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Visual-vestibular interaction in multiple sclerosis

From the Neuro-ophthalmology Unit, Division of Neurology, the Playfair Neuroscience Unit, Toronto Western Hospital, and the Departments of Medicine and Ophthalmology, University of Toronto, Toronto, Canada.

Address correspondence and reprint requests to Dr Sharpe, Neuro-ophthalmology Unit, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8 Canada.

Visual modulation of the vestibuloocular reflex (VOR) was analyzed in 20 patients with multiple sclerosis who had no vestibular or ocular motor symptoms. Visual suppression of the VOR was impaired in 75% of patients. VOR gains in darkness were elevated in 35% of patients. Elevated VOR gain in darkness is attributed to vestibular adaptation to defective smooth pursuit. This vestibular plasticity achieved retinal image stability by matching eye velocity to head velocity when stationary targets were viewed. The high incidence of impaired visual suppression of the VOR rivals the sensitivity of other physiologic tests used to identify multiple sclerosis.

This study was supported by Medical Research Council of Canada Grants Nos ME 5509 and MA 5404 and by The Physicians' Services Incorporated Foundation of Ontario.

Accepted for publication June 16, 1980.