Modulation of acquired monocular pendular nystagmus in multiple sclerosis: A modeling approach

Acquired pendular nystagmus (APN) often occurs in association with the disorders affecting the visual system, such as multiple sclerosis (MS). The proposed mechanisms of APN in MS have been a delayed conduction of the visual information for ocular stabilization and unstable neural integrator for feedback controls. We determined the effects of visual inputs on the nystagmus intensity and the effects of saccades on phase shift of the nystagmus in a patient with monocular pendular nystagmus from MS. In this patient, (1) during binocular viewing in the light, the nystagmus was observed only in the eye with more severe visual loss, (2) the nystagmus disappeared in darkness, (3) monocular viewing with either eye markedly suppressed the nystagmus, (4) the nystagmus decreased when the visual inputs became less asymmetric between the eyes, and (5) saccades resulted in a phase shift of the nystagmus. From these results, we propose that the difference in the visual inputs between the eyes is responsible for monocular APN by disturbing visual integration and increasing instability of the feedback.