Vertical Pursuit Research Articles

An Exploratory Analysis of Physical Examination Subtypes in Pediatric Athletes With Concussion.

Pediatric athletes with concussion present with a variety of impairments on clinical assessment and require individualized treatment. The Buffalo Concussion Physical Examination is a brief, pertinent clinical assessment for individuals with concussion. The purpose of this study was to identify physical examination subtypes in pediatric athletes with concussion within 2 weeks of injury that are relevant to diagnosis and treatment. Secondary analysis of a published cohort study and clinician consensus. Three university-affiliated sports medicine centers. Two hundred seventy children (14.9 ± 1.9 years). Orthostatic intolerance, horizontal and vertical saccades, smooth pursuits, vestibulo-ocular reflex, near-point convergence, complex tandem gait, neck range of motion, neck tenderness, and neck spasm. Correlations between independent variables were calculated, and network graphs were made. k -means and hierarchical clustering were used to identify clusters of impairments. Optimal number of clusters was assessed. Results were reviewed by experienced clinicians and consensus was reached on proposed subtypes. Physical examination clusters overlapped with each other, and no optimal number of clusters was identified. Clinician consensus suggested 3 possible subtypes: (1) visio-vestibular (horizontal and vertical saccades, smooth pursuits, and vestibulo-ocular reflex), (2) cervicogenic (neck range of motion and spasm), and (3) autonomic/balance (orthostatic intolerance and complex tandem gait). Although we identified 3 physical examination subtypes, it seemed that physical examination findings alone are not enough to define subtypes that are both statistically supported and clinically relevant, likely because they do not include symptoms, assessment of mood or cognitive problems, or graded exertion testing.

上眼瞼向き眼振・小脳萎縮など認めたParkinson病の 1 例

To the best of our knowledge, upbeat nystagmus (UBN) has not been reported before in patients with Parkinson's disease (PD). There are also very few reports of cerebellar atrophy in patients with PD. A-60-year-old woman with a 10-year history of PD visited our hospital for deep brain stimulation therapy for her camptocormia. Neurological examination revealed not only the core signs of PD (rigidity, resting tremor, postural instability), but also UBN. 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy revealed markedly diminished uptake of MIBG, strongly supporting the clinical diagnosis of PD. Brain MRI revealed prominent cerebellar atrophy, while the brainstem was preserved. ENG showed that the UBN was observed at the primary eye position and enhanced during upward gaze in the light, but not during downward gaze. In addition to UBN, several other abnormal ENG findings were also observed, including horizontal gaze-evoked nystagmus and rebound nystagmus. Secondly, both horizontal and vertical pursuits were disturbed and horizontal OKN was poorly induced. Lastly, the horizontal saccade was relatively hypometric, while the upward saccades were slight hypermetric. Although the pathogenesis of UBN in this patient still remains unclear, UBN is known to be mainly caused by dysfunction of the velocity-to-position integrator caused by pontomedullary lesions or pontomesencephalic lesions. Alternatively, cerebellar control over this integrator is presumably disrupted by lesions in the cerebellum itself or lesions in the cerebellar neural circuits. As for the pathogenesis of UBN in our case, pontomedullary lesion was first suspected, because, besides the abovementioned ENG findings, most cases of UBN reported in the literature are caused by medullary lesions, including lesions of both the medial vestibular and prepositus hypoglossi nuclei, which play an important role as the velocity-to-position integrator. In addition, dysfunction of the vestibular cerebellum was also suspected as a cause, judging from the cerebellar atrophy and other abnormal ENG findings. In conclusion, it is necessary to consider dysfunction of the vestibular cerebellum as a cause of abnormal eye movements in PD, not to mention dysfunction of the brainstem.

A New Immersive Rehabilitation Therapy (MoveR) Improves More Than Classical Visual Training Visual Perceptual Skills in Dyslexic Children.

In this study, we wonder how to compare the improvement in visual perceptual skills (by using the test of visual perceptual skills, TVPS) in children with dyslexia after two visual training types (a new immersive rehabilitation therapy called MoveR, and the classical vision therapy). Thirty-nine children with dyslexia were enrolled in the study. They were split into two groups (G1 and G2) matched in IQ (intelligence quotient), sex, and age. Children of the group G1 underwent to MoveR training while children of the group G2 underwent to visual training. TVPS scores of four subtests were assessed twice before and 6 months after the two different types of training (MoveR or visual). MoveR training is an immersive therapy to reinforce visual discrimination, visual attention, saccadic/vergence system and spatial orientation. Visual therapy is based by training different types of eyes movements (horizontal, vertical and oblique pursuits and saccades, convergence and divergence movements), reading task and some exercise for improving eyes-head coordination. Each training type lasted 30 min a day, five days a week, for two weeks. Before training, the TVPS scores of the four subtests measured were statistically similar for both groups of children with dyslexia (G1 and G2). After training, both group of children (G1 and G2) improved the TVPS score of the four subtests assessed; however, such improvement reached significance in G1 only. We conclude that MoveR training could be a more useful tool than classical visual training to improve visual perceptual abilities in dyslexic children. Follow up studies on a larger number of dyslexic children will be necessary in order to explore whether such improvement persists over time and its eventual implication in reading or other classroom's activities.

State-Following-Kernel-Based Online Reinforcement Learning Guidance Law Against Maneuvering Target

In this article, a state-following-kernel-based reinforcement learning method with an extended disturbance observer is proposed, whose application to a missile-target interception system is considered. First, the missile-target engagement is formulated as a vertical planar pursuit–evasion problem. The target maneuver is then estimated by an extended disturbance observer in real time, which leads to an infinite-horizon optimal regulation problem. Next, utilizing the local state approximation ability of state-following kernels, the critic neural network (NN) and actor NN for synchronous iteration are constructed to calculate the approximate optimal guidance policy. The states and NN weights are proven to be uniformly ultimately bounded using the Lyapunov method. Finally, numerical simulations against different types of nonstationary targets are effectively tested, and the results highlight the role of state-following kernels in the value function and policy approximation.

Progression of Clinical and Eye Movement Markers in Preataxic Carriers of Machado-Joseph Disease.

Little is known about preclinical stages of Machado-Joseph disease, a polyglutamine disorder characterized by progressive adult-onset ataxia. We aimed to describe the longitudinal progression of clinical and oculomotor variables in the preataxic phase of disease. Carriers and noncarriers were assessed at three visits. Preataxic carriers (Scale for Assessment and Rating of Ataxia score < 3) expected to start ataxia in ≤4 years were considered near onset (PAN). Progressions of ataxic and preataxic carriers, considering status at the end of the study, were described according to the start (or its prediction) of gait ataxia (TimeToAfterOnset) and according to the study time. A total of 35 ataxics, 38 preataxics, and 22 noncarriers were included. The "TimeToAfterOnset" timeline showed that Neurological Examination Scale for Spinocerebellar Ataxias (NESSCA; effect size, 0.09), Inventory of Non-Ataxia Symptoms (INAS0.07), and the vestibulo-ocular reflex gain (0.12) progressed in preataxic carriers, and that most slopes accelerate in PAN, turning similar to those of ataxics. In the study time, NESSCA (1.36) and vertical pursuit gain (1.17) significantly worsened in PAN, and 6 of 11 PANs converted to ataxia. For a clinical trial with 80% power and 2-year duration, 57 PANs are needed in each study arm to detect a 50% reduction in the conversion rate. NESSCA, INAS, vestibulo-ocular reflex, and vertical pursuit gains significantly worsened in the preataxic phase. The "TimeToAfterOnset" timeline unveiled that slopes of most variables are small in preataxics but increase and reach the ataxic slopes from 4 years before the onset of ataxia. For future trials in preataxic carriers, we recommend recruiting PANs and using the conversion rate as the primary outcome. © 2022 International Parkinson and Movement Disorder Society.

Pre-ataxic Changes of Clinical Scales and Eye Movement in Machado-Joseph Disease: BIGPRO Study.

The pathological burden of spinocerebellar ataxia type 3, also known as Machado-Joseph disease (SCA3/MJD), accumulates before the beginning of symptoms. Our study aims at validating biomarkers for disease progression since pre-ataxic periods. We report on baseline findings of clinical scales and oculomotor neurophysiology. Ataxic (Scale for the Assessment and Rating of Ataxia > 2.5) and at 50% risk subjects were included. The latter were subdivided into noncarriers, pre-ataxic carriers near (PAN), or pre-ataxic carriers far from (PAFF) ataxia onset (AO), with 4 years from the predicted age at onset being the cutoff. The subjects were assessed by Neurological Examination Score for Spinocerebellar Ataxia (NESSCA), International Cooperative Ataxia Rating Scale (ICARS), Inventory of Non-Ataxic Signs (INAScount), Composite Cerebellar Functions Score and SCA Functional Index, and video-oculography, including the regression slope of vestibulo-ocular reflex gain (VORr), main sequence of volitional and reflexive vertical saccades, slow-phase velocity of central and gaze-evoked (SPV-GE) nystagmus, and vertical pursuit gain. Correction for multiple comparisons was performed; the threshold for statistical significance was P < 0.05. A total of 35 ataxic, 14 PAN, 24 PAFF, and 22 noncarriers were included. All variables showed significant differences between groups and correlated to time to onset or time after onset, among all 73 SCA3/MJD carriers; none significantly changed with age in controls. NESSCA, ICARS, INAScount, VORr, main sequence of volitional saccades, and SPV-GE not only distinguished PAN from controls but also correlated with time left to AO. Clinical scales and video-oculography variables were already altered in pre-ataxic SCA3/MJD carriers and worsened with time. NESSCA, ICARS, INAScount, VORr, main sequence of vertical volitional saccades, and SPV-GE are good candidates to measure preclinical changes in SCA3/MJD. © 2021 International Parkinson and Movement Disorder Society.

Eye movements and association with regional brain atrophy in clinical subtypes of progressive supranuclear palsy.

To investigate oculomotor impairment in subtypes of progressive supranuclear palsy (PSP) and its associations with clinical features and regional brain volumes in PSP. We compared the video-oculography (VOG) findings of 123 PSP patients, consisting of 66 PSP-Richardson syndrome (PSP-RS), 28 PSP-parkinsonism (PSP-P), and 29 PSP-progressive gait freezing (PSP-PGF), along with 80 Parkinson's disease (PD) patients. We also investigated the associations of the VOG results with clinical features (disease duration, PSP rating scales [PSPRS] scores for dysphagia and postural stability) in the subtypes of PSP patients and with regional volumes in the brainstem, including the midbrain, pons, medulla, and the superior cerebellar peduncle (SCP), among the patients who had MRI images at the time of VOG (30 PSP). All of the three subtypes of PSP patients showed slower vertical saccades and smooth pursuit than that of the PD patients (adjusted p < 0.05). Among the PSP subtypes, saccadic peak velocity, saccadic accuracy, and pursuit gain were significantly decreased in patients with the PSP-RS compared to those with the PSP-PGF (adjusted p < 0.05). In multiple linear regression model, vertical saccadic velocity, latency, accuracy, and pursuit gain were associated with the PSPRS score for dysphagia (adjusted p < 0.05), and a decrease in vertical saccadic speed and accuracy was associated with SCP atrophy (corrected p < 0.05). This study demonstrated the severity of oculomotor dysfunction in differentiating the subtypes of PSP and its significant relationships with the dysphagia symptom and SCP volume in PSP.

Two-Dimensional Analysis of Horizontal and Vertical Pursuit in Infantile Nystagmus Reveals Quantitative Deficits in Accuracy and Precision.

PurposeInfantile nystagmus (IN) presents with continuous, predominantly horizontal eye oscillations. It remains controversial whether those with IN have normal horizontal pursuit, while vertical pursuit has rarely been studied. We examined whether there are pursuit deficits associated with IN by investigating the effect of target direction, velocity, and amplitude.MethodsTwelve adults with idiopathic IN performed a pursuit task, a 0.4° dot moved either horizontally or vertically at 8 or 16°/s, through amplitudes of 8°, 16°, or 32°. Accuracy and precision errors were computed as bivariate probability density functions of target-relative eye velocities.ResultsEye velocity was less precise along the horizontal axis during both horizontal and vertical pursuit, reflecting the primary axis of the eye oscillation. Mean accuracy error along the target trajectory during vertical pursuit was just as impaired as during horizontal pursuit. There was a greater error in accuracy along the target trajectory for 16°/s targets than 8°/s. Finally, targets that oscillated at 2.0 Hz had a greater error in accuracy along the target trajectory than frequencies of 1.0 Hz or 0.5 Hz. When studied using the same experimental protocol, pursuit performance for typical observers was always better.ConclusionsThese findings strongly support our hypothesis of severe deficits in pursuit accuracy in observers with IN for horizontally and vertically moving targets, as well as for targets that move at higher speeds or oscillate more quickly. Overall, IN pursuit impairment appears to have previously been underestimated, highlighting a need for further quantitative studies of dynamic visual function in those with IN.

Quantitative oculomotor and nonmotor assessments in late-onset GM2 gangliosidosis.

A cross-sectional study was performed to evaluate whether quantitative oculomotor measures correlate with disease severity in late-onset GM2 gangliosidosis (LOGG) and assess cognition and sleep as potential early nonmotor features. Ten patients with LOGG underwent quantitative oculomotor recordings, including measurements of the angular vestibulo-ocular reflex (VOR), with results compared to age- and sex-matched controls. Disease severity was assessed by ataxia rating scales. Cognitive/neuropsychiatric features were assessed by the cerebellar cognitive affective syndrome (CCAS) scale, Cerebellar Neuropsychiatric Rating Scale, and sleep quality evaluated using subjective sleep scales. Oculomotor abnormalities were found in all participants, including 3/10 with clinically normal eye movements. Abnormalities involved impaired saccadic accuracy (5/10), abnormal vertical (8/10) and horizontal (4/10) pursuit, reduced optokinetic nystagmus (OKN) responses (7/10), low VOR gain (10/10), and impaired VOR cancellation (2/10). Compared to controls, the LOGG group showed significant differences in saccade, VOR, OKN, and visually enhanced VOR gains. Severity of saccadic dysmetria, OKN, and VOR fixation-suppression impairments correlated with ataxia scales (p < 0.05). Nine out of ten patients with LOGG had evidence of the CCAS (5/10 definite, 2/10 probable, 2/10 possible). Excessive daytime sleepiness was present in 4/10 and 8/10 had poor subjective sleep quality. Cerebellar oculomotor abnormalities were present in all patients with LOGG, including those with normal clinical oculomotor examinations. Saccade accuracy (dorsal cerebellar vermis localization), fixation suppression, and OKN gain (cerebellar flocculus/paraflocculus localization) correlated with disease severity, suggesting that quantitative oculomotor measurements could be used to track disease progression. We found evidence of the CCAS, suggesting that cerebellar dysfunction may explain the cognitive disorder in LOGG. Sleep impairments were prevalent and require further study.

Two-Dimensional Analysis of Smooth Pursuit Eye Movements Reveals Quantitative Deficits in Precision and Accuracy.

PurposeSmall moving targets are followed by pursuit eye movements, with success ubiquitously defined by gain. Gain quantifies accuracy, rather than precision, and only for eye movements along the target trajectory. Analogous to previous studies of fixation, we analyzed pursuit performance in two dimensions as a function of target direction, velocity, and amplitude. As a subsidiary experiment, we compared pursuit performance against that of fixation.MethodsEye position was recorded from 15 observers during pursuit. The target was a 0.4° dot that moved across a large screen at 8°/s or 16°/s, either horizontally or vertically, through peak-to-peak amplitudes of 8°, 16°, or 32°. Two-dimensional eye velocity was expressed relative to the target, and a bivariate probability density function computed to obtain accuracy and precision. As a comparison, identical metrics were derived from fixation data.ResultsFor all target directions, eye velocity was less precise along the target trajectory. Eye velocities orthogonal to the target trajectory were more accurate during vertical pursuit than horizontal. Pursuit accuracy and precision along and orthogonal to the target trajectory decreased at the higher target velocity. Accuracy along the target trajectory decreased with smaller target amplitudes.ConclusionsOrthogonal to the target trajectory, pursuit was inaccurate and imprecise. Compared to fixation, pursuit was less precise and less accurate even when following the stimulus that gave the best performance.Translational RelevanceThis analytical approach may help the detection of subtle deficits in slow phase eye movements that could be used as biomarkers for disease progression and/or treatment.

Treatment of a 25-year-old female with severe motion sickness, positional dizziness, and anxiety using a novel sensorimotor and vestibular rehabilitative approach.

Event Abstract Back to Event Treatment of a 25-year-old female with severe motion sickness, positional dizziness, and anxiety using a novel sensorimotor and vestibular rehabilitative approach. Marc C. Case1* 1 Case Chiropractic Neurology Center, United States Presentation Motion sickness is a very common condition with myriad associated symptoms and triggers. Patients presenting with motion sickness should undergo extensive history and examination to determine most relevant causative components to their symptomatology, allowing appropriate diagnosis and treatment. A 25-year-old female patient presents to our clinic with long-standing history of severe motion sickness, positional dizziness, and anxiety. Examination Clinical infrared video goggle assessment revealed bilateral square wave jerks, hypermetric rightward saccades, left eye accommodation spasm, left lateral and left vertical gaze fixation instability, right eye accommodation spasm upon return to center from right horizontal gaze fixation, and hippus bilaterally. Force plate posturography revealed an average baseline center of pressure (COP) path length of 40cm during Fall Risk Assessment (FRA) on a firm surface with eyes closed, indicating a high fall risk, and a baseline composite COP path length of 177cm during modified Clinical Test of Sensory Integration and Balance (mCTSIB). Heart rate sit to stand measured 81 BPM seated to 93 BPM standing right, and 83 BPM seated to 97 BPM standing left. Tissue oxygenation saturation measured 96% bilaterally. Neurological examination revealed saccadic rightward pursuits, saccadic vertical pursuits, hypermetric leftward saccades, slight right palatal paresis, mild palmar hyperhidrosis bilaterally, hypermetria with right finger to nose, dysdiadochokinesia of the right upper extremity, right glossal deviation, and fasciculations of the left posterior deltoid and bilateral cervical spinal musculature with eyes closed standing on firm surface. Intervention Due to time restrictions, the patient was only able to be seen for two treatments in a single day. A brain-based, multimodal treatment approach included vestibular rehabilitation maneuvers, vestibular-ocular re-training, individualized eye movement therapies, sensorimotor integrative therapies, and specific at-home neurologic exercises. Re-examination was performed following treatments. Repeat force plate posturography revealed an average baseline COP path length of 20cm during FRA on firm surface eyes closed, indicating a low fall risk (50% improvement) and a baseline composite COP path length of 115cm during mCTSIB (62cm improvement). At the 6 week follow-up, the patient reported a maintained significant reduction in frequency and severity of motion sickness and anxiety, with complete resolution of positional dizziness. Conclusion A 25-year-old female with severe motion sickness, anxiety, and positional dizziness sees immediate, significant, and lasting results within a single-day, 2-treatment clinical timeframe. This case study reveals a hopeful and conservative approach to treatment of chronic motion sickness and associated symptoms. Further investigation is warranted for interventions involving brain-based, multimodal therapies for motion sickness, positional dizziness and anxiety. Figure 1 Figure 2 Keywords: Motion Sickness, Anxiety, Dizziness, vestibular rehabilitaiton, sensorimotor Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Case MC (2019). Treatment of a 25-year-old female with severe motion sickness, positional dizziness, and anxiety using a novel sensorimotor and vestibular rehabilitative approach.. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00046 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Dr. Marc C Case, Case Chiropractic Neurology Center, St. Marys, United States, marc.case15@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Marc C Case Google Marc C Case Google Scholar Marc C Case PubMed Marc C Case Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. 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CLINICAL NUTRITION AND MULTIMODAL NEUROREHABILITATION IMPROVE CHRONIC POST-CONCUSSION SYMPTOMS IN 22 YEAR OLD WOMAN

Event Abstract Back to Event CLINICAL NUTRITION AND MULTIMODAL NEUROREHABILITATION IMPROVE CHRONIC POST-CONCUSSION SYMPTOMS IN 22 YEAR OLD WOMAN David J. Clark1* 1 Carrick Institute, United States Background: A 22 year old woman presented with a 5 month history of fatigue, forgetfulness, difficulty concentrating, depression, irritability, light and sound sensitivity, dizziness/motion sickness, problems with balance and depth perception subsequent to a motor vehicle accident. She was on medical leave from University. Prior to presentation she had completed some vision therapy and primitive reflex remediation that worsened her symptoms. At time of prevention she was following a gluten-free, vegan diet. She was taking B12, Vitamin D, MCT oil, flax, ginkgo biloba and magnesium. Methods: Neurological examination revealed decreased left arm swing that improved with dual-tasking, horizontal and vertical pursuit testing at bedside elicited excessive sway, slowed vertical saccades tested at bedside, vertical saccades tested with VOG showed marked hypometria downwards and average latency greater than 200 ms, vertical optokinetics tested with VOG showed low gain in both directions, drowsiness and hippus during the VOG assessment. Ingestion of Th1 and Th2 boosters provoked her symptoms. Laboratory examination revealed low ferritin (8 ng/mL), clinically significantly low LDH (119 IU/L) , folate (10.7 ng/mL), magnesium (1.9 mg/dL). Initially, her diet was modified to increase her total protein and calorie intake, as well as the frequency of calorie intake. She was placed on supplemental folate, iron, turmeric, resveratrol, vitamin, magnesium, and a multi-nutrient to support normal tissue glucose levels. After 5 months of this program she was enrolled in a 4 day multi-modal neurorehabilitation program utilizing active gaze stabilization, Interactive Metronome, proprioceptive exercises, progressive balance exercises, and coupled reduction manipulation. Results: Due to improvement in her original presenting complaints, 2 months after her finishing her initial program, she re-enrolled in University. At last follow up she reported only some difficulty in cognitive set shifting. She continued to take Vitamin D, folate, iron, and the multi-nutrient formula to support normal tissue glucose levels. Conclusion: The author suggests further investigation into comprehensive, multimodal forms of neurorehabilitation and clinical nutrition in the treatment of chronic post-concussion symptoms. Keywords: post concussion syndrome (PCS), Neurorehabilitation, Clinical Nutrition, supplementation, Anti-inflammatory diet Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Clark DJ (2019). CLINICAL NUTRITION AND MULTIMODAL NEUROREHABILITATION IMPROVE CHRONIC POST-CONCUSSION SYMPTOMS IN 22 YEAR OLD WOMAN. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00013 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Mx. David J Clark, Carrick Institute, Cape Canaveral, Florida, 32920, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Premanifest Huntington's disease: Examination of oculomotor abnormalities in clinical practice.

IntroductionDifferent oculomotor abnormalities have been reported to occur in premanifest Huntington’s disease. The aim of this study is to investigate which oculomotor items of the Unified Huntington’s Disease Rating Scale (UHDRS) are affected in premanifest individuals compared to healthy controls, and if CAG repeat length and age are correlated with oculomotor abnormalities in premanifest Huntington’s disease gene carriers.MethodsWe compared baseline data of 70 premanifest individuals and 27 controls who participated in the Enroll-HD study at the Leiden University Medical Center, the Netherlands. Premanifest gene carriers were divided in individuals near to disease onset and individuals far from disease onset.ResultsUsing a logistic regression model, only horizontal ocular pursuit of the six oculomotor items of the UHDRS was significantly more frequently affected in premanifest individuals close to disease onset compared to controls (p = 0.044, OR 13.100). Age was significantly higher in premanifest individuals with affected horizontal ocular pursuit (p = 0.016, OR 1.115) and with affected vertical ocular pursuit (p = 0.030, OR 1.065) compared to premanifest individuals without ocular pursuit deficits.ConclusionsOur results suggest that horizontal ocular pursuit is the only affected oculomotor item of the UHDRS in premanifest individuals and could be used to assess early clinical signs of Huntington’s disease. Saccade initiation and saccade velocity do not seem useful for detecting differences between premanifest individuals and controls.

Vestibular Test Patterns in the NICoE Intensive Outpatient Program Patient Population.

The National Intrepid Center of Excellence (NICoE), on the campus of Walter Reed National Military Medical Center, was developed to help improve the lives of active duty service members (SMs) with traumatic brain injury (TBI) and comorbid behavioral health (BH) conditions. During the NICoE intensive outpatient program, SM who have all been identified as having some degree of TBI, undergo extensive interdisciplinary evaluations, including comprehensive vestibular assessment. These SMs sometimes present with vestibular symptoms ranging from lightheadedness to vertigo associated with the dual TBI/BH diagnoses, and vestibular testing results reported elsewhere have varied among this population. The study's purpose was to collate the vestibular test results obtained from a sample of the NICoE patients to determine if specific tests have a tendency to be abnormal in these SMs. Results indicate that oculomotor tests, particularly pursuit and saccade, were most often abnormal. The vertical subtests of the pursuit and saccade tests were abnormal more frequently than the horizontal subtests, suggesting that the vertical subtests should be utilized when evaluating the TBI population. Overall, oculomotor tests of vertical pursuit and saccades, as well as tests of central vestibular function, appear useful for detecting neurologic changes in active duty SMs with chronic symptoms after TBI.

Long-Term Treatment of Niemann-Pick Type C1 Disease With Intrathecal 2-Hydroxypropyl-β-Cyclodextrin

BackgroundIntrathecal 2-hydoxypropyl-β-cyclodextrin has been found to mobilize cholesterol, extend life, reduce cerebellar pathology, and delay onset of ataxia in the mouse and cat models of Niemann-Pick disease, type C1, a clinically variable progressive and ultimately fatal neurodegenerative storage disorder characterized by endolysosomal accumulation of unesterified cholesterol. ObjectiveIn this study, the long-term effects of intrathecal 2-hydoxypropyl-β-cyclodextrin treatment for 2.5 to three years in humans with Niemann-Pick disease, type C, were evaluated. MethodsThree patients with Niemann-Pick disease, type C, in different stages of progression and displaying varying disease manifestations were treated with intrathecal 2-hydoxypropyl-β-cyclodextrin (VTS-270) delivered by lumbar puncture infusion through an intermediate-size patient population investigational new drug application for expanded access. Disease progression was monitored with the Niemann-Pick disease, type C, Neurological Severity Scale and numerous objective measures of function in five neurological domains typically impacted by the disease: cognitive/language, gait/balance, fine motor, swallowing, and eye movement. ResultsNo worsening in any domain except eye movements (vertical pursuit gain) was seen for any of the three patients, and in the other domains, improved scores on measures were seen over time for one or more patients. The Niemann-Pick disease type C (NPC) Neurological Severity Scale (NSS) showed stable to slightly improved ratings. ConclusionsThese trajectories are not consistent with the typical trajectory of the disease and suggest that intrathecal 2-hydoxypropyl-β-cyclodextrin has stabilized the disease over an extended period of time, supporting the current phase 2/3 controlled registration trial with VTS-270.

Mechanisms of Image Stabilization in Central Vision Loss: Smooth Pursuit.

In addition to understanding the adaptive mechanisms of eccentric viewing during smooth pursuit, the ocular motor adaptations of patients with central vision loss give us a better understanding of the basic mechanisms of smooth pursuit in the healthy visual system. For patients with age-related macular degeneration and controls with normal vision, we examined the closed-loop gain of horizontal and vertical smooth pursuit eye movements as a function of stimulus speed and direction. We hypothesized that pursuit gain functions would be affected by stimulus speed and the location of the preferred retinal locus (PRL) in relation to the scotoma as determined by a fixation stability task using a microperimeter. Specifically, that a PRL on the left of the scotoma in the visual field would decrease the rightward gain relative to the leftward gain and a PRL below the scotoma in the visual field would decrease the upward gain. Ten patients and 15 controls were tested in a step-ramp procedure with direction (left/right for horizontal motion; up/down for vertical motion), speed (5, 10, 15, 20, and 30 deg/s), and five replication conditions randomized and blocked by orientation (horizontal vs. vertical). Horizontal pursuit had a higher gain than vertical pursuit. The two eyes of the patients moved conjugately with similar smooth pursuit gains. For horizontal pursuit, all patients, regardless of PRL location, showed significantly better pursuit of leftward motion. For vertical pursuit, downward pursuit had a higher gain than upward pursuit for most patients. PRL location was not predictive of the directional preponderance of pursuit performance. These results imply that patients may not use the PRL that was initially found during a static fixation task; they may adapt to the task by using a PRL that appears more suitable.

The effects of enhanced attention and working memory on smooth pursuit eye movement.

It has long been suggested that increasing attentional demands can alter smooth pursuit eye movements, but the precise nature of the changes generated is not clear. Our goal was to examine smooth pursuit with a task that enhanced attention to the target and that increased demands on working memory, without distracting from the target. 15 subjects tracked a target moving around a predictable circular trajectory at a constant tangential velocity. An n-back task with two levels of additional working memory load was integrated into the pursuit target to increase cognitive demands. In the single-task conditions, subjects either performed pursuit alone or the n-back task with a stationary target. In the dual-task conditions, pursuit and the n-back task were performed together. Performance of the n-back tasks was not impaired by simultaneous smooth pursuit. The n-back tasks had negligible effects on horizontal or vertical pursuit gain, but generated increased phase lag and reduced the variability of position error during pursuit. Increasing the difficulty of the n-back task further reduced the variability of position errors. We conclude that enhanced attention does not alter the velocity gain of smooth pursuit but ratherimproves its consistency. As long as attention remains focused on the target, increased attentional demands further reduce pursuit variability. Increases in phase lag may serve to improve attentional processing of the target.

The Effectiveness of Vertical Perspective and Pursuit Eye Movements for Disambiguating Motion Parallax Transformations.

In the kinetic depth effect, the direction of the perceived depth and the direction of apparent rotation of a 3-D structure are linked, and typically ambiguous, whereas depth from motion parallax during both observer- and object-movement is stable and unambiguous. Rogers and Rogers demonstrated that the vertical perspective transformations play an important role in disambiguating the direction of the perceived depth in parallax-defined surfaces but more recently Nawrot etal. have proposed that pursuit eye movements provide the crucial disambiguating information. Theoretical considerations suggest that pursuit eye movements could not, in principle, provide the necessary information because 3-D objects as surfaces may rotate during observer- or object-movement. The empirical evidence presented here shows that vertical perspective transformations are sufficient for the unambiguous perception of parallax depth whereas pursuit eye movements are not necessary and may not even be sufficient.

Teaching Video Neuro Images : Vertical supranuclear ophthalmoparesis

A 30-year-old man presented with 10 years of progressive cognitive decline (poor academic performance followed by forgetfulness and calculation and visuospatial difficulties), 5 years of gait and limb ataxia and dysarthria, and 3 years of dysphagia. His 2 elder siblings had similar symptoms and died in their 20s. Examination revealed splenomegaly, global cognitive impairment, brisk gag reflex, pancerebellar ataxia, bipyramidal signs, and vertical saccade paresis (video on the Neurology ® Web site at [Neurology.org][1]). Vertical pursuit was preserved. Bone marrow aspirate and trephine biopsy revealed non-Gaucher-type storage foam cells (figure). Considering the diagnosis of Niemann-Pick C, he was treated symptomatically. Vertical supranuclear ophthalmoparesis is a red flag suggestive of Niemann-Pick C in young-onset dementia.1,2 [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000002442

MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION PROGRAM IMPROVE PURSUITS AND DRIVING ABILITY IN 69 YEAR OLD FEMALE

Event Abstract Back to Event MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION PROGRAM IMPROVE PURSUITS AND DRIVING ABILITY IN 69 YEAR OLD FEMALE David J. Clark1* 1 Carrick Institute of Clinical Neuroscience and Rehabilitation, United States Background: A 69 year old woman presented with chief complaints of difficulty moving the left leg during walking, subjective problems with maintaining balance, back and hip pain, and difficulty driving. Symptoms began twelve years prior subsequent to a fall and head injury. MRI one year prior to presentation discovered extensive and non-specific white matter changes likely secondary to small vessel ischemic disease. Methods: Neurological examination revealed freezing during dual tasking of gait, Grade 2 on the Unified Parkinson’s Disease Rating Scale (UPDRS) on the left side during finger tapping and fist making tests, small amplitude titubation, normal strength and sensation in all 4 limbs. VNG testing revealed large amplitude square wave jerks with a right bias, saccadic horizontal pursuits with gains as follows: 0.1 Hz 0.66, at 0.2 Hz 0.77, and at 0.4 Hz 0.58. VNG showed saccadic vertical pursuits with gains as follows: at 0.1 Hz 0.63, at 0.2 Hz 0.40 and 0.4 Hz 0.22. Patient was treated with a three day multimodal rehabilitation program utilizing a gap stimulus and small amplitude saccades. Then, for two weeks the patient was placed on an anti-inflammatory diet, and supplement protocol featuring turmeric, resveratrol and omega fatty acids. Results: After the initial three days of treatment the horizontal pursuit gains had changed to the following: at 0.1 Hz 62, at 0.2 Hz 75 and at 0.4 Hz 0.73. The amplitude of the square wave jerks had decreased. After two weeks of the anti-inflammatory diet and supplementation the horizontal pursuit gains had improved as follows: at 0.1 Hz 0.82, at 0.2 Hz 0.74, at 0.4 Hz 0.72. The frequency of the square wave jerks was unchanged but the amplitude was smaller than before treatment. The patient reported that driving was no longer difficult. Patient did not exhibit freezing during dual tasking of gait. Fist making and finger tapping tests were Grade 1 UPDRS. Conclusion: The author suggests further investigation into the combination of multimodal forms of neurorehabilitation with anti-inflammatory diet and supplementation in the treatment of patients with saccadic pursuits and square wave jerks subsequent to head injury. Keywords: smooth pursuit eye movements, Head injury, Gait Disorders, Neurologic, Square wave jerks, driving Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Clark DJ (2016). MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION PROGRAM IMPROVE PURSUITS AND DRIVING ABILITY IN 69 YEAR OLD FEMALE . Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00062 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. David J Clark, Carrick Institute of Clinical Neuroscience and Rehabilitation, Cape Canaveral, FL, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.