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Square-wave jerks induced by pallidotomy in parkinsonian patients

From the Departments of Neurology (Drs. Averbuch-Heller, Stahl, and Leigh) and Neurosurgery (Dr. Hlavin), University Hospitals of Cleveland and Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH.

Address correspondence and reprint requests to Dr. Lea Averbuch-Heller, Division of Neuro-ophthalmology, Rabin Medical Center, Campus Beilinson, Petaq Tiqva 49100, Israel.

Square-wave jerks (SWJs) are small, inappropriate saccades that intrude on steady fixation by taking the eye away from the target and then returning it after approximately 200 msec. The pathophysiology of SWJs is unknown; they have not been attributed to any specific lesion. We found that unilateral pallidotomy substantially increased the frequency of SWJs in three patients with Parkinson’s disease. This effect is likely due to imbalance in the fixation system caused by asymmetric reactivation of prefrontal cortex via ascending thalamocortical projections. Alternatively, disruption of nigral projections to the superior colliculus might be responsible.

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