Comparison of smooth pursuit eye movement deficits in multiple system atrophy and Parkinson's disease
Comparison of smooth pursuit eye movement deficits in multiple system atrophy and Parkinson's disease
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DOI：
10.1007/s00415-009-5131-5
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发表时间：
2009-09-01
影响因子：
6
通讯作者：
Juergens, Reinhart
中科院分区：
文献类型：
--
作者：
Pinkhardt, Elmar H.;Kassubek, Jan;Juergens, Reinhart
由于帕金森病（PD）和多系统萎缩（MSA）的眼球运动改变的大量重叠和定量相似性，眼球运动的测量通常被认为对鉴别诊断没有帮助。然而，鉴于MSA和PD之间以及MSA的小脑（MSA-C）和帕金森病（MSA-P）亚型之间的病理生理差异，我们想知道是否对眼科表现进行详细研究将揭示有助于区分这些实体的参数。我们用视频眼电图记录了11例MSA-P、8例MSA-C和27例PD患者在正弦追踪过程中的眼动，并与23例健康对照（CTL）进行了比较。平滑追踪眼球运动（SPEM）分量的增益在三个受试者组（MSA、PD、对照组）中的每一个组之间表现出显著的组差异，但在MSA-P和MSA-C之间没有表现出显著的组差异。在MSA-P和MSA-C中的追踪障碍的相似性表明，尽管缺乏临床体征，但在MSA-P中小脑病理开始。否则，由于广泛重叠，SPEM增益对MSA和PD之间的鉴别诊断用处不大。然而，对追踪的扫视分量的检查显示，在MSA中，扫视通常校正在SPEM时期期间积累的位置误差（“追赶性扫视”），而在PD中，扫视通常指向未来的目标位置（“预期性扫视”）。PD和MSA之间追踪追踪的差异足够大，足以保证其作为区分这些疾病的辅助诊断标准。
Because of the large overlap and quantitative similarity of eye movement alterations in Parkinson's disease (PD) and multiple system atrophy (MSA), a measurement of eye movement is generally not considered helpful for the differential diagnosis. However, in view of the pathophysiological differences between MSA and PD as well as between the cerebellar (MSA-C) and Parkinsonian (MSA-P) subtypes of MSA, we wondered whether a detailed investigation of oculomotor performance would unravel parameters that could help to differentiate between these entities. We recorded eye movements during sinusoidal pursuit tracking by means of video-oculography in 11 cases of MSA-P, 8 cases of MSA-C and 27 cases of PD and compared them to 23 healthy controls (CTL). The gain of the smooth pursuit eye movement (SPEM) component exhibited significant group differences between each of the three subject groups (MSA, PD, controls) but not between MSA-P and MSA-C. The similarity of pursuit impairment in MSA-P and in MSA-C suggests a commencement of cerebellar pathology in MSA-P despite the lack of clinical signs. Otherwise, SPEM gain was of little use for differential diagnosis between MSA and PD because of wide overlap. However, inspection of the saccadic component of pursuit tracking revealed that in MSA saccades typically correct for position errors accumulated during SPEM epochs ("catchup saccades''), whereas in PD, saccades were often directed toward future target positions ("anticipatory saccades''). The differences in pursuit tracking between PD and MSA were large enough to warrant their use as ancillary diagnostic criteria for the distinction between these disorders.