Normal Gain of VOR with Refixation Saccades in Patients with Unilateral Vestibulopathy

Pérez-Fernández, Nicolas; Eza-Nuñez, Paloma

doi:10.5152/iao.2015.1087

Cited by 49 publications

(47 citation statements)

References 21 publications

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“…This may result in alterations in vestibular function, characterized by reduced vestibulo-ocular reflex (VOR) gain and increased VOR gain variability with advancing age ( 1 , 2 , 8 ). Reduced function of the angular VOR results in generation of compensatory saccades ( 3 , 9 , 10 ). Studies have shown that compensatory saccades occur more frequently with increasing age ( 3 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Aging Increases Compensatory Saccade Amplitude in the Video Head Impulse Test

et al. 2016

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ObjectiveRotational vestibular function declines with age resulting in saccades as a compensatory mechanism to improve impaired gaze stability. Small reductions in rotational vestibulo-ocular reflex (VOR) gain that would be considered clinically normal have been associated with compensatory saccades. We evaluated whether compensatory saccade characteristics varied as a function of age, independent of semicircular canal function as quantified by VOR gain.MethodsHorizontal VOR gain was measured in 243 participants age 27–93 from the Baltimore Longitudinal Study of Aging using video head impulse testing. Latency and amplitude of the first saccade (either covert – occurring during head impulse, or overt – occurring following head impulse) were measured for head impulses with compensatory saccades (n = 2230 head impulses). The relationship between age and saccade latency, as well as the relationship between age and saccade amplitude, were evaluated using regression analyses adjusting for VOR gain, gender, and race.ResultsOlder adults (mean age 75.9) made significantly larger compensatory saccades relative to younger adults (mean age 45.0). In analyses adjusted for VOR gain, there was a significant association between age and amplitude of the first compensatory covert saccade (β = 0.015, p = 0.008). In analyses adjusted for VOR gain, there was a significant association between age and amplitude of the first compensatory overt saccade (β = 0.02, p < 0.001). Compensatory saccade latencies did not vary significantly by age.ConclusionWe observed that aging increases the compensatory catch-up saccade amplitude in healthy adults after controlling for VOR gain. Size of compensatory saccades may be useful in addition to VOR gain for characterizing vestibular function in aging adults.

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Section: Introductionmentioning

confidence: 99%

“…Studies have shown that compensatory saccades occur more frequently with increasing age ( 3 , 11 ). Interestingly, compensatory saccades have been observed in older individuals even when VOR gain was clinically in the normal range ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Aging Increases Compensatory Saccade Amplitude in the Video Head Impulse Test

et al. 2016

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“…Instead, a compensatory quick eye movement toward the target, called refixation saccades, will occur ( 3 ). Recently, several studies reported that refixation saccades with normal gain values can occur in patients with unilateral vestibulopathy ( 11 , 20 , 21 ). However, the hand position was not described in these studies.…”

Section: Discussionmentioning

confidence: 99%

Effects of Hand Positions During Video Head-Impulse Test (vHIT) in Patients With Unilateral Vestibular Neuritis

Zhao

et al. 2018

Front. Neurol.

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Background: The aim of this study is to identify the effects of hand positions (head and jaw) on the video head-impulse test (vHIT).Methods: Eighty-six healthy volunteers and sixty-seven patients with unilateral vestibular neuritis (UVN) were recruited for this study. Different hand positions (head and jaw) were used in the vHIT of horizontal semicircular canals in healthy volunteers and UVN patients. All the obtained horizontal vHIT gains were analyzed.Results: It was observed that when horizontal vHIT was performed with the head hand position, the number of head impulses that produced overhigh vestibulo-ocular reflex (VOR) gains was more than that with the jaw hand position (p < 0.01), irrespective of whether the test was performed in healthy volunteers or UVN patients. The gains obtained were lower when the jaw hand position was used than that obtained when the head hand position was used (p < 0.05). However, no significant difference existed in the mean head velocity between the two hand positions (p > 0.05). Using the head hand position has greater a chance to elicit in UVN patients normal horizontal vHIT gains with refixation saccades than using the jaw hand position (p = 0.04).Conclusion: The jaw hand position can increase the accuracy of vHIT in determining the lesion side.

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“…Refixation saccades with normal gain values have been reported to occur more frequently with increasing age (2–4). …”

Section: Discussionmentioning

confidence: 99%

“…Using vHIT, Perez-Fernandez and Eza-Nunez examined 623 patients with vertigo and dizziness (4). In the final population, he included patients with gain values > 0.8 with unilateral refixation saccades.…”

Section: Discussionmentioning

confidence: 99%

Refixation Saccades with Normal Gain Values: A Diagnostic Problem in the Video Head Impulse Test: A Case Report

et al. 2017

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Refixation saccades with normal gain value occur more frequently with increasing age. The phenomenon has also been observed in different vestibular disorders. In this case, we present a young male with normal gain value and refixation saccades tested with the video head impulse test (vHIT) the day after his cochlear implantation. One month after surgery, refixation saccades were no longer present. This suggests that refixation saccades can occur as a result of temporary pathology such as surgery. Refixation saccades with normal gain values might reflect a partial deficit in the vestibulo-ocular reflex. However, this partial deficit is in conflict with the current way of interpreting vHIT results in which the vestibular function is classified as either normal or pathological based only on the gain value. Refixation saccades, which are evident signs of vestibulopathy, are not considered in the evaluation. A new way of interpreting the vHIT based on the saccades must be considered.

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Normal Gain of VOR with Refixation Saccades in Patients with Unilateral Vestibulopathy

Cited by 49 publications

References 21 publications

Aging Increases Compensatory Saccade Amplitude in the Video Head Impulse Test

Aging Increases Compensatory Saccade Amplitude in the Video Head Impulse Test

Effects of Hand Positions During Video Head-Impulse Test (vHIT) in Patients With Unilateral Vestibular Neuritis

Refixation Saccades with Normal Gain Values: A Diagnostic Problem in the Video Head Impulse Test: A Case Report

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