Journal of Neurology

, Volume 255, Issue 12, pp 1916–1925

Differential diagnostic value of eye movement recording in PSP-parkinsonism, Richardson's syndrome, and idiopathic Parkinson's disease

  • Elmar H. Pinkhardt
  • Reinhart Jürgens
  • Wolfgang Becker
  • Federica Valdarno
  • Albert C. Ludolph
  • Jan Kassubek
ORIGINAL COMMUNICATION

Abstract

Vertical gaze palsy is a highly relevant clinical sign in parkinsonian syndromes. As the eponymous sign of progressive supranuclear palsy (PSP), it is one of the core features in the diagnosis of this disease. Recent studies have suggested a further differentiation of PSP in Richardson's syndrome (RS) and PSP-parkinsonism (PSPP). The aim of this study was to search for oculomotor abnormalities in the PSP-P subset of a sample of PSP patients and to compare these findings with those of (i) RS patients, (ii) patients with idiopathic Parkinson's disease (IPD), and (iii) a control group. Twelve cases of RS, 5 cases of PSP-P, and 27 cases of IPD were examined by use of video-oculography (VOG) and compared to 23 healthy normal controls. Both groups of PSP patients (RS, PSP-P) had significantly slower saccades than either IPD patients or controls, whereas no differences in saccadic eye peak velocity were found between the two PSP groups or in the comparison of IPD with controls. RS and PSP-P were also similar to each other with regard to smooth pursuit eye movements (SPEM), with both groups having significantly lower gain than controls (except for downward pursuit); however, SPEM gain exhibited no consistent difference between PSP and IPD. A correlation between eye movement data and clinical data (Hoehn & Yahr scale or disease duration) could not be observed. As PSP-P patients were still in an early stage of the disease when a differentiation from IPD is difficult on clinical grounds, the clear-cut separation between PSP-P and IPD obtained by measuring saccade velocity suggests that VOG could contribute to the early differentiation between these patient groups.

Key words

video-oculography oculomotor alterations in parkinsonian syndromes Richardson's syndrome PSP-parkinsonism progressive supranuclear palsy idiopathic Parkinson's disease 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bhidayasiri R, Riley DE, Somers JT,Lerner AJ, Buttner-Ennever JA, LeighRJ (2001) Pathophysiology of slowvertical saccades in progressive supranuclearpalsy. Neurology 57:2070–2077PubMedGoogle Scholar
  2. 2.
    Briand KA, Strallow D, Hening W,Poizner H, Sereno AB (1999) Controlof voluntary and reflexive saccades inParkinson's disease. Exp Brain Res129:38–48PubMedCrossRefGoogle Scholar
  3. 3.
    Constantinescu R, Richard I, Kurlan R(2007) Levodopa responsiveness indisorders with parkinsonism: a reviewof the literature. Mov Disord 22:2141–2148; quiz 2295PubMedCrossRefGoogle Scholar
  4. 4.
    Garbutt S, Riley DE, Kumar AN, Han Y,Harwood MR, Leigh RJ (2004) Abnormalitiesof optokinetic nystagmus inprogressive supranuclear palsy. J NeurolNeurosurg Psychiatry 75:1386–1394CrossRefGoogle Scholar
  5. 5.
    Gibb WR, Lees AJ (1988) The relevanceof the Lewy body to the pathogenesisof idiopathic Parkinson's disease.J Neurol Neurosurg Psychiatry 51:745–752PubMedCrossRefGoogle Scholar
  6. 6.
    Hood AJ, Amador SC, Cain AE, BriandKA, Al-Refai AH, Schiess MC, SerenoAB (2007) Levodopa slows prosaccadesand improves antisaccades: an eyemovement study in Parkinson's disease.J Neurol Neurosurg Psychiatry78:565–570PubMedCrossRefGoogle Scholar
  7. 7.
    Leigh RJ, Zee DS (2006) The Neurologyof Eye Movement. Oxford UniversityPress, OxfordGoogle Scholar
  8. 8.
    Litvan I, Agid Y, Calne D, Campbell G,Dubois B, Duvoisin RC, Goetz CG,Golbe LI, Grafman J, Growdon JH,Hallett M, Jankovic J, Quinn NP, TolosaE, Zee DS (1996) Clinical researchcriteria for the diagnosis of progressivesupranuclear palsy (Steele-Richardson-Olszewski syndrome): reportof the NINDS-SPSP internationalworkshop. Neurology 47:1–9PubMedCrossRefGoogle Scholar
  9. 9.
    Pearce JM (2007) Progressive supranuclearpalsy (Steele-Richardson-Olszewski syndrome): a short historicalreview. Neurologist 13:302–304PubMedCrossRefGoogle Scholar
  10. 10.
    Rascol O, Clanet M, Montastruc JL, SimonettaM, Soulier-Esteve MJ, DoyonB, Rascol A (1989) Abnormal ocularmovements in Parkinson’s disease.Evidence for involvement of dopaminergicsystems. Brain 112(Pt 5):1193–1214PubMedCrossRefGoogle Scholar
  11. 11.
    Rottach KG, Riley DE, DiScenna AO,Zivotofsky AZ, Leigh RJ (1996) Dynamicproperties of horizontal andvertical eye movements in parkinsoniansyndromes. Ann Neurol 39:368–377PubMedCrossRefGoogle Scholar
  12. 12.
    Steele JC, Richardson JC, Olszewski J(1964) Progressive Supranuclear Palsy.A Heterogeneous Degeneration Involvingthe Brain Stem, Basal Ganglia andCerebellum with Vertical Gaze andPseudobulbar Palsy, Nuchal Dystoniaand Dementia. Arch Neurol 10:333–359PubMedGoogle Scholar
  13. 13.
    Vidailhet M, Rivaud S, Gouider-KhoujaN, Pillon B, Bonnet AM, Gaymard B,Agid Y, Pierrot-Deseilligny C (1994)Eye movements in parkinsonian syndromes.Ann Neurol 35:420–426PubMedCrossRefGoogle Scholar
  14. 14.
    Waterston JA, Barnes GR, Grealy MA,Collins S (1996) Abnormalities ofsmooth eye and head movement controlin Parkinson's disease. Ann Neurol39:749–760PubMedCrossRefGoogle Scholar
  15. 15.
    Williams DR, de Silva R, Paviour DC,Pittman A, Watt HC, Kilford L, HoltonJL, Revesz T, Lees AJ (2005) Characteristicsof two distinct clinical phenotypesin pathologically provenprogressive supranuclear palsy:Richardson's syndrome and PSPparkinsonism.Brain 128:1247–1258PubMedCrossRefGoogle Scholar
  16. 16.
    Williams DR, Holton JL, Strand C,Pittman A, de Silva R, Lees AJ, Revesz T(2007) Pathological tau burden anddistribution distinguishes progressivesupranuclear palsy-parkinsonismfrom Richardson's syndrome. Brain130:1566–1576PubMedCrossRefGoogle Scholar
  17. 17.
    Williams DR, Pittman AM, Revesz T,Lees AJ, de Silva R (2007) Geneticvariation at the tau locus and clinicalsyndromes associated with progressivesupranuclear palsy. Mov Disord 22:895–897PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2009

Authors and Affiliations

  • Elmar H. Pinkhardt
    • 1
  • Reinhart Jürgens
    • 2
  • Wolfgang Becker
    • 2
  • Federica Valdarno
    • 2
  • Albert C. Ludolph
    • 1
  • Jan Kassubek
    • 1
    • 2
  1. 1.Dept. of NeurologyUniversity of UlmUlmGermany
  2. 2.Section Neurophysiology, Dept. of NeurologyUniversity of UlmUlmGermany

Personalised recommendations