Alexander’s Law in Patients with Acute Vestibular Tone Asymmetry—Evidence for Multiple Horizontal Neural Integrators

Alexander's law (AL) states that the slow-phase velocity of spontaneous nystagmus of peripheral vestibular origin is dependent on horizontal gaze position, with greater velocity when gaze is directed in the fast-phase direction. AL is thought to be a compensatory reaction resulting from adaptive changes in the horizontal ocular motor neural integrator. Until now, only horizontal eye movements have been investigated with respect to AL. Because spontaneous nystagmus usually includes vertical and torsional components, we asked whether horizontal gaze changes would have an effect on the 3D drift of spontaneous nystagmus and, thus, on the vertical/torsional neural integrator. We hypothesized that AL reduces all nystagmus components proportionally. Moreover, we questioned the classical theory of a single bilaterally organized horizontal integrator and searched for nonlinearities of AL implying a network of multiple integrators. Using dual scleral search coils, we measured AL in 17 patients with spontaneous nystagmus. Patients followed a pulsed laser dot at eye level jumping in 5 degrees steps along the horizontal meridian between 25 degrees right and left in otherwise complete darkness. AL was observed in 15 of 17 patients. Whereas individual patients typically showed a change of 3D-drift direction at different horizontal eye positions, the average change in direction was not different from zero. The strength of AL (= rate of change of total velocity with gaze position) correlated with nystagmus slow-phase velocity (Spearman's rho = 0.5; p < 0.05) and, on average, did not change the 3D nystagmus drift direction. In general, eye velocity did not vary linearly with eye position. Rather, there was a stronger dependence of velocity on horizontal position when subjects looked in the slow-phase direction compared to the fast-phase direction. We conclude that the theory of a simple leak of a single horizontal neural integrator is not sufficient to explain all aspects of AL.     

Eye movements evoked by the selective stimulation of the utricular nerve in cats

Objective: Eye movements evoked by otolith organ are not well-investigated compare with canal related eye movements due to the technical difficulties. We try to solve this problem by means of our methods. Methods: Eye movements evoked by selective utricular (UT) nerve stimulation were investigated using both electrooculography (EOG) and video recording in decerebrated cats in the presence or absence of anesthesia. Electrical stimulation was applied to the UT nerve through implanted acupuncture needles. Results: In the absence of anesthesia and with stimulus intensities less than 2.6±0.7×N₁T, we found ipsilaterally directed horizontal eye movements in both eyes in one cat, abduction in the ipsilateral eye in two cats, and adduction in the contralateral eye in another cat. Other types of eye movements (e.g., supraduction or diagonal eye movements) were observed in both eyes of cats in the absence of anesthesia at a stimulus intensity of 12.2±7.6×N₁T, an intensity in which current spread to the adjacent nerve could not be ruled out. In the presence of anesthesia, UT nerve stimulation alone failed to evoke horizontal eye movements, but with an intensity 13.8±6.4×N₁T, supraduction or diagonal eye movements were evoked. UT nerve stimulation at 2–3×N₁T facilitated horizontal eye movements induced by ipsilateral abducens (AB) nucleus stimulation or contralateral horizontal canal nerve stimulation. Conclusion: This is the first report to our knowledge in which UT nerve-evoked horizontal eye movements are documented. These results confirm the known monosynaptic and disynaptic anatomical connections from utricular primary afferents to the ipsilateral AB nucleus neurons.     

Restoration of Function in the Paralyzed Rabbit Orbicularis Oculi Muscle by Direct Functional Electrical Stimulation

Restoration of the ability to blink and protect the eye in the patient with facial paralysis remains a challenge. Although many treatments exist, no one approach corrects all the deficits associated with the loss of orbicularis oculi function. In this study, the author investigated the feasibility of restoring function by direct electrical stimulation of the paralyzed orbicularis oculi muscle in the rabbit model. Using a pacing device developed by the author, functional restoration of a normal-appearing blink was produced throughout 30 days of continuous pacing in six rabbits with transected facial nerves. Histologic evaluations of the paced tissues demonstrated no evidence of detrimental effects attributable to the electrical stimulation. The findings of this study support the feasibility of employing direct electrical stimulation to restore the function of paralyzed orbicularis oculi muscles. Potential applications may also exist in other areas in which peripheral denervation creates functional impairment.     

How to do and why perform the skull vibration-induced nystagmus test

The skull vibration-induced nystagmus test (SVINT) is a global vestibular test stimulating otoliths and semicircular canals at a frequency of 100 Hz, not modified by vestibular compensation, which may reveal vibration-induced nystagmus (VIN). Bone-conducted vibration applied to the mastoid processes and the vertex instantaneously induces predominantly low-velocity (∼10°/s) horizontal nystagmus, with rapid phases beating away from the affected side in patients with unilateral vestibular loss (UVL). VIN starts and stops immediately with stimulation, is continuous, reproducible, beats in the same direction irrespective of which mastoid process is stimulated, with no or little habituation. The SVINT acts like a vestibular Weber test. In peripheral UVL, the SVINT is a good marker of vestibular asymmetry and demonstrates pathological nystagmus beating towards the healthy side in 90% of cases of vestibular neuritis, 71% of cases of Menière's diseases and 44 to 78% of vestibular schwannomas. In superior semicircular canal dehiscence, VIN usually beats towards the affected side due to facilitation of bone conduction related to the presence of a third window. Stimulation of the vertex is more effective than in UVL patients, with sensitivity extending to higher frequencies, up to 700 Hz. Observation of vibration-induced nystagmus then reveals equally represented vertical, torsional, and horizontal components beating towards the affected ear, suggesting dominant, but not exclusive, stimulation of the dehiscent superior semicircular canal.