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Karl Wessel, MD; Carsten Moschner, MD; Klaus-Peter Wandinger, MD; Deflef Kömpf, MD; Wolfgang Heide, MD

Arch Neurol. 1998;55:949-956.

Background  Oculomotor abnormalities have been reported in patients with degenerative ataxic disorders.

Objective  To assess the diagnostic sensitivity and specificity of oculomotor deficits in patients with Friedreich ataxia (FA), cerebellar atrophy (CA), and olivopontocerebellar atrophy (OPCA).

Setting  Neurology clinic at a university hospital in Lübeck, Germany.

Patients  Seven patients with FA, 9 with CA, and 10 with OPCA were studied. These patients were selected from an ongoing follow-up study.

Main Outcome Measures  Eye movements were recorded by electro-oculography; an extensive battery of quantitative tests was used.

Results  A proven CAG repeat expansion on chromosome 6 or 14 was significantly associated with reduced saccadic eye velocity and vertical gaze palsy (P<.001, Mann-Whitney U test). All 6 patients with OPCA and slow saccades had an autosomal-dominant inheritance; 4 of them were proved to have spinocerebellar atrophy type 1. In 9 of these patients (4 with FA, 1 with CA, and 4 with OPCA), the genetic defect could not be identified. Saccadic dysmetria, impairment of smooth pursuit and optokinetic nystagmus, deficient suppression of the vestibulo-ocular reflex by either visual or otolith input, and pathological nystagmus were attributed to degenerative lesions in different parts of the cerebellum. However, these symptoms failed to clearly distinguish between the different groups of patients, whereas decreased vestibulo-ocular reflex gain, slow saccades, and vertical gaze palsy pointed to an extracerebellar manifestation of the degenerative disease, occurring only in patients with OPCA and FA.

Conclusions  In this prospective study, oculomotor disturbances were mainly related to cerebellar dysfunction. Only a few of them were caused by extracerebellar manifestations of the disease, such as slowing of saccades, which was characteristic for patients with OPCA of autosomal-dominant inheritance.

From the Department of Neurology, Medical University, Lübeck, Germany. Dr Wessel is now with the Department of Neurology, Clinic of Braunschweig, Braunschweig, Germany.

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