Parkinsonism and Related Disorders xxx (2015) 1e3
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Parkinsonism and Related Disorders journal homepage: www.elsevier.com/locate/parkreldis
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Fast vergence eye movements are disrupted in Parkinson's disease: A video-oculography study s Sieger a, e, Robert Jech a, Jaromír Hanuska a, b, 1, Cecilia Bonnet a, c, 1, Jan Rusz a, d, Toma choux f, g, Marie Vidailhet c, f, g, Bertrand Gaymard f, g, Ev zen R u zi cka a, * Sophie Rivaud-Pe a Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic b Dept. of Neurosurgery, Hospital Na Homolce, Prague, Czech Republic c AP HP, Neurology Department, Piti e Salp^ etri ere Hospital, Paris, France d Dept. of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic e Dept. of Cybernetics, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic f CRICM UPMC/INSERM UMR_S975, CNRS UMR7225, ICM, Piti e-Salp^ etri ere Hospital, Paris, France g Pierre et Marie Curie Paris-6 University, Paris, France
a r t i c l e i n f o
a b s t r a c t
Article history: Received 17 November 2014 Received in revised form 3 March 2015 Accepted 15 April 2015
Background: Blurred near vision is a common non-motor symptom in patients with Parkinson's disease (PD), however detailed characterization of vergence eye movements (VEM) is lacking. Methods: Convergence and divergence were examined in 18 patients with PD and 18 control subjects using infrared video-oculography. VEM metrics analyzed included latency, velocity and accuracy, in vertical and horizontal planes. Results: The latency of convergence and divergence was significantly increased in PD subjects. Additionally, divergence was slow and hypometric, while other convergence metrics were similar to controls. Conclusion: We provide evidence in favor of disrupted VEM in PD. © 2015 Elsevier Ltd. All rights reserved.
Keywords: Vergence eye movements Convergence Divergence Parkinson's disease
1. Introduction Vergence eye movements (VEM) are disjunctive eye movements necessary for reading and tracking objects moving in depth, maintaining a fused and singular percept [1]. They consist of convergent and divergent movements that may be divided into fast vergence (to step targets) and slow vergence (to track sinusoidal targets). Patients with Parkinson's disease (PD) sometimes complain about blurred near vision, which may be related to convergence deficits. Diplopia is one of the non-motor signs found in approximately 20% of PD patients and may be caused by convergence insufficiency [2]. Visual discomfort in PD has been studied with several ophthalmological devices and questionaries revealing
* Corresponding author. Department of Neurology, First Medical Faculty, Charles University in Prague, Katerinsk a 30, 120 00, Prague 2, Czech Republic. Tel.: þ420 224 965550; fax: þ420 224 922678. E-mail address: [email protected] (E. R u zi cka). 1 Contributed equally.
decreased convergence amplitude, convergence insufficiency, heterophoria and divergent strabism [3]. Video-based infrared eye tracking is an objective method increasingly used in clinical neurology for oculomotor testing in the diagnosis of some neurodegenerative (e.g., parkinsonian syndromes), hereditary or metabolic disorders [4]. The aim of the present study was thus to describe fast VEM in PD using video-oculography. 2. Materials and methods 2.1. Subjects Patients and healthy controls were examined at the Department of Neurology, First Faculty of Medicine, Charles University in Prague. All participants provided signed, informed consent. The study was approved by the local ethics committee and was in compliance with the Declaration of Helsinki. Eighteen PD patients (8 female, 10 males; age 40e71 (mean 53.4, SD 10.2) years diagnosed according to UK Parkinson's Disease Society Brain Bank criteria and followed at the movement disorders clinic were included. PD duration ranged from 1 to 21 (mean 9.3, SD 5.6) years, with UPDRS III score 8e47 (mean 25.2, SD 10.8) and Hoehn & Yahr [5] score 1e3 (mean 1.9, SD 0.6). Sixteen of eighteen patients were treated with dopamine agonists (10 ropinirol, 6 pramipexol), 10 of which were treated in combination with levodopa, while 1 patient received levodopa monotherapy and one patient was
http://dx.doi.org/10.1016/j.parkreldis.2015.04.014 1353-8020/© 2015 Elsevier Ltd. All rights reserved.
Please cite this article in press as: J. Hanuska, et al., Fast vergence eye movements are disrupted in Parkinson's disease: A video-oculography study, Parkinsonism and Related Disorders (2015), http://dx.doi.org/10.1016/j.parkreldis.2015.04.014
J. Hanuska et al. / Parkinsonism and Related Disorders xxx (2015) 1e3
2
Fig. 1. Eye movement task employed. A: patient position; B: examination of convergence; C: examination of divergence; h: head support construction; r: eye movement recorder; n: near fixation point; s: screen; a ¼ 10 cm; b ¼ 60 cm; a ¼ 43.6 ; b ¼ 7.6 ; FC: focus change.
untreated at the time of examination. The levodopa equivalent daily dose was mean 822, range 0e2890 mg [6]. All medicated patients were examined in the “on” condition, following a regular dose of their dopaminergic medication. Exclusion criteria were cognitive impairment with an MMSE
Contents lists available at ScienceDirect
Parkinsonism and Related Disorders journal homepage: www.elsevier.com/locate/parkreldis
Short communication
Fast vergence eye movements are disrupted in Parkinson's disease: A video-oculography study s Sieger a, e, Robert Jech a, Jaromír Hanuska a, b, 1, Cecilia Bonnet a, c, 1, Jan Rusz a, d, Toma choux f, g, Marie Vidailhet c, f, g, Bertrand Gaymard f, g, Ev zen R u zi cka a, * Sophie Rivaud-Pe a Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic b Dept. of Neurosurgery, Hospital Na Homolce, Prague, Czech Republic c AP HP, Neurology Department, Piti e Salp^ etri ere Hospital, Paris, France d Dept. of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic e Dept. of Cybernetics, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic f CRICM UPMC/INSERM UMR_S975, CNRS UMR7225, ICM, Piti e-Salp^ etri ere Hospital, Paris, France g Pierre et Marie Curie Paris-6 University, Paris, France
a r t i c l e i n f o
a b s t r a c t
Article history: Received 17 November 2014 Received in revised form 3 March 2015 Accepted 15 April 2015
Background: Blurred near vision is a common non-motor symptom in patients with Parkinson's disease (PD), however detailed characterization of vergence eye movements (VEM) is lacking. Methods: Convergence and divergence were examined in 18 patients with PD and 18 control subjects using infrared video-oculography. VEM metrics analyzed included latency, velocity and accuracy, in vertical and horizontal planes. Results: The latency of convergence and divergence was significantly increased in PD subjects. Additionally, divergence was slow and hypometric, while other convergence metrics were similar to controls. Conclusion: We provide evidence in favor of disrupted VEM in PD. © 2015 Elsevier Ltd. All rights reserved.
Keywords: Vergence eye movements Convergence Divergence Parkinson's disease
1. Introduction Vergence eye movements (VEM) are disjunctive eye movements necessary for reading and tracking objects moving in depth, maintaining a fused and singular percept [1]. They consist of convergent and divergent movements that may be divided into fast vergence (to step targets) and slow vergence (to track sinusoidal targets). Patients with Parkinson's disease (PD) sometimes complain about blurred near vision, which may be related to convergence deficits. Diplopia is one of the non-motor signs found in approximately 20% of PD patients and may be caused by convergence insufficiency [2]. Visual discomfort in PD has been studied with several ophthalmological devices and questionaries revealing
* Corresponding author. Department of Neurology, First Medical Faculty, Charles University in Prague, Katerinsk a 30, 120 00, Prague 2, Czech Republic. Tel.: þ420 224 965550; fax: þ420 224 922678. E-mail address: [email protected] (E. R u zi cka). 1 Contributed equally.
decreased convergence amplitude, convergence insufficiency, heterophoria and divergent strabism [3]. Video-based infrared eye tracking is an objective method increasingly used in clinical neurology for oculomotor testing in the diagnosis of some neurodegenerative (e.g., parkinsonian syndromes), hereditary or metabolic disorders [4]. The aim of the present study was thus to describe fast VEM in PD using video-oculography. 2. Materials and methods 2.1. Subjects Patients and healthy controls were examined at the Department of Neurology, First Faculty of Medicine, Charles University in Prague. All participants provided signed, informed consent. The study was approved by the local ethics committee and was in compliance with the Declaration of Helsinki. Eighteen PD patients (8 female, 10 males; age 40e71 (mean 53.4, SD 10.2) years diagnosed according to UK Parkinson's Disease Society Brain Bank criteria and followed at the movement disorders clinic were included. PD duration ranged from 1 to 21 (mean 9.3, SD 5.6) years, with UPDRS III score 8e47 (mean 25.2, SD 10.8) and Hoehn & Yahr [5] score 1e3 (mean 1.9, SD 0.6). Sixteen of eighteen patients were treated with dopamine agonists (10 ropinirol, 6 pramipexol), 10 of which were treated in combination with levodopa, while 1 patient received levodopa monotherapy and one patient was
http://dx.doi.org/10.1016/j.parkreldis.2015.04.014 1353-8020/© 2015 Elsevier Ltd. All rights reserved.
Please cite this article in press as: J. Hanuska, et al., Fast vergence eye movements are disrupted in Parkinson's disease: A video-oculography study, Parkinsonism and Related Disorders (2015), http://dx.doi.org/10.1016/j.parkreldis.2015.04.014
J. Hanuska et al. / Parkinsonism and Related Disorders xxx (2015) 1e3
2
Fig. 1. Eye movement task employed. A: patient position; B: examination of convergence; C: examination of divergence; h: head support construction; r: eye movement recorder; n: near fixation point; s: screen; a ¼ 10 cm; b ¼ 60 cm; a ¼ 43.6 ; b ¼ 7.6 ; FC: focus change.
untreated at the time of examination. The levodopa equivalent daily dose was mean 822, range 0e2890 mg [6]. All medicated patients were examined in the “on” condition, following a regular dose of their dopaminergic medication. Exclusion criteria were cognitive impairment with an MMSE
