IntroductionAlthough restriction of vertical ocular range of motion is known to be the hallmark of progressive supranuclear palsy (PSP), the maximal amplitude of ocular movement has not been quantitatively assessed despite of accumulating evidences of oculomotor dysfunction in Parkinson's disease (PD). Here, we evaluated the maximal oculomotor range and its response to levodopa in PD, and compare findings to atypical parkinsonism.MethodsWe recruited 159 healthy controls (HC) as well as 154 PD, 30 PSP, and 16 multiple system atrophy (MSA) patients. Oculomotor range was assessed using a kinetic perimeter-adapted device for the vertical and horizontal axes (four positions). Parameters were reassessed after levodopa challenge and compared among PD, PSP, and MSA patients.ResultsMaximum oculomotor range in PD patients was reduced as compared to HC. Levodopa improved oculomotor range in all directions; corrective effects of upward range positively correlated with improvements in Unified Parkinson's Disease Rating Scale III and bradykinesia sub-scores among PD patients. Although oculomotor range was markedly restricted among PSP and MSA patients, the beneficial effects of levodopa was less pronounced. Reduced oculomotor range of motion was more significant among PSP as compared to PD or MSA patients; MSA patients did not significantly differ from PD patients. The range of upward gaze was optimally sensitive for differentiating among PD, PSP, and MSA patients.ConclusionMaximum oculomotor range was reduced among PD patients significantly improved by levodopa treatment. Variations in, as well as the positively effects of levodopa on, the range of upward gaze assist diagnostic differentiation among PD, PSP, and MSA patients.

中文翻译：

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帕金森病患者眼球运动最大范围的减少及其对急性左旋多巴挑战的反应

简介虽然已知眼球垂直运动范围受限是进行性核上性麻痹（PSP）的标志，但尽管帕金森病（PD）动眼功能障碍的证据不断增加，但眼球运动的最大幅度尚未得到定量评估。在这里，我们评估了 PD 患者的最大动眼范围及其对左旋多巴的反应，并将结果与​​非典型帕金森病进行比较。方法我们招募了 159 名健康对照 (HC) 以及 154 名 PD、30 名 PSP 和 16 名多系统萎缩 (MSA) 患者。使用动态周长适应设备的垂直轴和水平轴（四个位置）评估动眼神经范围。左旋多巴激发后重新评估参数，并在 PD、PSP 和 MSA 患者之间进行比较。结果与 HC 相比，PD 患者的最大动眼范围减小。左旋多巴改善各个方向的动眼范围；向上范围的纠正效果与帕金森病统一评定量表 III 和 PD 患者运动徐缓子评分的改善呈正相关。尽管 PSP 和 MSA 患者的动眼神经范围明显受限，但左旋多巴的有益作用不太明显。与 PD 或 MSA 患者相比，PSP 患者动眼运动范围的减少更为显着； MSA 患者与 PD 患者没有显着差异。向上凝视的范围对于区分PD、PSP和MSA患者最为敏感。结论PD患者的最大动眼范围减小，左旋多巴治疗显着改善。左旋多巴对向上凝视范围的变化以及左旋多巴的积极影响有助于 PD、PSP 和 MSA 患者的诊断区分。