Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
Exp Brain Res. 2024 Jul;242(7):1797-1806. doi: 10.1007/s00221-024-06864-1. Epub 2024 Jun 5.
People with multiple sclerosis (PwMS) who report dizziness often have gaze instability due to vestibulo-ocular reflex (VOR) deficiencies and compensatory saccade (CS) abnormalities. Herein, we aimed to describe and compare the gaze stabilization mechanisms for yaw and pitch head movements in PwMS. Thirty-seven PwMS (27 female, mean ± SD age = 53.4 ± 12.4 years old, median [IQR] Expanded Disability Status Scale Score = 3.5, [1.0]. We analyzed video head impulse test results for VOR gain, CS frequency, CS latency, gaze position error (GPE) at impulse end, and GPE at 400 ms after impulse start. Discrepancies were found for median [IQR] VOR gain in yaw (0.92 [0.14]) versus pitch-up (0.71 [0.44], p < 0.001) and pitch-down (0.81 [0.44], p = 0.014]), CS latency in yaw (258.13 [76.8]) ms versus pitch-up (208.78 [65.97]) ms, p = 0.001] and pitch-down (132.17 [97.56] ms, p = 0.006), GPE at impulse end in yaw (1.15 [1.85] degs versus pitch-up (2.71 [3.9] degs, p < 0.001), and GPE at 400 ms in yaw (-0.25 [0.98] degs) versus pitch-up (1.53 [1.07] degs, p < 0.001) and pitch-down (1.12 [1.82] degs, p = 0.001). Compared with yaw (0.91 [0.75]), CS frequency was similar for pitch-up (1.03 [0.93], p = 0.999) but lower for pitch-down (0.65 [0.64], p = 0.023). GPE at 400 ms was similar for yaw and pitch-down (1.88 [2.76] degs, p = 0.400). We postulate that MS may have preferentially damaged the vertical VOR and saccade pathways in this cohort.
多发性硬化症（MS）患者常报告头晕，这通常是由于前庭眼反射（VOR）缺陷和代偿性扫视（CS）异常引起的眼球不稳定。在此，我们旨在描述和比较 MS 患者在俯仰头运动时的眼球稳定机制。研究纳入了 37 名 MS 患者（27 名女性，平均年龄 53.4 ± 12.4 岁，中位数 [IQR] 扩展残疾状态量表评分 3.5 [1.0]）。我们分析了视频头脉冲测试结果，包括 VOR 增益、CS 频率、CS 潜伏期、脉冲结束时的凝视位置误差（GPE）和脉冲开始后 400 ms 的 GPE。结果发现，在俯仰时，VOR 增益的中位数 [IQR] 为 0.92 [0.14]，而在仰头时为 0.71 [0.44]，差异有统计学意义（p < 0.001），在低头时为 0.81 [0.44]，差异有统计学意义（p = 0.014）；在俯仰时，CS 潜伏期的中位数 [IQR] 为 258.13 [76.8] ms，而在仰头时为 208.78 [65.97] ms，差异有统计学意义（p = 0.001），在低头时为 132.17 [97.56] ms，差异有统计学意义（p = 0.006）；在俯仰时，脉冲结束时的 GPE 中位数 [IQR] 为 1.15 [1.85] 度，而在仰头时为 2.71 [3.9] 度，差异有统计学意义（p < 0.001），在低头时为 2.01 [2.95] 度，差异有统计学意义（p = 0.003）；在俯仰时，400 ms 时的 GPE 中位数 [IQR] 为-0.25 [0.98] 度，而在仰头时为 1.53 [1.07] 度，差异有统计学意义（p < 0.001），在低头时为 1.12 [1.82] 度，差异有统计学意义（p = 0.001）。与俯仰时的 CS 频率（0.91 [0.75]）相比，CS 频率在仰头时相似（1.03 [0.93]，p = 0.999），但在低头时较低（0.65 [0.64]，p = 0.023）。俯仰和低头时 400 ms 的 GPE 相似（1.88 [2.76] 度，p = 0.400）。我们推测，在本研究队列中，MS 可能优先损害了垂直 VOR 和扫视通路。
