatigue disappears within 30min. A second Dix-Hallpike test should be performed at least 30min after the first.

Effects of Sustained Otolith-Only Stimulation on Post-Rotational Nystagmus.

Constant velocity rotations in darkness evoke vestibulo-ocular reflex in form of pre- and post-rotational nystagmus under cerebellar supervision. Reorientation of the head with respect to gravity, stimulating otolith and semicircular canal, during post-rotational phase rapidly suppresses the post-rotational nystagmus. We asked if pure otolith stimulation without semicircular canal signal is sufficient for the suppression of post-rotational nystagmus. The experimental paradigm comprised of on-axis rotations in the horizontal plane when the subject was sitting upright, followed by a novel stimulus that combined off-axis centrifugation in the horizontal plane with amplitude matched, yet out-of-phase, on-axis horizontal rotation-double centrifugation. The resultant effect of double centrifugation was pure otolith stimulation that constantly changed direction, yet completely canceled out angular velocity (no horizontal semicircular canal stimulation). Double centrifugation without pre-existing on-axis rotations evoked mixture of horizontal and vertical eye movements, latter reflected the known uncertainty of the vestibular system to differentiate whether the sensory signal is related to low-frequency translations in horizontal plane or head tilts relative to the gravity. Double centrifugation during post-rotational phase suppressed the peak slow phase eye velocity of the post-rotational nystagmus, hence affecting the vestibular ocular reflex gain (eye velocity/head velocity) matrix. The decay time constant, however, was unchanged. Amount of suppression of the peak slow phase eye velocity of the post-rotational nystagmus during double centrifugation correlated with the peak vertical eye velocity evoked by the pure otolith stimuli in the absence of pre-existing on axis rotations. In post-rotational phase, the pure otolith signal affects vestibular ocular reflex gain matrix but does not affect the time constant.

Unravelling Stimulus Direction Dependency of Visual Acuity in Larval Zebrafish by Consistent Eye Displacements Upon Optokinetic Stimulation.

Impairment of visual acuity (VA) can be seen early on in various diseases and has a major impact on patients' daily activities. Zebrafish is an important model for studying visual disorders. We developed a new method in zebrafish larva to easily and precisely measure the VA, which should allow for better estimation of affected vision such as after genetic manipulation or pharmacologic intervention. We used an optokinetic reflex (OKR) paradigm with a staircase technique to estimate VA of zebrafish larva. Consistent eye displacements were used as the indicator for OKR. We measured VA and determined the dependence of VA on clockwise and counterclockwise horizontal stimulus directions. Visual acuity in zebrafish larva was estimated to be 0.179 ± 0.013 cyc/deg binocularly and 0.129 ± 0.008 cyc/deg (left eye) and 0.128 ± 0.012 cyc/deg (right eye) monocularly. We found within single subjects spatial frequency thresholds that showed highly significant differences between the two horizontal stimulus directions. Average higher and lower binocular thresholds were 0.181 ± 0.026 and 0.158 ± 0.014 cyc/deg, respectively. Importantly, no correlations were found between spatial frequency thresholds and average median peak slow-phase eye velocities (SPV) of OKR in all experiments. Consistent eye displacements evoked by OKR stimuli can be used as an indirect measure of VA in zebrafish larva. Conversely, using SPV of OKR to determine VA does not seem to be accurate. With our method, single larva showed significantly different VA depending on stimulus directions, which might reflect asymmetric maturation of retinal and/or visual pathway structures.

16. Psychophysical assessment of vestibular function and vestibular disorders

Vestibular disorders usually present with vertigo, a subjective symptom characterised by altered motion perception. Current clinical investigation probes the integrity of the labyrinth and brainstem pathways. While caloric and head impulse tests and vestibular evoked myogenic potentials, can identify specific anatomical deficits and assist diagnosis of certain specific disorders, many patients with vertigo have negative results on these tests. A direct approach to examining disordered motion perception might provide important insights into pathophysiology and clinical diagnosis. To quantify perception of movement we rotated seated subjects by 30–180° over 5 s and had them indicate their start position. To isolate vestibular input we evoked illusory rotation using bipolar galvanic vestibular stimulation (GVS). In 10 normal subjects, exposure to whole-body motion (10 min stochastic yaw) produced a long-lasting reduction in the perception of imposed movements, and the size of GVS-evoked balance reflexes. Importantly, conditioning reduced sensations of illusory rotation of pure vestibular origin (mean 113°with 1 mA GVS for 10 s) by 44% and they remained low after one hour. The same conditioning had no or minimal effect on the vestibulo-ocular reflex gain (measured by slow-phase eye velocity during sinusoidal yaw and by head impulse testing). Vestibular migraine and mal de debarquement syndrome (MDS) are important vestibular disorders where vertigo and imbalance are associated with normal results on routine vestibular tests. We studied 10 MDS patients all of whom had normal vestibular examination and routine test results. Compared with controls, these patients perceived imposed real yaw rotation to be 47% greater and illusory rotation (GVS-evoked) to be 128% greater. Low amplitude sinusoidal rocking (roll at 1 o -4°, 0.5 Hz) and illusory rocking (GVS 0.5–2 mA) were perceived to be 147% and 130% greater respectively. Despite normal balance by posturography, the MDS group showed a 5-fold increase in the size of the galvanic-evoked balance reflex. We conclude that psychophysical tests can help corroborate and quantify vestibular symptoms in disorders not identified by standard vestibular tests. We conjecture that failure of appropriate vestibular adaptation could underlie such disorders of motion perception.

Real-time computer-based visual feedback improves visual acuity in downbeat nystagmus - a pilot study.

BackgroundPatients with downbeat nystagmus syndrome suffer from oscillopsia, which leads to an unstable visual perception and therefore impaired visual acuity. The aim of this study was to use real-time computer-based visual feedback to compensate for the destabilizing slow phase eye movements.MethodsThe patients were sitting in front of a computer screen with the head fixed on a chin rest. The eye movements were recorded by an eye tracking system (EyeSeeCam®). We tested the visual acuity with a fixed Landolt C (static) and during real-time feedback driven condition (dynamic) in gaze straight ahead and (20°) sideward gaze. In the dynamic condition, the Landolt C moved according to the slow phase eye velocity of the downbeat nystagmus. The Shapiro-Wilk test was used to test for normal distribution and one-way ANOVA for comparison.ResultsTen patients with downbeat nystagmus were included in the study. Median age was 76 years and the median duration of symptoms was 6.3 years (SD +/- 3.1y). The mean slow phase velocity was moderate during gaze straight ahead (1.44°/s, SD +/- 1.18°/s) and increased significantly in sideward gaze (mean left 3.36°/s; right 3.58°/s). In gaze straight ahead, we found no difference between the static and feedback driven condition. In sideward gaze, visual acuity improved in five out of ten subjects during the feedback-driven condition (p = 0.043).ConclusionsThis study provides proof of concept that non-invasive real-time computer-based visual feedback compensates for the SPV in DBN. Therefore, real-time visual feedback may be a promising aid for patients suffering from oscillopsia and impaired text reading on screen. Recent technological advances in the area of virtual reality displays might soon render this approach feasible in fully mobile settings.

Influence of Age on Caloric Response.

In an aging society, the number of patients suffering from vertigo and dizziness is increasing. Vertigo is mostly thought to occur owing to otorhinolaryngologic disease. In contrast, it is difficult to diagnose dizziness, because of its varied causes, and we believe that the number of elderly patients suffering from dizziness is increasing. Here, we evaluated the relationship between canal paralysis and symptoms at the first medical examination and age-related changes in caloric response, and obtained the following 3 main findings: (a) 41.3% of the patients with canal paralysis complained of dizziness at the first medical examination, with an increased tendency in patients aged >70 years; (b) the slow-phase eye velocity (SPEV) of patients aged >70 years was lower than that of patients aged ≤69 years, and the SPEV of patients complaining of vertigo was higher than that of patients who complained of dizziness during a caloric test, and (c) the percentage of patients complaining of dizziness and those not complaining of symptoms during a caloric test increased with age. In conclusion, patients with canal paralysis tend to complain of dizziness at the first medical examination, and the percentage of patients without vertigo during a caloric test increased with age.

A CMOS Neural Interface for a Multichannel Vestibular Prosthesis.

We present a high-voltage CMOS neural-interface chip for a multichannel vestibular prosthesis (MVP) that measures head motion and modulates vestibular nerve activity to restore vision- and posture-stabilizing reflexes. This application specific integrated circuit neural interface (ASIC-NI) chip was designed to work with a commercially available microcontroller, which controls the ASIC-NI via a fast parallel interface to deliver biphasic stimulation pulses with 9-bit programmable current amplitude via 16 stimulation channels. The chip was fabricated in the ONSemi C5 0.5 micron, high-voltage CMOS process and can accommodate compliance voltages up to 12 V, stimulating vestibular nerve branches using biphasic current pulses up to 1.45±0.06 mA with durations as short as 10 μs/phase. The ASIC-NI includes a dedicated digital-to-analog converter for each channel, enabling it to perform complex multipolar stimulation. The ASIC-NI replaces discrete components that cover nearly half of the 2nd generation MVP (MVP2) printed circuit board, reducing the MVP system size by 48% and power consumption by 17%. Physiological tests of the ASIC-based MVP system (MVP2A) in a rhesus monkey produced reflexive eye movement responses to prosthetic stimulation similar to those observed when using the MVP2. Sinusoidal modulation of stimulus pulse rate from 68-130 pulses per second at frequencies from 0.1 to 5 Hz elicited appropriately-directed slow phase eye velocities ranging in amplitude from 1.9-16.7 °/s for the MVP2 and 2.0-14.2 °/s for the MVP2A. The eye velocities evoked by MVP2 and MVP2A showed no significant difference ( t-test, p=0.34), suggesting that the MVP2A achieves performance at least as good as the larger MVP2.

Role of the mouse retinal photoreceptor ribbon synapse in visual motion processing for optokinetic responses.

The ribbon synapse is a specialized synaptic structure in the retinal outer plexiform layer where visual signals are transmitted from photoreceptors to the bipolar and horizontal cells. This structure is considered important in high-efficiency signal transmission; however, its role in visual signal processing is unclear. In order to understand its role in visual processing, the present study utilized Pikachurin-null mutant mice that show improper formation of the photoreceptor ribbon synapse. We examined the initial and late phases of the optokinetic responses (OKRs). The initial phase was examined by measuring the open-loop eye velocity of the OKRs to sinusoidal grating patterns of various spatial frequencies moving at various temporal frequencies for 0.5 s. The mutant mice showed significant initial OKRs with a spatiotemporal frequency tuning (spatial frequency, 0.09 ± 0.01 cycles/°; temporal frequency, 1.87 ± 0.12 Hz) that was slightly different from the wild-type mice (spatial frequency, 0.11 ± 0.01 cycles/°; temporal frequency, 1.66 ± 0.12 Hz). The late phase of the OKRs was examined by measuring the slow phase eye velocity of the optokinetic nystagmus induced by the sinusoidal gratings of various spatiotemporal frequencies moving for 30 s. We found that the optimal spatial and temporal frequencies of the mutant mice (spatial frequency, 0.11 ± 0.02 cycles/°; temporal frequency, 0.81 ± 0.24 Hz) were both lower than those in the wild-type mice (spatial frequency, 0.15 ± 0.02 cycles/°; temporal frequency, 1.93 ± 0.62 Hz). These results suggest that the ribbon synapse modulates the spatiotemporal frequency tuning of visual processing along the ON pathway by which the late phase of OKRs is mediated.

Preserved otolith organ function in caspase-3-deficient mice with impaired horizontal semicircular canal function.

Genetically engineered mice are valuable models for elucidation of auditory and vestibular pathology. Our goal was to establish a comprehensive vestibular function testing system in mice using: (1) horizontal angular vestibulo-ocular reflex (hVOR) to evaluate semicircular canal function and (2) otolith-ocular reflex (OOR) to evaluate otolith organ function and to validate the system by characterizing mice with vestibular dysfunction. We used pseudo off-vertical axis rotation to induce an otolith-only stimulus using a custom-made centrifuge. For the OOR, horizontal slow-phase eye velocity and vertical eye position were evaluated as a function of acceleration. Using this system, we characterized hVOR and OOR in the caspase-3 (Casp3) mutant mice. Casp3 (-/-) mice had severely impaired hVOR gain, while Casp3 (+/-) mice had an intermediate response compared to WT mice. Evaluation of OOR revealed that at low-to-mid frequencies and stimulus intensity, Casp3 mutants and WT mice had similar responses. At higher frequencies and stimulus intensity, the Casp3 mutants displayed mildly reduced otolith organ-related responses. These findings suggest that the Casp3 gene is important for the proper function of the semicircular canals but less important for the otolith organ function.

Vestibular implantation and longitudinal electrical stimulation of the semicircular canal afferents in human subjects.

Animal experiments and limited data in humans suggest that electrical stimulation of the vestibular end organs could be used to treat loss of vestibular function. In this paper we demonstrate that canal-specific two-dimensionally (2D) measured eye velocities are elicited from intermittent brief 2 s biphasic pulse electrical stimulation in four human subjects implanted with a vestibular prosthesis. The 2D measured direction of the slow phase eye movements changed with the canal stimulated. Increasing pulse current over a 0-400 μA range typically produced a monotonic increase in slow phase eye velocity. The responses decremented or in some cases fluctuated over time in most implanted canals but could be partially restored by changing the return path of the stimulation current. Implantation of the device in Meniere's patients produced hearing and vestibular loss in the implanted ear. Electrical stimulation was well tolerated, producing no sensation of pain, nausea, or auditory percept with stimulation that elicited robust eye movements. There were changes in slow phase eye velocity with current and over time, and changes in electrically evoked compound action potentials produced by stimulation and recorded with the implanted device. Perceived rotation in subjects was consistent with the slow phase eye movements in direction and scaled with stimulation current in magnitude. These results suggest that electrical stimulation of the vestibular end organ in human subjects provided controlled vestibular inputs over time, but in Meniere's patients this apparently came at the cost of hearing and vestibular function in the implanted ear.

前庭核中心に plaque 病変を認めた多発性硬化症2例における視運動性眼振所見の継時的検討

Electronystagmography (ENG) findings were chronologically studied through the clinical courses in two multiple sclerosis patients (1 male and 1 female, both 25 years of age). At the initial bout, they showed left facial palsy and horizontal gaze nystagmus. The MRI demonstrated a single plaque lesion around the left vestibular nuclei at the ponto-medullary junction in both cases. In ENG recordings of both cases, the slow phase velocities of optokinetic nystagmus (OKN) were severely attenuated bilaterally at onset. In contrast, the smooth pursuit was relatively preserved in both cases through their clinical courses. In several months activities of daily living had recovered to normal. In accordance with their recovery, the OKN finally improved to the normal level in both cases. The Present ENG studies showed a definite dissociation between eye movements of pursuit and optokinetic systems. In Cohen and Raphan's model, the slow phase eye velocity of OKN is comprised of two components: the “direct pathway” involving the flocculus, which is the mechanism responsible for the rapid rise in slow phase eye velocity and is also utilized in mediating ocular pursuit. The second component is the “indirect pathway” which is responsible for producing slow phase eye velocity during vestibular nystagmus, OKN, and optokinetic after-nystagmus (OKAN). A key element in the indirect pathway is velocity storage, which is closely related to the mechanism of the vestibular nuclei. Although the neural circuits that produce velocity storage remain unclear, our previous experimental studies demonstrated that microstimulation mainly in the central medial vestibular nuclei (MVN) of monkeys elicited horizontal nystagmus and after-nystagmus related to velocity storage. Furthermore, after microinjection of muscimol (a GABA-A agonist) into the stimulus effective sites in the MVN, the slow component of OKN, the dominant time constant of aVOR and OKAN transiently disappeared bilaterally. These findings suggested that the horizontal velocity storage is generated in the MVN. The results of our present ENG studies were quite coincident with those of our previous experimental studies. Consequently, in both cases in the present study, it was assumed that the “indirect pathway” was transiently disturbed by the plaque lesion around the VN. In addition, two important points were particularly emphasized. First, the neural networks related to the horizontal velocity storage should be situated at the restricted area of the MVN, mainly the central MVN. Second, a single unilateral vestibular lesion caused a deficit in the horizontal velocity storage in both directions, in a similar manner to the results of studies in the MVN on a single experimental lesion. In conclusion, the findings of the present study and previous studies suggest that the horizontal velocity storage is generated in similar neural circuits of the human vestibular nuclei.

Light cupula: the pathophysiological basis of persistent geotropic positional nystagmus

ObjectiveTo clarify the pathophysiological basis of persistent geotropic positional nystagmus (PGN) in patients with the horizontal canal type of benign paroxysmal positional vertigo (H-BPPV), the time constant (TC) of nystagmus...

少量注水法に対応するエアーカロリック検査の刺激条件の検討

In the present study, we examined the temperature of aural air stimulation that was equivalent to aural stimulation with water at 20°C in the caloric test. In 10 ears of 5 healthy volunteers, the maximum slow phase eye velocities (MSPEVs) of nystagmus induced by aural stimulation with air at 22°C, 46°C and 16°C were the same as those with water at 30°C, 44°C and 20°C, respectively. These findings suggest that caloric stimulation with air at 16°C is equivalent to that with water at 20°C that is commonly used in the caloric test in Japan. The MSPEVs of nystagmus induced by aural stimulation with air at 16°C were over 20°/sec in all ears except one, in which the MSPEV was 19.7°/sec. The criteria of canal paresis where the MSPEV of caloric nystagmus induced by aural stimulation with water at 20°C is less than 20°/sec can be used in the caloric test with aural air stimulation at 16°C.

Magnetic Vestibular Stimulation in Subjects with Unilateral Labyrinthine Disorders

We recently discovered that static magnetic fields from high-strength MRI machines induce nystagmus in all normal humans, and that a magneto-hydrodynamic Lorentz force, derived from ionic currents in the endolymph and pushing on the cupula, best explains this effect. Individuals with no labyrinthine function have no nystagmus. The influence of magnetic vestibular stimulation (MVS) in individuals with unilateral deficits in labyrinthine function is unknown and may provide insight into the mechanism of MVS. These individuals should experience MVS, but with a different pattern of nystagmus consistent with their unilateral deficit in labyrinthine function. We recorded eye movements in the static magnetic field of a 7 T MRI machine in nine individuals with unilateral labyrinthine hypofunction, as determined by head impulse testing and vestibular-evoked myogenic potentials (VEMP). Eye movements were recorded using infrared video-oculography. Static head positions were varied in pitch with the body supine, and slow-phase eye velocity (SPV) was assessed. All subjects exhibited predominantly horizontal nystagmus after entering the magnet head-first, lying supine. The SPV direction reversed when entering feet-first. Pitching chin-to-chest caused subjects to reach a null point for horizontal SPV. Right unilateral vestibular hypofunction (UVH) subjects developed slow-phase-up nystagmus and left UVH subjects, slow-phase-down nystagmus. Vertical and torsional components were consistent with superior semicircular canal excitation or inhibition, respectively, of the intact ear. These findings provide compelling support for the hypothesis that MVS is a result of a Lorentz force and suggest that the function of individual structures within the labyrinth can be assessed with MVS. As a novel method of comfortable and sustained labyrinthine stimulation, MVS can provide new insights into vestibular physiology and pathophysiology.

Velocity storage mechanism in zebrafish larvae

The optokinetic reflex (OKR) and the angular vestibulo-ocular reflex (aVOR) complement each other to stabilize images on the retina despite self- or world motion, a joint mechanism that is critical for effective vision. It is currently hypothesized that signals from both systems integrate, in a mathematical sense, in a network of neurons operating as a velocity storage mechanism (VSM). When exposed to a rotating visual surround, subjects display the OKR, slow following eye movements frequently interrupted by fast resetting eye movements. Subsequent to light-off during optokinetic stimulation, eye movements do not stop abruptly, but decay slowly, a phenomenon referred to as the optokinetic after-response (OKAR). The OKAR is most likely generated by the VSM. In this study, we observed the OKAR in developing larval zebrafish before the horizontal aVOR emerged. Our results suggest that the VSM develops prior to and without the need for a functional aVOR. It may be critical to ocular motor control in early development as it increases the efficiency of the OKR.

Effects of endolymphatic sac decompression surgery on endolymphatic hydrops

Conclusions: The present findings suggest that complete control of vertigo after endolymphatic sac decompression surgery (ESDS) does not always depend on improved vestibular function or reduced endolymphatic hydrops. Vertigo control is, however, associated with hearing stability.Objective: Among surgical treatments for intractable Meniere’s disease, ESDS is performed to preserve and improve inner ear function. We examined the correlation between changes in vertigo frequency and neuro-otologic function to understand the condition of the inner ear in patients whose vertigo was completely controlled after undergoing ESDS.Methods: This was a retrospective cross-tabulation study. Between 1997 and 2001, we treated 52 patients with intractable vertigo using ESDS and followed the patients regularly for 2 years. Postoperatively we evaluated and recorded changes in vertigo attack frequency, maximum slow phase eye velocity, worst hearing level, and glycerol test results according to modified American Academy of Otolaryngology–Head and Neck Surgery 1995 criteria.Results: We found no correlation between vertigo control and vestibular function. There was also no correlation between vertigo control and negative conversion of the glycerol test. There was a significant correlation between vertigo control and hearing control .

Vestibular function after vestibular neuritis

Objective: To measure horizontal semicircular canal function over days, weeks, and months after an acute attack of vestibular neuritis. Design: The video head impulse test (vHIT) was used to measure the eye movement response to small unpredictable passive head turns at intervals after the attack. Study sample: Two patients diagnosed with acute right unilateral vestibular neuritis. Results: There was full restoration of horizontal canal function in one patient (A) as shown by the return of the slow phase eye velocity response to unpredictable head turns, while in the other patient (B) there was little or no recovery of horizontal canal function. Instead this second patient generated covert saccades during head turns. Conclusion: Despite the objective evidence of their very different recovery patterns, both patients reported, at the final test, being happy and feeling well recovered, even though in one of the patients there was clear absence of horizontal canal function. The results indicate covert saccades seem a successful way of compensating for loss of horizontal canal function after unilateral vestibular neuritis. Factors other than recovery of the slow phase eye velocity are significant for patient recovery.

A randomised double-blind, cross-over trial of 4-aminopyridine for downbeat nystagmus—effects on slowphase eye velocity, postural stability, locomotion and symptoms

ObjectiveThe effects of 4-aminopyridine (4-AP) on downbeat nystagmus (DBN) were analysed in terms of slow-phase velocity (SPV), stance, locomotion, visual acuity (VA), patient satisfaction and side effects using standardised questionnaires.MethodsTwenty-seven...

Contributions of retinal direction‐selective ganglion cells to optokinetic responses in mice

In the mouse retina, there are two distinct groups of direction-selective ganglion cells, ON and ON-OFF, that detect movement of visual images. To understand the roles of these cells in controlling eye movements, we studied the optokinetic responses (OKRs) of mutant mice with dysfunctional ON-bipolar cells that have a functional obstruction of transmission to ON direction-selective ganglion cells. Experiments were carried out to examine the initial and late phases of OKRs. The initial phase was examined by measurement of eye velocity using stimuli of sinusoidal grating patterns of various spatiotemporal frequencies that moved for 0.5s. The mutant mice showed significant initial OKRs, although the range of spatiotemporal frequencies that elicited these OKRs was limited and the response magnitude was weaker than that in wild-type mice. To examine the late phase of the OKRs, the same visual patterns were moved for 30s to induce alternating slow and quick eye movements (optokinetic nystagmus) and the slow-phase eye velocity was measured. Wild-type mice showed significant late OKRs with a stimulus in an appropriate range of spatiotemporal frequencies (0.0625-0.25cycles/°, 0.75-3.0Hz, 3-48°/s), but mutant mice did not show late OKRs in response to the same visual stimuli. The results suggest that two groups of direction-selective ganglion cells play different roles in OKRs: ON direction-selective ganglion cells contribute to both initial and late OKRs, whereas ON-OFF direction-selective ganglion cells contribute to OKRs only transiently.