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      Characteristics of vestibular corrective saccades in patients with slow visual saccades, vestibular disorders and controls: A descriptive analysis

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          Abstract

          Objective

          Our aim was to determine whether overt catch up saccades (OS) provoked by vestibular stimuli, as observed in the video head impulse test (vHIT), have comparable metrics as visually triggered horizontal saccades (VS), indicating a common saccadic brainstem generator.

          Methods

          Three groups of patients were studied: patients with neurological disorders causing slow saccades (group 1, n = 12), patients with peripheral vestibular lesions (group 2, n = 43), and normal controls (group 3, = 24). All patients underwent vHIT and Videooculographic testing. OS velocity, acceleration, amplitude and duration and VS velocity in this group was compared between the groups.

          Results

          There was significant reduction in the velocity of visually guided saccades in group 1, as expected from the patient selection constraints of this study. Group 1 also exhibited saccades which were longer in duration and of reduced acceleration when compared to subjects without saccadic slowing to visual targets (Group 2 and 3). There were significant positive correlations between OS acceleration and amplitude in both normal saccade groups (2 and 3) which was not observed in the slow saccade group (1).

          Conclusions

          The metrics of overt saccades measured by the vHIT in patients with slow saccades and normal controls are similar to visually guided saccades. This supports the hypothesis that overt saccades associated with vestibular stimuli and visually triggered saccades share common circuitry that controls metrics.

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          Most cited references26

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          The video head impulse test: diagnostic accuracy in peripheral vestibulopathy.

          The head impulse test (HIT) is a useful bedside test to identify peripheral vestibular deficits. However, such a deficit of the vestibulo-ocular reflex (VOR) may not be diagnosed because corrective saccades cannot always be detected by simple observation. The scleral search coil technique is the gold standard for HIT measurements, but it is not practical for routine testing or for acute patients, because they are required to wear an uncomfortable contact lens. To develop an easy-to-use video HIT system (vHIT) as a clinical tool for identifying peripheral vestibular deficits. To validate the diagnostic accuracy of vHIT by simultaneous measures with video and search coil recordings across healthy subjects and patients with a wide range of previously identified peripheral vestibular deficits. Horizontal HIT was recorded simultaneously with vHIT (250 Hz) and search coils (1,000 Hz) in 8 normal subjects, 6 patients with vestibular neuritis, 1 patient after unilateral intratympanic gentamicin, and 1 patient with bilateral gentamicin vestibulotoxicity. Simultaneous video and search coil recordings of eye movements were closely comparable (average concordance correlation coefficient r(c) = 0.930). Mean VOR gains measured with search coils and video were not significantly different in normal (p = 0.107) and patients (p = 0.073). With these groups, the sensitivity and specificity of both the reference and index test were 1.0 (95% confidence interval 0.69-1.0). vHIT measures detected both overt and covert saccades as accurately as coils. The video head impulse test is equivalent to search coils in identifying peripheral vestibular deficits but easier to use in clinics, even in patients with acute vestibular neuritis.
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            A clinical sign of canal paresis.

            Unilateral loss of horizontal semicircular canal function, termed canal paresis, is an important finding in dizzy patients. To our knowledge, apart from head-shaking nystagmus, no clinical sign of canal paresis has yet been described and the term derives from the characteristic finding on caloric tests: little or no nystagmus evoked by either hot or cold irrigation of the affected ear. We describe a simple and reliable clinical sign of total unilateral loss of horizontal semicircular canal function: one large or several small oppositely directed, compensatory, refixation saccades elicited by rapid horizontal head rotation toward the lesioned side. Using magnetic search coils to measure head and eye movement, we have validated this sign in 12 patients who had undergone unilateral vestibular neurectomy.
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              The main sequence, a tool for studying human eye movements

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysis
                Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                30 May 2018
                2018
                : 13
                : 5
                : e0197079
                Affiliations
                [1 ] Department of Neurology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina
                [2 ] Memory and Balance Clinic, Buenos Aires, Argentina
                [3 ] Audiology Department, Interacoustics Academy, Middelfart, Denmark
                [4 ] Northwestern University, Chicago, Illinois, United States of America
                Tokai University, JAPAN
                Author notes

                Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Leigh Martin: Employed by Interacoustics A/S who distribute the EyeSeeCam vHIT system. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Article
                PONE-D-18-03649
                10.1371/journal.pone.0197079
                5976173
                29847602
                20b23663-3134-4d57-8881-fb713f0c8f33
                © 2018 Yacovino et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 February 2018
                : 25 April 2018
                Page count
                Figures: 1, Tables: 3, Pages: 12
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Sensory Physiology
                Visual System
                Eye Movements
                Medicine and Health Sciences
                Physiology
                Sensory Physiology
                Visual System
                Eye Movements
                Biology and Life Sciences
                Neuroscience
                Sensory Systems
                Visual System
                Eye Movements
                Physical Sciences
                Physics
                Classical Mechanics
                Acceleration
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Vision
                Biology and Life Sciences
                Psychology
                Sensory Perception
                Vision
                Social Sciences
                Psychology
                Sensory Perception
                Vision
                Biology and Life Sciences
                Anatomy
                Brain
                Brainstem
                Medicine and Health Sciences
                Anatomy
                Brain
                Brainstem
                Physical Sciences
                Physics
                Classical Mechanics
                Motion
                Velocity
                Biology and Life Sciences
                Anatomy
                Head
                Medicine and Health Sciences
                Anatomy
                Head
                Biology and Life Sciences
                Anatomy
                Head
                Eyes
                Medicine and Health Sciences
                Anatomy
                Head
                Eyes
                Biology and Life Sciences
                Anatomy
                Ocular System
                Eyes
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Eyes
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Lesions
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Lesions
                Custom metadata
                All data necessary to replicate the results of the study are present in the paper and its Supporting Information files. The full dataset is available upon request with approval from the Dr Cesar Milstein Hospital Ethics Committee. Requests for these data may be sent to Dr. Diego Caruso ( cei.milstein@ 123456gmail.com ).

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