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Neurology. 2008 Mar 4;70(10):802-9. doi: 10.1212/01.wnl.0000304134.33380.1e. Epub 2008 Jan 16.

Why do patients with PSP fall? Evidence for abnormal otolith responses.

Author information

1
Neurology Service and Daroff-Dell'Osso Laboratory, Veterans Affairs Medical Center and University Hospitals, Case Western Reserve University, Cleveland, OH, USA.

Abstract

BACKGROUND:

Patients with progressive supranuclear palsy (PSP) fall frequently, beginning early in the course of their disease. Abnormal vestibulospinal reflexes are suspected, but the angular vestibulo-ocular reflex, which is mediated by the labyrinthine semicircular canals, survives late into the course of the disease.

OBJECTIVE:

To test the hypothesis that otolithic-mediated reflexes are abnormal in PSP.

METHODS:

We tested otolith-ocular reflexes (the translational vestibulo-ocular reflex [tVOR]) during combined rotation-translation in nine patients with PSP and nine age-matched control subjects; subjects viewed far and near targets. We also tested click-induced otolith-spinal reflexes (vestibular-evoked myogenic potentials [VEMPs]) in 10 patients with PSP and 30 age-matched controls.

RESULTS:

All patients with PSP had small tVOR responses during near viewing that were, on average, only 12% of those of control subjects (p = 0.001). Patients with PSP also showed a reduction of the amplitude of VEMPs compared to control subjects (median [range]: 54.3 [16.8 to 214] vs 149 [11.6 to 466], p = 0.001).

CONCLUSIONS:

Taken together, these results indicate that abnormal otolith-mediated reflexes may be at least partly responsible for frequent falls in progressive supranuclear palsy, and deserve further study.

[Indexed for MEDLINE]

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