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1502887 
Journal Article 
Central Ocular Motor Disorders and Nystagmus: Diagnosis and Current Treatment 
Strupp, M; Kremmyda, O; Sandmann, R; Frenzel, C; Huefner, K; Brandt, T 
2010 
Yes 
Aktuelle Neurologie
ISSN: 0302-4350 
37 
10 
493-500 
WOS:000288346000002 
In many neurological, ENT, and ophthalmological diseases
there are often disorders of the ocular motor system or a fixation, spontaneous or positional
nystagmus. The key to the diagnosis of ocular motor disorders and nystagmus is a systematic
clinical investigation of the different eye movements (pursuit, saccades, fixation, convergence,
optokinetic reflex, vestibuloocular reflex), gaze holding function as well as the various forms
of nystagmus. Due to our precise knowledge about the anatomy, physiology and pathophysiology of
ocular movements no other motor system has been so thoroughly investigated it is from the type of
the ocular motor disorder possible in most cases to make a topographic-anatomic diagnosis in the
region of the brainstem and cerebellum. Clinically important examples of ocular motor disorders
that allow an anatomic classification are as follows. Isolated disorders of vertical saccades
indicate a mesencephalic lesion (rostral interstitial nucleus of the medial longitudinal
fasciculus, riMLF), isolated disorders of horizontal saccades suggest a pontine lesion
(paramedian pontine reticular formation, PPRF). A purely vertical gaze palsy is suggestive of a
mesencephalic lesion (interstitial nucleus of Cajal, INC), a purely horizontal one for a ponto-
medullary lesion (nucleus prepositus hypoglossi, vestibular cerebellum and! or vestibular
nuclei). On the other hand an all-sided gaze-evoked nystagmus or an all-sided saccadic smooth
pursuit can have various causes such as, e.g., alcohol or substance abuse; both are also
frequently found in cases of cerebellar, mostly neurodegenerative diseases. The most frequent
nystagmus forms are downbeat and upbeat nystagmus. Downbeat nystagmus is mostly due to a
bilateral lesion of the flocculus. Downbeat nystagmus can be successfully treated with
aminopyridines as a novel treatment principle. 
ocular motor disorders; nystagmus; smooth pursuit; gaze palsy; vertigo