Pinkhardt Elmar H, Jürgens Reinhart, Becker Wolfgang, Valdarno Federica, Ludolph Albert C, Kassubek Jan
Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm, Germany.
J Neurol. 2008 Dec;255(12):1916-25. doi: 10.1007/s00415-009-0027-y. Epub 2009 Jan 14.
Vertical gaze palsy is a highly relevant clinical sign in parkinsonian syndromes. As the eponymous sign of progressive supranuclear palsy (PSP), it is one of the core features in the diagnosis of this disease. Recent studies have suggested a further differentiation of PSP in Richardson's syndrome (RS) and PSP-parkinsonism (PSPP). The aim of this study was to search for oculomotor abnormalities in the PSP-P subset of a sample of PSP patients and to compare these findings with those of (i) RS patients, (ii) patients with idiopathic Parkinson's disease (IPD), and (iii) a control group. Twelve cases of RS, 5 cases of PSP-P, and 27 cases of IPD were examined by use of video-oculography (VOG) and compared to 23 healthy normal controls. Both groups of PSP patients (RS, PSP-P) had significantly slower saccades than either IPD patients or controls, whereas no differences in saccadic eye peak velocity were found between the two PSP groups or in the comparison of IPD with controls. RS and PSP-P were also similar to each other with regard to smooth pursuit eye movements (SPEM), with both groups having significantly lower gain than controls (except for downward pursuit); however, SPEM gain exhibited no consistent difference between PSP and IPD. A correlation between eye movement data and clinical data (Hoehn & Yahr scale or disease duration) could not be observed. As PSP-P patients were still in an early stage of the disease when a differentiation from IPD is difficult on clinical grounds, the clear-cut separation between PSP-P and IPD obtained by measuring saccade velocity suggests that VOG could contribute to the early differentiation between these patient groups.
垂直凝视麻痹是帕金森综合征中一个高度相关的临床体征。作为进行性核上性麻痹（PSP）的同名体征，它是该疾病诊断的核心特征之一。最近的研究表明，PSP可进一步分为理查森综合征（RS）和PSP-帕金森综合征（PSPP）。本研究的目的是在一组PSP患者的PSP-P亚组中寻找眼球运动异常，并将这些结果与以下三组进行比较：（i）RS患者；（ii）特发性帕金森病（IPD）患者；（iii）一个对照组。通过视频眼动图（VOG）检查了12例RS患者、5例PSP-P患者和27例IPD患者，并与23名健康正常对照进行比较。两组PSP患者（RS、PSP-P）的扫视速度均明显慢于IPD患者或对照组，而两个PSP组之间以及IPD与对照组的比较中，扫视眼峰值速度没有差异。在平稳跟踪眼球运动（SPEM）方面，RS和PSP-P也彼此相似，两组的增益均明显低于对照组（向下跟踪除外）；然而，PSP和IPD之间的SPEM增益没有一致的差异。未观察到眼球运动数据与临床数据（Hoehn & Yahr量表或病程）之间的相关性。由于PSP-P患者仍处于疾病早期，临床上难以与IPD区分，通过测量扫视速度在PSP-P和IPD之间获得的明确区分表明，VOG可能有助于这些患者组之间的早期区分。
