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From the Department of Neurology, Ludwig Maximilians University, Munich, Germany.
Address correspondence and reprint requests to Dr. S. Glasauer, Zentrum für Sensomotorik, Klinikum Grosshadern, University of Munich, Marchioninistrasse 23, 81377 Munich, Germany; e-mail: sglasauer{at}nefo.med.uni-muenchen.de
Background: Downbeat nystagmus (DBN), a frequent ocular motor sign often caused by cerebellar lesions, is a fixational nystagmus with fast phases directed downward. Its precise etiology is not known. One hypothesis is that it is caused by a central imbalance of pathways of the vertical vestibulo-ocular reflex (VOR). Such an imbalance would cause not only ocular drift but also deficient and asymmetric vertical VOR responses.
Objective: To test this hypothesis, the authors analyzed the functionally relevant VOR responses to head impulses in the roll, pitch, and yaw planes.
Methods: Head and eye movements were measured with the search-coil method in 10 patients with DBN and 10 age-matched control subjects.
Results: Analysis revealed no gain difference in patients with DBN compared with control subjects. Specifically, upward and downward VOR responses in patients with DBN in the pitch plane were symmetric.
Conclusions: These findings do not support the hypothesis of a vertical VOR imbalance and put into question the view that DBN is a central vestibular syndrome in the sense of vestibular dysfunction. Although DBN possibly involves vestibulocerebellar pathways, in the patients that we studied, DBN did not affect the immediate VOR responses in the high-frequency range that corresponds to natural head movements.
Received December 24, 2003. Accepted in final form May 14, 2004.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the August 24 issue to find the title link for this article.
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