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Bedside tested ocular motor disorders in multiple sclerosis patients
G Servillo1, D Renard2, G Taieb2
1Department of Medical and Health Sciences, University of Trieste, 34100 Trieste, Italy ; Service de Neurologie, Centre Hospitalier Universitaire Caremeau, 30029 Nîmes, France.
Abstract:
Background/Aims. Ocular motor disorders (OMDs) are a common feature of multiple sclerosis (MS). In clinical practice, if not reported by patients, OMDs are often underdiagnosed and their prevalence is underestimated. Methods. We studied 163 patients (125 women, 76.7%, 38 men, 23.3%; median age 45.0 years; median disease duration 10 years; median EDSS 3.5) with definite MS (n = 150, 92%) or clinically isolated syndrome (n = 13, 8%) who underwent a thorough clinical examination of eye movements. Data on localization of previous relapses, MS subtype, and MRI findings were collected and analyzed. Results. Overall, 111/163 (68.1%) patients showed at least one abnormality of eye movement. Most frequent OMDs were impaired smooth pursuit (42.3%), saccadic dysmetria (41.7%), unilateral internuclear ophthalmoplegia (14.7%), slowing of saccades (14.7%), skew deviation (13.5%), and gaze evoked nystagmus (13.5%). Patients with OMDs had more severe disability (P = 0.0005) and showed more frequently infratentorial MRI lesions (P = 0.004). Localization of previous relapses was not associated with presence of OMDs. Conclusion. OMDs are frequent in patients with stable (no relapses) MS. A precise bedside examination of eye motility can disclose abnormalities that imply the presence of subclinical MS lesions and may have a substantial impact on definition of the diagnosis and on management of MS patients.
Insights
Ocular motor disorders (OMDs) are common in multiple sclerosis (MS), affecting nearly 70% of patients. A simple eye movement exam can reveal these issues, aiding MS diagnosis and management.
Area of Science:
- Neurology
- Ophthalmology
- Neuroscience
Background:
- Ocular motor disorders (OMDs) are frequently observed in multiple sclerosis (MS) but often underdiagnosed.
- Underdiagnosis leads to an underestimation of OMD prevalence in MS patients.
- Early identification of OMDs is crucial for comprehensive MS care.
Purpose of the Study:
- To determine the prevalence and types of OMDs in patients with MS.
- To investigate the association between OMDs and MS disability and MRI findings.
- To highlight the diagnostic and management implications of bedside eye movement examinations.
Main Methods:
- A cohort of 163 patients with definite MS or clinically isolated syndrome underwent detailed eye movement examinations.
- Data collected included patient demographics, MS subtype, disease duration, EDSS scores, and MRI lesion locations.
- Statistical analysis was performed to correlate OMDs with clinical and radiological MS characteristics.
Main Results:
- 68.1% of MS patients exhibited at least one OMD.
- Impaired smooth pursuit and saccadic dysmetria were the most common OMDs.
- OMDs were significantly associated with greater MS disability and infratentorial MRI lesions.
Conclusions:
- OMDs are highly prevalent in stable MS, indicating subclinical disease.
- Bedside ocular motility assessment is valuable for detecting OMDs in MS.
- Identifying OMDs can impact MS diagnosis, prognosis, and treatment strategies.
