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急性前庭张力不对称患者的亚历山大定律——多个水平神经整合器的证据

Alexander's law in patients with acute vestibular tone asymmetry--evidence for multiple horizontal neural integrators.

作者信息

Hegemann S, Straumann D, Bockisch C

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital, Frauenklinikstr. 24, Ch-8091, Zurich, Switzerland.

出版信息

J Assoc Res Otolaryngol. 2007 Dec;8(4):551-61. doi: 10.1007/s10162-007-0095-6. Epub 2007 Sep 19.

Abstract

Alexander's law (AL) states that the slow-phase velocity of spontaneous nystagmus of peripheral vestibular origin is dependent on horizontal gaze position, with greater velocity when gaze is directed in the fast-phase direction. AL is thought to be a compensatory reaction resulting from adaptive changes in the horizontal ocular motor neural integrator. Until now, only horizontal eye movements have been investigated with respect to AL. Because spontaneous nystagmus usually includes vertical and torsional components, we asked whether horizontal gaze changes would have an effect on the 3D drift of spontaneous nystagmus and, thus, on the vertical/torsional neural integrator. We hypothesized that AL reduces all nystagmus components proportionally. Moreover, we questioned the classical theory of a single bilaterally organized horizontal integrator and searched for nonlinearities of AL implying a network of multiple integrators. Using dual scleral search coils, we measured AL in 17 patients with spontaneous nystagmus. Patients followed a pulsed laser dot at eye level jumping in 5 degrees steps along the horizontal meridian between 25 degrees right and left in otherwise complete darkness. AL was observed in 15 of 17 patients. Whereas individual patients typically showed a change of 3D-drift direction at different horizontal eye positions, the average change in direction was not different from zero. The strength of AL (= rate of change of total velocity with gaze position) correlated with nystagmus slow-phase velocity (Spearman's rho = 0.5; p < 0.05) and, on average, did not change the 3D nystagmus drift direction. In general, eye velocity did not vary linearly with eye position. Rather, there was a stronger dependence of velocity on horizontal position when subjects looked in the slow-phase direction compared to the fast-phase direction. We conclude that the theory of a simple leak of a single horizontal neural integrator is not sufficient to explain all aspects of AL.

摘要

亚历山大定律(AL)指出,外周前庭源性自发性眼球震颤的慢相速度取决于水平注视位置,当注视方向为快相方向时速度更快。AL被认为是水平眼球运动神经积分器适应性变化导致的一种代偿反应。到目前为止,关于AL仅研究了水平眼动。由于自发性眼球震颤通常包括垂直和扭转成分,我们探讨水平注视变化是否会对自发性眼球震颤的三维漂移产生影响,进而影响垂直/扭转神经积分器。我们假设AL会按比例降低所有眼球震颤成分。此外,我们质疑了单一双侧组织的水平积分器的经典理论,并寻找暗示多个积分器网络的AL的非线性特征。我们使用双巩膜搜索线圈,测量了17例自发性眼球震颤患者的AL。患者在完全黑暗的环境中,追踪眼水平处的脉冲激光点,该点沿水平子午线在左右25度之间以5度步长跳跃。17例患者中有15例观察到了AL。虽然个体患者通常在不同的水平眼位显示三维漂移方向的变化,但方向的平均变化与零无差异。AL的强度(=总速度随注视位置的变化率)与眼球震颤慢相速度相关(斯皮尔曼相关系数ρ = 0.5;p < 0.05),并且平均而言,不会改变三维眼球震颤漂移方向。一般来说,眼速度与眼位并非呈线性变化。相反,与快相方向相比,当受试者看向慢相方向时,速度对水平位置的依赖性更强。我们得出结论,单一水平神经积分器简单泄漏的理论不足以解释AL的所有方面。

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