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Diagnostic accuracy of a smartphone bedside test to assess the fixation suppression of the vestibulo-ocular reflex: when nothing else matters.

ABSTRACT: OBJECTIVE:Validation of a bedside test to objectify the fixation suppression of the vestibulo-ocular reflex (FS-VOR) in patients with a cerebellar syndrome and healthy controls. METHODS:The vestibulo-ocular reflex and its fixation suppression were assessed by video-nystagmography (VNG) in 20 healthy subjects (mean age 56?±?15) and 19 patients with a cerebellar syndrome (mean age 70?±?11). The statistical cutoff delineating normal from pathological FS-VOR was determined at the 2.5th percentile of the normal distribution of the healthy cohort. VNG was then compared to a bedside test, where eye movements were recorded with a smartphone while patients were rotated on a swivel chair at a defined speed and amplitude. These videos were rated as normal or pathological FS-VOR by six blinded raters, and results compared to VNG. RESULTS:VNG in healthy controls showed FS-VOR with a reduction of nystagmus beats by 95.0%?±?7.2 (mean?±?SD). The statistical cutoff was set at 80.6%. Cerebellar patients reduced nystagmus beats by only 26.3%?±?25.1. Inter-rater agreement of the smartphone video ratings was 85%. The sensitivity of the video ratings to detect an impaired FS-VOR was 99%, its specificity 92%. Inter-test agreement was 91%. CONCLUSION:The smartphone bedside test is an easily performed, reliable, sensitive, specific, and inexpensive alternative for assessing FS-VOR.

SUBMITTER: Gandor F

PROVIDER: S-EPMC7351825 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Diagnostic accuracy of a smartphone bedside test to assess the fixation suppression of the vestibulo-ocular reflex: when nothing else matters.

Gandor Florin F Tesch Manfred M Neuhauser Hannelore H Gruber Doreen D Heinze Hans-Jochen HJ Ebersbach Georg G Lempert Thomas T

Journal of neurology 20200601 7

<h4>Objective</h4>Validation of a bedside test to objectify the fixation suppression of the vestibulo-ocular reflex (FS-VOR) in patients with a cerebellar syndrome and healthy controls.<h4>Methods</h4>The vestibulo-ocular reflex and its fixation suppression were assessed by video-nystagmography (VNG) in 20 healthy subjects (mean age 56 ± 15) and 19 patients with a cerebellar syndrome (mean age 70 ± 11). The statistical cutoff delineating normal from pathological FS-VOR was determined at the 2.5t ...[more]

PMID: 32488297

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Project description:The three-dimensional vestibulo-ocular reflex (3D VOR) ideally generates compensatory ocular rotations not only with a magnitude equal and opposite to the head rotation but also about an axis that is collinear with the head rotation axis. Vestibulo-ocular responses only partially fulfill this ideal behavior. Because animal studies have shown that vestibular stimulation about particular axes may lead to suboptimal compensatory responses, we investigated in healthy subjects the peaks and troughs in 3D VOR stabilization in terms of gain and alignment of the 3D vestibulo-ocular response. Six healthy upright sitting subjects underwent whole body small amplitude sinusoidal and constant acceleration transients delivered by a six-degree-of-freedom motion platform. Subjects were oscillated about the vertical axis and about axes in the horizontal plane varying between roll and pitch at increments of 22.5 degrees in azimuth. Transients were delivered in yaw, roll, and pitch and in the vertical canal planes. Eye movements were recorded in with 3D search coils. Eye coil signals were converted to rotation vectors, from which we calculated gain and misalignment. During horizontal axis stimulation, systematic deviations were found. In the light, misalignment of the 3D VOR had a maximum misalignment at about 45 degrees . These deviations in misalignment can be explained by vector summation of the eye rotation components with a low gain for torsion and high gain for vertical. In the dark and in response to transients, gain of all components had lower values. Misalignment in darkness and for transients had different peaks and troughs than in the light: its minimum was during pitch axis stimulation and its maximum during roll axis stimulation. We show that the relatively large misalignment for roll in darkness is due to a horizontal eye movement component that is only present in darkness. In combination with the relatively low torsion gain, this horizontal component has a relative large effect on the alignment of the eye rotation axis with respect to the head rotation axis.

Dataset Information

Diagnostic accuracy of a smartphone bedside test to assess the fixation suppression of the vestibulo-ocular reflex: when nothing else matters.

Publications

Diagnostic accuracy of a smartphone bedside test to assess the fixation suppression of the vestibulo-ocular reflex: when nothing else matters.

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