Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea.
Cerebellum. 2024 Aug;23(4):1369-1376. doi: 10.1007/s12311-023-01653-y. Epub 2023 Dec 20.
A clinical scale fully dedicated to evaluating ocular motor abnormalities is required for now. We investigated the utility of a recently developed Scale for Ocular motor Disorders in Ataxia (SODA) in patients with multiple system atrophy (MSA). We prospectively assessed SODA in consecutive patients with MSA between August 2021 and August 2023 at the Korea University Medical Center. The results of the clinical exam-based SODA were compared with those measured using video-oculography (VOG-guided SODA). We also compared the findings with other established clinical scales targeting patients with MSA, including the Unified Multiple System Atrophy Rating Scale (UMSARS) I-II, Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (UPDRS-III), Scale for Assessment of Rating of Ataxia (SARA), Composite Autonomic Symptom Score-31 (COMPASS-31), and Composite Autonomic Severity Score (CASS). Twenty patients were enrolled in our study (17 with cerebellar-type MSA and three with Parkinson-type MSA). Scores ranged from 1 to 14 (median [interquartile range (IQR)] = 8 [5-10]). Among the subscales, saccades had a median score of 2.5 (IQR = 1-3), followed by ocular pursuit (1 [0-1]), nystagmus (1 [0-2]), saccadic intrusions (1 [0-1]), vestibulo-ocular reflex (VOR) (0.5 [0-1]), ocular alignment (0 [0-1]), and VOR cancellation (1 [0-1]). The clinical-exam-based SODA (p = 0.020) and VOG-guided SODA (p = 0.034) positively correlated with disease duration. No correlation was found between clinical exam-based SODA and other scales. Skew deviation, gaze-evoked nystagmus, VOR cancellation, and smooth pursuit had the highest precision among the items. Ocular misalignment and spontaneous and positional nystagmus were frequently false positive and were poorly detected with clinical exam-based SODA. Six patients with repeated evaluation exhibited higher scores, along with deterioration documented on other clinical scales. The SODA can reliably predict neurodegeneration as an additional clinical surrogate in MSA.
目前需要一种专门用于评估眼球运动异常的临床量表。我们研究了最近开发的用于共济失调的眼运动障碍量表（SODA）在多系统萎缩（MSA）患者中的应用。我们前瞻性地评估了 2021 年 8 月至 2023 年 8 月期间在韩国大学医疗中心连续就诊的 MSA 患者的 SODA。基于临床检查的 SODA 结果与使用视频眼动描记术（VOG 引导的 SODA）测量的结果进行了比较。我们还将这些发现与针对 MSA 患者的其他既定临床量表进行了比较，包括统一多系统萎缩评定量表（UMSARS）I-II、运动障碍学会统一帕金森病评定量表运动部分（UPDRS-III）、共济失调评定量表（SARA）、综合自主症状评分-31 项（COMPASS-31）和综合自主严重程度评分（CASS）。我们的研究纳入了 20 名患者（17 名小脑型 MSA，3 名帕金森型 MSA）。评分范围为 1 至 14 分（中位数[四分位数间距（IQR）]为 8 [5-10]）。在子量表中，扫视的中位数评分为 2.5 分（IQR=1-3），其次是眼球追踪（1 分[0-1]）、眼震（1 分[0-2]）、扫视性冲动（1 分[0-1]）、前庭眼反射（VOR）（0.5 分[0-1]）、眼球对齐（0 分[0-1]）和 VOR 取消（1 分[0-1]）。基于临床检查的 SODA（p=0.020）和 VOG 引导的 SODA（p=0.034）与疾病持续时间呈正相关。基于临床检查的 SODA 与其他量表之间没有相关性。偏斜偏差、凝视诱发的眼震、VOR 取消和平滑追踪是项目中具有最高精度的。眼球不对位和自发性及位置性眼震经常出现假阳性，且基于临床检查的 SODA 检测效果不佳。六名接受重复评估的患者表现出更高的分数，并且在其他临床量表上记录到病情恶化。SODA 可作为 MSA 的额外临床替代指标，可靠地预测神经退行性变。
