Impaired fixation suppression of horizontal vestibular nystagmus during smooth pursuit: pathophysiology and clinical implications

Athanasia Korda, David S. Zee, Thomas Wyss, Ewa Zamaro, Marco D. Caversaccio, Franca Wagner, Roger Kalla, Georgios Mantokoudis

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose: A peripheral spontaneous nystagmus (SN) is typically enhanced or revealed by removing fixation. Conversely, failure of fixation suppression of SN is usually a sign of a central disorder. Based on Luebke and Robinson (Vision Res 1988, vol. 28 (8), pp. 941–946), who suggested that the normal fixation mechanism is disengaged during pursuit, it is hypothesized that vertical tracking in the light would bring out or enhance a horizontal SN. Methods: Eighteen patients with acute vestibular neuritis were studied. Eye movements were recorded using video-oculography at straight-ahead gaze with and without visual fixation, and during smooth pursuit. The slow-phase velocity and the fixation suppression indices of nystagmus (relative to SN in darkness) were compared in each condition. Results: During vertical tracking, the slow-phase velocity of horizontal SN with eyes near straight-ahead gaze was significantly higher (median 2.7°/s) than under static visual fixation (median 1.2°/s). Likewise, the fixation index was significantly higher (worse suppression) during pursuit (median 48%) than during fixation (median 26%). A release of SN was also suggested during horizontal pursuit, if one assumes superposition of SN on a normal and symmetrical pursuit capability.

Original languageEnglish (US)
Pages (from-to)2614-2621
Number of pages8
JournalEuropean Journal of Neurology
Volume28
Issue number8
DOIs
StatePublished - Aug 2021

Keywords

  • fixation suppression
  • nystagmus
  • pursuit
  • vestibular

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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