Liao K, Wagner J, Joshi A, Estrovich I, Walker M F, Strupp M, Leigh R J
Neurology Service and Daroff-Dell'Osso Laboratory, Veterans Affairs Medical Center and University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
Neurology. 2008 Mar 4;70(10):802-9. doi: 10.1212/01.wnl.0000304134.33380.1e. Epub 2008 Jan 16.
Patients with progressive supranuclear palsy (PSP) fall frequently, beginning early in the course of their disease. Abnormal vestibulospinal reflexes are suspected, but the angular vestibulo-ocular reflex, which is mediated by the labyrinthine semicircular canals, survives late into the course of the disease.
To test the hypothesis that otolithic-mediated reflexes are abnormal in PSP.
We tested otolith-ocular reflexes (the translational vestibulo-ocular reflex [tVOR]) during combined rotation-translation in nine patients with PSP and nine age-matched control subjects; subjects viewed far and near targets. We also tested click-induced otolith-spinal reflexes (vestibular-evoked myogenic potentials [VEMPs]) in 10 patients with PSP and 30 age-matched controls.
All patients with PSP had small tVOR responses during near viewing that were, on average, only 12% of those of control subjects (p = 0.001). Patients with PSP also showed a reduction of the amplitude of VEMPs compared to control subjects (median [range]: 54.3 [16.8 to 214] vs 149 [11.6 to 466], p = 0.001).
Taken together, these results indicate that abnormal otolith-mediated reflexes may be at least partly responsible for frequent falls in progressive supranuclear palsy, and deserve further study.
进行性核上性麻痹（PSP）患者在疾病早期就经常跌倒。怀疑存在异常的前庭脊髓反射，但由迷路半规管介导的角前庭眼反射在疾病后期仍存在。
检验PSP患者耳石介导的反射异常这一假设。
我们在9例PSP患者和9例年龄匹配的对照受试者进行联合旋转 - 平移时测试了耳石眼反射（平移前庭眼反射[tVOR]）；受试者观看远处和近处目标。我们还在10例PSP患者和30例年龄匹配的对照中测试了点击诱发的耳石脊髓反射（前庭诱发肌源性电位[VEMPs]）。
所有PSP患者在近视力时tVOR反应均较小，平均仅为对照受试者的12%（p = 0.001）。与对照受试者相比，PSP患者的VEMPs振幅也降低（中位数[范围]：54.3[16.8至214]对149[11.6至466]，p = 0.001）。
综上所述，这些结果表明异常的耳石介导反射可能至少部分导致进行性核上性麻痹患者频繁跌倒，值得进一步研究。
