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Biomedical subjects

D S Zee

Publications and source records attributed to D S Zee.

At least 73 records · Page 4Linked to original sources
PubMed1996

Disorders of binocular control of eye movements in patients with cerebellar dysfunction.

Recent research has implicated the cerebellum in conjugate ocular motor control, including steady gaze-holding and accuracy of pursuit and saccades. Whether the cerebellum also has a role in the control of the alignment of the eyes during fixation and of the yoking of the eyes during movement i. less certain. We have studied binocular (disconjugate) ocular motor control in nine patients with cerebellar dysfunction and compared the results with those of normal subjects. Eye alignment during fixation and the yoking of the eyes during and immediately after saccades were quantified by recording the movements of both eyes using scleral search coils. Patients had disturbances of ocular alignment. All had an esophoria during monocular viewing and many an esotropia during binocular viewing, implying an increase in convergence tone. Most had a vertical misalignment that varied with horizontal eye position ('alternating skew deviation'). Patients showed conjugate dysmetria (saccade under- or overshoot and postsaccade drift) and disconjugate dysmetria (the eyes were poorly yoked during and immediately after saccades). Both the conjugate and disconjugate abnormalities were incommitant, i.e. they varied with orbital eye position. Correlations amongst the various abnormalities suggested that one part of the cerebellum, perhaps the dorsal vermis and the underlying posterior fastigial nucleus, controls the conjugate size of saccades and that another part of the cerebellum, perhaps the flocculus/paraflocculus, controls the yoking of the eyes during saccades and both the disconjugate and conjugate components of postsaccade drift.

Adult↗
PubMed1996

Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop.

To improve the specificity and sensitivity of the clinical diagnosis of progressive supranuclear palsy (PSP, Steele-Richardson-Olszewski syndrome), the National Institute of Neurological Disorders and Stroke (NINDS) and the Society for PSP, Inc. (SPSP) sponsored an international workshop to develop an accurate and universally accepted set of criteria for this disorder. The NINDS-SPSP criteria, which were formulated from an extensive review of the literature, comparison with other previously published sets of criteria, and the consensus of experts, were validated on a clinical data set from autopsy-confirmed cases of PSP. The criteria specify three degrees of diagnostic certainty: possible PSP, probable PSP, and definite PSP. Possible PSP requires the presence of a gradually progressive disorder with onset at age 40 or later, either vertical supranuclear gaze palsy or both slowing of vertical saccades and prominent postural instability with falls in the first year of onset, as well as no evidence of other diseases that could explain these features. Probable PSP requires vertical supranuclear gaze palsy, prominent postural instability, and falls in the first year of onset, as well as the other features of possible PSP. Definite PSP requires a history of probable or possible PSP and histopathologic evidence of typical PSP. Criteria that support the diagnosis of PSP, and that exclude diseases often confused with PSP, are presented. The criteria for probable PSP are highly specific, making them suitable for therapeutic, analytic epidemiologic, and biologic studies, but not very sensitive. The criteria for possible PSP are substantially sensitive, making them suitable for descriptive epidemiologic studies, but less specific. An appendix provides guidelines for diagnosing and monitoring clinical disability in PSP.

Humans↗
PubMed1996

The contribution of the vertical semicircular canals to high-velocity horizontal vestibulo-ocular reflex (VOR) in normal subjects and patients with unilateral vestibular nerve section.

We have examined to what extent the vertical semicircular canals contribute to the nonlinearity of the horizontal VOR imposed by the driving of primary vestibular afferents into inhibitory cutoff at high velocities of head rotation (Ewald's second law). The gain (eye velocity/head velocity) of the horizontal component of the VOR with the head pitched down 30 degrees and pitched up 30 degrees was examined during constant-velocity rotations in normal subjects and patients following unilateral vestibular nerve section. In normal subjects, VOR gain decreases as chair velocity increases from 60-300 degrees/s when the head is pitched up, but VOR gain remains constant when the head is pitched down. This finding implies that the mechanism by which the gain of the horizontal VOR gain remains constant at all velocities of rotation depends upon the pattern of labyrinthine stimulation. Following unilateral nerve section, we found that the directional preponderance (DP) in horizontal VOR depends upon whether the head is pitched up 30 (mean asymmetry = 5%) or pitched down 30 degrees (mean asymmetry = 20%). This is what is expected based on the degree to which the lateral and vertical semicircular canals sense horizontal head acceleration with the head in different degrees of pitch. Hence, following unilateral vestibular lesions, the DP of horizontal VOR gain is most easily elicited at high velocities of head rotation and with the head pitched down 30 degrees. Evidence for DP at the bedside using the "head-shaking nystagmus" technique may be optimally elicited with the head pitched down 30 degrees.

Acceleration↗
PubMed1996

Torsional nystagmus during vertical pursuit.

We examined three patients with cavernous angioma within the middle cerebellar peduncle. Each patient had an unusual ocular motor finding: the appearance of a strong torsional nystagmus during vertical pursuit. The uncalled-for torsion changed direction when vertical pursuit changed direction. In one patient, we recorded eye movements with the magnetic field technique using a combined direction and torsion eye coil. The slow-phase velocity of the inappropriate torsional nystagmus was linearly related to the slow-phase velocity of vertical smooth pursuit, and changed direction when vertical pursuit changed direction. This torsional nystagmus also appeared during fixation suppression of the vertical vestibulo-ocular reflex (VOR), but was minimal during vertical head rotation when fixing a stationary target in the light. We suggest that inappropriately directed eye movements during pursuit might be another ocular motor sign of cerebellar dysfunction. Furthermore, we speculate that the signals used for vertical smooth pursuit are, at some stage, encoded in a semicircular canal VOR coordinate framework. To illustrate, for the vertical semicircular canals, vertical and torsional motion are combined on the same cells, with the anterior semicircular canals mediating upward movements and the posterior semicircular canals mediating downward movements. For the right labyrinth, however, both vertical semicircular canals produce clockwise slow phases (ipsilateral eye intorts, contralateral eye extorts). The opposite is true for the vertical semicircular canals in the left labyrinth; counterclockwise slow phases are produced. Hence, to generate a pure vertical VOR, the anterior or posterior semicircular canals on both sides of the head must be excited so that opposite-directed torsional components cancel. Thus, if pursuit were organized in a way similar to the VOR, pure vertical pursuit would require that oppositely-directed torsional components cancel in normals. If this did not happen, a residual torsional nystagmus could appear during attempted vertical pursuit.

Adult↗
PubMed1995

Ocular neuromyotonia: clinical features, physiological mechanisms, and response to therapy.

Ocular neuromyotonia (ONM) is a rare disorder characterized by episodic diplopia, occurring either spontaneously or following sustained eccentric gaze. Most patients have had prior radiation therapy to the sellar and parasellar region. ONM is thought to reflect impaired muscle relaxation due to inappropriate discharges from oculomotor, trochlear, or abducens neurons or axons with unstable cell membranes. Patients with ONM often benefit from membrane stabilizing agents such as carbamazepine. Here we describe a 71-year-old man, with no history of radiation therapy, who for 18 months had had transient episodic diplopia that occurred after down gaze. Clinical examination indicated ONM in muscles supplied by the right oculomotor nerve. Binocular scleral search coil eye movement recordings revealed a defect not only of muscle relaxation but also of maximal muscle contraction. The patient was treated with carbamazepine 200 mg per day with complete resolution of his symptoms. ONM may be more common than previously recognized, and patients with unexplained transient episodic diplopia should be specifically tested for diplopia and ocular misalignment following sustained eccentric gaze.

Aged↗
PubMed1995

Short-term adaptation of the phase of the vestibulo-ocular reflex (VOR) in normal human subjects.

We investigated the effects of short-term vestibulo-ocular reflex (VOR) adaptation on the gain and phase of the VOR, and on eccentric gaze-holding in darkness, in five normal human subjects. For 1 h, subjects sat in a chair that rotated sinusoidally at 0.2 Hz while surrounded by a visual stimulus (optokinetic drum). The drum was rotated relative to the chair, to require a VOR with either a phase lead or lag of 45 deg (with respect to a compensatory phase of zero) with no change in gain, or a gain of 1.7 or 0.5 with no change in phase. Immediately before and after each training session, VOR gain and phase were measured in the dark with 0.2 Hz sinusoidal rotation. Gaze-holding was evaluated following 20 deg eccentric saccades in darkness. Adaptation paradigms that called only for a phase lead produced an adapted VOR with 33% of the required amount of phase change, a 20% decrease in VOR gain, and an increased centripetal drift after eccentric saccades made in darkness. Adaptation paradigms that called for a phase lag produced an adapted VOR with 29% of the required amount of phase change, no significant change in VOR gain, and a centrifugal drift after eccentric saccades. Adaptation paradigms requiring a gain of 1.7 produced a 15% increase in VOR gain with small increases in phase and in centripetal drift. Adaptation paradigms requiring a gain of 0.5 produced a 31% decrease in VOR gain with a 6 deg phase lag and a centrifugal drift. The changes in drift and phase were well correlated across all adaptation paradigms; the changes in phase and gain were not. We attribute the effects on phase and gaze-holding to changes in the time constant of the velocity-to-position ocular motor neural integrator. Phase leads and the corresponding centripetal drift are due to a leaky integrator, and phase lags and the corresponding centrifugal drift are due to an unstable integrator. These results imply that in the short-term adaptation paradigm used here, the control of drift and VOR phase are tightly coupled through the neural integrator, whereas VOR gain is controlled by another mechanism.

Adaptation, Psychological↗
PubMed1995

Visual attention in Huntington's disease: the effect of cueing on saccade latencies and manual reaction times.

Studies of eye movements in patients with Huntington's disease (HD) have suggested that frontal lobe-basal ganglia structures are more involved in HD than the parietal lobes. To test this hypothesis further we compared the ability of HD patients and normal subjects to direct "covert" visual attention, using saccade latency and thumb press reaction time tasks that have been shown to be sensitive to parietal lobe dysfunction. Subjects were instructed to move their eyes or to press a button when a peripheral target was illuminated. The peripheral stimulus appeared at various intervals after the appearance of a central arrow(s) that pointed in the direction of the target (valid cue), in the opposite direction (invalid cue), or pointed simultaneously in both directions (neutral cue). For both saccade and thumb press paradigms, the difference in the latencies for trials with invalid and valid cues was the same in HD patients and normals. These findings suggest that the ability to direct visual attention is normal in HD and are compatible with the hypothesis that in HD, frontal-basal-ganglia circuits are more affected than parietal lobe pathways.

Attention↗
PubMed1995

Regulation of static and dynamic ocular alignment in patients with trochlear nerve pareses.

Ocular alignment and saccades were studied in seven patients with trochlear nerve pareses, before and after strabismus surgery. Prior to surgery, a position-dependent vertical ocular misalignment was present, and downward saccades were hypometric in the paretic eye. Strabismus surgery reduced the magnitude and position-dependence of the static misalignment. Saccade conjugacy improved in the patients with congenital pareses, and in the patient with a gradual-onset acquired paresis, but less improvement occurred in subjects with traumatic pareses. The post-operative change in saccade conjugacy relative to the change in static alignment correlated with pre-operative vertical vergence, suggesting that changes in saccade yoking depend on an interaction between saccades and vertical vergence.

Adaptation, Ocular↗
PubMed1995

Gap-overlap effects on latencies of saccades, vergence and combined vergence-saccades in humans.

We examined the effect of gap-overlap stimuli on the distribution of latencies for pure saccades, pure vergence and combined saccades and vergence in three normal subjects. With the gap stimulus, a distinct peak of "express saccades" occurred, both with and without associated vergence, but a distinct "express vergence" response was not identified. Nevertheless, with the gap stimulus there was a decrease in vergence latencies (17 msec), but less so than for saccades (41 msec). In the combined paradigm the gap effects on saccades and vergence resembled those for each component made alone. In addition, the latencies of the saccade and vergence components were linearly correlated with an average slope of 0.5. To explain these results we suggest that there is common signal processing at an early stage of saccade and vergence initiation, which is followed by activity that builds in separate trigger mechanisms that can be influenced by the conditions of fixation.

Adult↗
PubMed1995

Transient torsion during and after saccades.

In five normal subjects, we analyzed uncalled for torsion (blips) during and after horizontal and vertical saccades. Torsion was defined as movement out of Listing's plane. During horizontal saccades in downward gaze the abducting eye extorted and the adducting eye intorted. The direction of the blips reversed in upward gaze. Peak torsional amplitudes (up to 1-2 deg) were always reached during saccades; drifts back to Listing's plane outlasted the saccades. Torsion of the extorting eye was larger than that of the intorting eye, producing a transient positive cyclovergence. Torsion and cyclovergence evoked by vertical saccades were also stereotyped in each eye, but showed idiosyncratic differences among subjects. We conclude that Listing's law is violated during saccades. Transient saccade-evoked torsion might reflect properties of the three-dimensional velocity-to-position integrator and/or the ocular plant.

Adult↗
PubMed1995

Control of vertical eye alignment in three-dimensional space.

A target that is nearer to one eye than the other subtends a larger visual angle in the closer eye. Consequently, when making saccades between vertically separated targets that are closer to one eye, there is a vertical retinal disparity that must be overcome by a change in the relative alignment of the eyes. We recorded eye movements in three normal subjects and showed that in such viewing circumstances subjects made unequal vertical saccades that led to a rapid change (peak velocity up to 30 deg/sec) in vertical eye alignment. On average, 81% of the required change in alignment occurred within the saccade for downward movements and 47% for upward movements. Such unequal vertical saccades occurred independently of immediate disparity cues; saccades remained unequal when refixing to the remembered locations of the vertically-oriented targets, or even when the natural vertical disparity was nullified by a prism. On the other hand, when subjects wore the nullifying prism in front of the inferior visual field of the left eye for 8-20 hr, they showed a decrease in saccade disconjugacy (to 12-35% of the preadaptation value) to targets closer to the left eye in the inferior but not in the superior visual field. We suggest that the brain develops a three-dimensional map (horizontal, vertical, depth) for vertical saccade yoking, which is under adaptive control, and which is used to preprogram automatically the relative excursions of the eyes during vertical saccades as a function of the current and the desired point of regard.

Adaptation, Ocular↗
PubMed1995

Cerebral ocular Whipple's disease: a 62-year odyssey from death to diagnosis.

A 47-year-old white man with dementia, supranuclear ophthalmoplegia, and myoclonic ocular and facial jerks died in 1931. The case report in 1936 by Ford and Walsh diagnosed encephalitis. In 1993, we made a clinical diagnosis of Whipple's disease on the basis of the 1936 publication. We restudied the pathologic material and found, in addition to extensive encephalitis, PAS-positive material in only the eye, brain, spinal cord, and pituitary. Electron microscopy demonstrated free and intracytoplasmic microorganisms in the eye and brain. We review the history of cerebral ocular Whipple's disease and the implications from this case, which occurred before the development of antibiotics.

Astrocytes↗
PubMed1994

Short-term vestibulo-ocular reflex adaptation in humans. I. Effect on the ocular motor velocity-to-position neural integrator.

We investigated the effect of short-term vestibulo-ocular reflex (VOR) adaptation in normal human subjects on the dynamic properties of the velocity-to-position ocular motor integrator that holds positions of gaze. Subjects sat in a sinusoidally rotating chair surrounded by an optokinetic nystagmus drum. The movement of the visual surround (drum) was manipulated relative to the chair to produce an increase (x 1.7 viewing), decrease (x 0.5, x 0 viewing), or reversal (x (-2.5) viewing) of VOR gain. Before and after 1 h of training, VOR gain and gaze-holding after eccentric saccades in darkness were measured. Depending on the training paradigm, eccentric saccades could be followed by centrifugal drift (after x 0.5 viewing), implying an unstable integrator, or by centripetal drift [after x 1.7 or x (-2.5) viewing], implying a leaky integrator. The changes in the neural integrator appear to be context specific, so that when the VOR was tested in non-training head orientations, both the adaptive change in VOR gain and the changes in the neural integrator were much smaller. The changes in VOR gain were on the order of 10% and the induced drift velocities were several degrees per second at 20 deg eccentric positions in the orbit. We propose that (1) the changes in the dynamic properties of the neural integrator reflect an attempt to modify the phase (timing) relationships of the VOR and (2) the relative directions of retinal slip and eye velocity during head rotation determine whether the integrator becomes unstable (and introduces more phase lag) or leaky (and introduces less phase lag).

Adaptation, Physiological↗
PubMed1994

Short-term vestibulo-ocular reflex adaptation in humans. II. Error signals.

We oscillated humans sinusoidally at 0.2 Hz for 1 h, using various combinations of rotations of the head and visual surround to elicit short-term adaptation of the gain of the vestibulo-ocular reflex (VOR). Before and after each period of training, the gain of the VOR was measured in darkness, in response to a position step of head rotation. A small foveal target served as well as a full-field stimulus at driving VOR adaptation. Oscillation of the visual surround alone produced a substantial increase in the VOR gain. When the visual scene was rotated in phase with the head but with a larger amplitude to produce a reversal of the VOR, the VOR gain increased if the movement of the visual scene was much greater than that of the head, otherwise the gain decreased. We interpreted these results with a model of VOR adaptation that uses as its "error signal" the combination of motion of images on the retina (retinal slip) and any additional slow-phase eye velocity, beyond that generated by the VOR through the vestibular nuclei, necessary to prevent such retinal slip during head rotation. The slow phase velocity generated by the VOR is derived from "inferred head rotation", a signal based on the discharge of neurons in the vestibular nuclei that receive both labyrinthine and visual (optokinetic) inputs. The amplitude and sign of the ratio of the "error signal" to "inferred head velocity" determined the amplitude and the direction (increase or decrease) of VOR gain adaptation.

Adaptation, Physiological↗
PubMed1994

Changes in ocular alignment and pointing accuracy after sustained passive rotation of one eye.

We have investigated the contribution of ocular muscle proprioception (OMP) to the long-term maintenance of ocular alignment in normal human beings. Using a scleral suction lens, one eye was rotated laterally 30 deg away from the position of the other eye. This procedure selectively affects OMP without altering the efferent copy of the ocular motor command. The passively displaced eye was covered while the unimpeded eye fixed upon a stationary target. The suction lens was removed after 6 or 10 min and the measures of alignment begun immediately. Three tests were used to determine the effects of the deviation on ocular alignment: the Lancaster red-green test; saccadic eye movement responses to stepping targets; and hand pointing to monocularly presented targets. All three tests indicated a change of ocular alignment of about 2-4 deg, lasting 5-10 min: sustained temporal deviation resulted in exophoria (relative divergence of the visual axis), and sustained nasal deviation induced esophoria (relative convergence). Binocular viewing rapidly abolished the effect. The hand pointing test showed a large shift in the perceived position of a target during monocular viewing with either eye and its amplitude was correlated with the change of ocular alignment. These results indicate that a sustained passive rotation of one eye can lead to a persistent change in ocular alignment even after the eye is released, without any disparity cues. We further suggest that central mechanisms, based upon ocular motor afferents, rather than passive orbital mechanical factors, are the main cause of this phenomenon.

Adult↗
PubMed1994

Richardson Lecture. Adaptive control of eye movements: clinical implications.

This paper is directed primarily to clinicians who diagnose and treat patients with neurological disorders. It is an attempt to illustrate that even with modern imaging technology and other advances in laboratory testing, a thorough understanding of neurophysiology and its anatomical substrate still plays an important role in the diagnosis and management of patients with neurological diseases. One area in neurophysiology in which there has been great progress in the last few decades is the ocular motor system. Particular interest has been focused on the ways that the brain can adapt to lesions, and more specifically, how the ocular motor system keeps itself calibrated in the face of normal development and aging as well as in response to disease and trauma. Since disorders of eye movements are such common and often dramatic manifestations of neurological disease it seems appropriate to bring some of the newer concepts in ocular motor physiology to the "bedside".

Adaptation, Physiological↗
PubMed1994

Symptomatic and essential palatal tremor. 1. Clinical, physiological and MRI analysis.

Palatal tremor (brief, rhythmic involuntary movements of the soft palate) apparently comprises two different nosological entities: essential palatal tremor (EPT) and symptomatic palatal tremor (SPT). The site of the abnormality in EPT is unknown, whereas SPT is believed to arise from a lesion of the brainstem or cerebellum (within the Guillain-Mollaret triangle). The clinical and physiological properties of these conditions were studied in four patients with EPT and six patients with SPT. Patients with EPT had normal cerebellar function, but those with SPT had clinical signs of cerebellar dysfunction. The palatal movements were consistent with activation of the tensor veli palatini muscle in EPT and of the levator veli palatini muscle in SPT. During sleep, EPT stopped, whereas SPT continued with only slight variations in the tremor rate. The cycle of palatal tremor could not be reset by stimulation of trigeminal afferents in either EPT or SPT patients, and Valsalva's manoeuvre did not consistently affect the rhythm of the tremor in either group. The palatal tremor cycle exerted remote effects on the tonic electromyographic activity of the upper and lower extremities only in patients with SPT. These effects were present only on the side of the cerebellar signs (opposite the side with the enlarged inferior olive) in patients with a unilateral syndrome. Essential palatal tremor patients had only polysynaptic brainstem reflex abnormalities, whereas SPT patients had abnormalities of monosynaptic, oligosynaptic and polysynaptic brainstem reflexes. Magnetic resonance imaging showed no evidence of structural abnormalities in EPT patients, but SPT patients had a hyperdense signal of the ventral upper medulla (the region of the inferior olive) on T2-weighted images. These observations support the hypothesis that EPT and SPT are two different diseases. In SPT, cerebellar dysfunction ipsilateral to the palatal tremor may be due, in part, to abnormal function of the contralateral hypertrophic inferior olive. The proposed basis of SPT is a disturbance of electrotonic coupling between the cells of the inferior olive induced by a lesion of the dentato-olivary pathway. Similar mechanisms could be responsible for postural tremors in general. The pathophysiological basis of EPT remains unknown.

Adult↗