Biomedical subjects

F S Shawkat

Publications and source records attributed to F S Shawkat.

14 recordsLinked to original sources

PubMed2001

Spontaneous reversal of nystagmus in the dark.

AIM: To report five children with horizontal jerk nystagmus in whom eye movement recordings in the dark revealed a spontaneous reversal in the direction of the nystagmus beat. Three patients were blind in one eye and were diagnosed as having a manifest latent nystagmus (MLN), and two patients had strabismus and congenital nystagmus (CN). METHODS: Eye movements were recorded using DC electro-oculography with simultaneous video recording, including infrared recording in total darkness. RESULTS: Four patients had decelerating velocity slow phase jerk nystagmus when recorded under natural lighting conditions; the fifth case had accelerating velocity and linear slow phase jerk nystagmus. Under absolute darkness, nystagmus reversed in direction of beat with a mixture of linear and decelerating velocity slow phase waveforms. One child with unilateral anophthalmos could wilfully reverse the beat direction of his nystagmus by trying to look with his blind eye in the light and dark. CONCLUSIONS: These observations support the theory that LN/MLN beat direction is determined by the "presumed" viewing eye and may be consciously controlled. The spontaneous reversal of beat direction in the dark suggests eye dominance is predetermined. Eye movement recordings identified mixed nystagmus waveforms indicating that CN (accelerating velocity slow phases) and LN/MLN (linear/decelerating velocity slow phases) coexist in these subjects.

Anophthalmos↗

PubMed2000

A study of the effects of contrast change on pattern VEPS, and the transition between onset, reversal and offset modes of stimulation.

We studied the relationship between the visual evoked potential (VEP) components by tracing the transition from onset/offset mode of stimulation to the reversal mode by a series of contrast change steps. VEPs on the ipsilateral and contralateral side of the scalp with respect to the left half-field checkerboard stimulus (checksizes: 12', 50' and 80') were recorded in 15 subjects. Eight contrast steps for each checksize were recorded. Each test step consisted of the alternation of a constant high contrast checkerboard (A), with a second checkerboard (B) in which the contrast was changed. Checkerboard B was initially of identical spatial phase to A, but contrast was reduced systematically until B was a uniform grey field (i.e. onset/offset). In subsequent steps checkerboard B was of opposite spatial phase and contrast was increased until the final step when B was of equal high contrast (i.e. full reversal). All ipsilateral and contralateral onset components, ipsilateral offset components, and the reversal P100 component significantly enlarged with increasing contrast. The extent of amplitude change with contrast was greatest for offset, followed by onset and then reversal. A clear association could be discerned between all offset and reversal components. Onset CI and CII appeared to be related to the reversal P100 and N145, respectively. When small 12' checks were used, onset Co appeared to have common features with the reversal N80. The contralateral onset P105 component did not have a comparable component in the reversal mode.

Adult↗

PubMed2000

Vertical or asymmetric nystagmus need not imply neurological disease.

AIM: To indicate that congenital idiopathic nystagmus (CIN) and sensory defect nystagmus (SDN) can be vertical or asymmetric in some children. METHODS: Of 276 children presenting with nystagmus for electrophysiological testing, 14 were identified as having CIN or SDN, yet had a nystagmus which was either vertical (n=11) or horizontal asymmetric (n=3). Flash electroretinograms and flash and pattern visual evoked potentials (VEPs) were recorded in all patients. Eye movement assessment, including horizontal optokinetic nystagmus (OKN) testing, was carried out in 11/14 patients. RESULTS: Eight patients (seven with vertical, one with asymmetric horizontal nystagmus) had congenital cone dysfunction. One patient with vertical and another with asymmetric nystagmus had cone-rod dystrophy. One patient with vertical upbeat had congenital stationary night blindness. Two patients (one downbeat, one upbeat nystagmus) had normal electrophysiological, clinical, and brain magnetic resonance imaging findings and were classified as having CIN. One patient with asymmetric nystagmus showed electrophysiological and clinical findings associated with albinism. Horizontal OKN was present in 80% of patients tested, including the three cases with horizontal asymmetric nystagmus. This is atypical in both CIN and SDN, where the OKN is usually absent. CONCLUSIONS: Vertical and asymmetric nystagmus are most commonly associated with serious intracranial pathology and its presence is an indication for neuroimaging studies. However, such nystagmus can occur in children with retinal disease, albinism, and in cases with CIN. These findings stress the importance of non-invasive VEP/ERG testing in all cases of typical and also atypical nystagmus.

Child, Preschool↗

PubMed1998

Comparison of pattern-onset, -reversal and -offset VEPs in treated amblyopia.

PURPOSE: There are differences in the properties of visual evoked potentials (VEPs) to various forms of pattern stimulation and it is not clear how these differences reflect macular and parmacular function in amblyopic and normal eyes. We assessed pattern-onset, -reversal and -offset VEPs from amblyopic eyes and compared them with the responses from the fellow eyes, and from controls, to gauge the relative effectiveness of these stimulus modes. METHODS: The three modes of pattern stimulation were presented sequentially in a single recording run to enable direct comparisons to be made for identical recording conditions. Half-field stimulation was used, as this elicits components over the ipsilateral and contralateral occipital scalp relative to the stimulated half-field, which reflect stimulation of macular and paramacular areas of the visual field. Eighteen amblyopes treated by occlusion and 20 control children were studied. RESULTS: Multivariate analysis of variance showed significant differences between ambylopic and fellow eyes in amblyopes: pattern-onset components were significantly attenuated and ipsilateral reversal components were significantly prolonged in amblyopic eyes. When fellow eyes of amblyopes were compared with the eyes of controls, the reversal P100 and offset P110 and N165 components showed significant differences. CONCLUSIONS: Ipsilateral reversal components and onset CII and contralateral P105 were the most affected in amblyopic eyes. The subnormal findings for the fellow eyes of amblyopes suggest that occlusion may have a long-standing physiological effect on the patched eye, not normally clinically apparent.

Adolescent↗

PubMed1998

Familial congenital saccade initiation failure and isolated cerebellar vermis hypoplasia.

The underlying lesion in congenital saccade initiation failure (c-SIF) ('congenital ocular motor apraxia', 'Cogan's apraxia') is uncertain. Often no abnormality can be found, yet in others a midline cerebellar abnormality has often been reported. We examined this cerebellar association in a brother and sister. In addition to standard ophthalmological and neurological examinations, both siblings underwent ocular motor testing and neuroradiological investigations including CT and MRI. Both siblings exhibited the typical signs of c-SIF, including headthrusting, synkinetic blinking, missed-nystagmus quick phases, mild developmental delay, and speech difficulties. CT and MRI revealed cerebellar vermis hypoplasia in the brother, but appeared normal in the sister. No other neuroradiological abnormalities were detected. These cases highlight the wide variability in the association of vermis abnormalities with c-SIF, despite the inheritance and similar clinical manifestations. They show that either: (1) the vermis is causal in saccade triggering, but that c-SIF may result from very subtle damage that is beyond MRI resolution in some cases; or (2) that a vermis abnormality per se is not causative but only a marker of another subtle abnormality, either structural or possibly biochemical.

Apraxias↗

PubMed1998

Saccadic strategies in children with hemianopia.

Multiple hypometric (undershooting) saccades are generally reported as a compensatory strategy in adults with homonymous hemianopia. However, hypermetric (overshooting) saccades have been reported to develop spontaneously as a beneficial strategy in response to predictable targets. We examined the saccades of 10 children (aged 5 to 16 years) with homonymous hemianopia to determine the type of compensatory eye-movement strategies employed 6 months to 16 years after hemianopia onset. Homonymous hemianopia was identified using perimetry and/or pattern visual evoked potentials and supported with results of neuroimaging. Eye movements were recorded using bitemporal electrooculography. Saccades were elicited to a red light source in a semipredictable paradigm. We found that hypermetria was not a consistent compensatory strategy in our patients. In spite of the predictability of our paradigm and the long follow-up period, multiple hypometric saccades into the blind field appeared to be the preferred strategy.

Adolescent↗

PubMed1998

Sequential pattern-onset, -reversal and -offset VEPs: comparison of effects of checksize.

The effects of checksize on individual components of half-field pattern-onset, -reversal and -offset VEPs were studied by presenting these three modes of stimulation sequentially in a single recording epoch so as to provide near identical recording and subject conditions. Components on the side of the scalp ipsilateral and contralateral to the stimulated half-field were measured so as to separate the macular and paramacular contributions. Ten checksizes were used (6'-110'). MANOVA showed a significant effect of checksize: small checksizes enhanced onset ipsilateral CII and contralateral P105, as well as all ipsilateral reversal components and offset N85 component, suggesting they are reflecting macular function. Onset CI, and contralateral reversal N105 and offset N115 components increased in amplitude with increasing checksize, suggesting they are predominantly of paramacular origin. The morphology of the contralateral onset P105 component was checksize dependent: small checks (< 35') produced a sharply defined positivity (macular sub-component), whereas larger checks produced a broadened/bifid waveform, suggesting the emergence of a later paramacular sub-component.

Adult↗

PubMed1997

Interocular interaction assessed by VEPs to pattern-onset, -reversal, and -offset in normally sighted and amblyopic subjects.

The extent of interocular interaction reflected in sequentially averaged VEPs to checkerboard onset, reversal and offset stimulation was investigated to assess the relative efficacy of the three modes of pattern stimulation. Thirty-one controls and 18 amblyopic children were studied. Components on the side of the scalp ipsilateral and contralateral to the stimulated left half-field were measured for checksizes 12', 20', 50' and 80'. Binocular:monocular amplitude ratios for normals were compared with 'binocular:good eye' amplitude ratios for amblyopes. The reversal P100 ratio was found to differ significantly between normals and amblyopes for 12', 20' and 50' checks. Ipsilateral (CII) and contralateral (P105) onset components also differed significantly but for the smallest 12' checks only. In controls, onset components (P105 and CIII) and, reversal components (N80 and P100) showed significantly shorter binocular as compared with monocular latencies. These latency differences were not found in amblyopes. Our results show that interocular interaction in normals is best shown by potentials which predominantly reflect macular pathway activation, and are most conspicuous for reversal N80 and P100 components. Similarly, these components demonstrated the clearest differences when comparing binocular interaction effects between controls and amblyopic subjects.

Adolescent↗

PubMed1997

Eye movement abnormalities in a case of Tourette syndrome.

Tourette syndrome (TS) is a neuropsychiatric disorder that is characterised by the presence of multiple vocal, facial, and motor tics which change with time, and a number of other behavioural phenomena. Previous studies have not revealed any ocular-motor abnormalities. We report the eye movement studies of a patient with TS, using electrooculography and simultaneous video recording. Intrusive saccades occurred during smooth pursuit and optokinetic nystagmus. Reflexive and voluntary saccades were dysmetric and there was a complete failure of antisaccades. These abnormalities are characteristic of disease of the frontal lobes and basal ganglia. We review the literature with respect to the eye movement abnormalities associated with TS.

Adolescent↗

PubMed1996

The role of ERG/VEP and eye movement recordings in children with ocular motor apraxia.

Ocular motor apraxia (OMA) is characterised by an intermittent inability to initiate voluntary saccades, and a failure to produce optokinetic and vestibular quick phases. Some patients have no other abnormalities (idiopathic OMA), whereas in others it appears associated with a variety of neurological conditions which may affect the sensory visual pathway. Electroretinograms (ERGs), flash and pattern visual evoked potentials (VEPs) and eye movements were assessed in 53 children with OMA (age range 17 days to 14 years) to determine their efficacy in helping to distinguish between idiopathic and non-idiopathic cases. Seven patients (13.2%) had idiopathic OMA and the remaining 46 (86.8%) had other associated clinical conditions. All patients had episodes of absent quick phases ('lock up') during optokinetic nystagmus (OKN) and/or vestibular testing. Flash ERGs were abnormal in only 7 patients (13.2%); 6 had syndromes involving a pigmentary retinopathy (Joubert's, Bardet-Biedl, infantile Refsum's, Kearns-Sayre's), and the seventh had a cone dystrophy with vermis hypoplasia. VEPs were normal in all 7 patients with idiopathic OMA. Thirty-three (72%) patients with OMA in association with neurological conditions had abnormal VEPs and 13 had normal VEPs (28%). There was a significant positive correlation between VEP abnormality and poor OKN gain. VEP/ERG testing and eye movement studies are useful when OMA is suspected as they help in distinguishing isolated idiopathic cases from those with more widespread neurological abnormalities.

Adolescent↗

PubMed1995

The optokinetic response differences between congenital profound and nonprofound unilateral visual deprivation.

BACKGROUND: The occurrence of monocular naso-to-temporal optokinetic nystagmus (OKN) asymmetry, as a reflection of the immature oculomotor system in infants, and its persistence with early onset monocular visual deprivation, is well known. This asymmetry has been linked with poor binocular function and attributed to disruption of the development of binocular cortical projections to the pretectum. Optokinetic nystagmus symmetry in patients with congenital uniocular total pattern vision deprivation has not been fully investigated. METHODS: The authors compared the optokinetic responses in six children with "profound" uniocular visual deprivation, who were born with untreated conditions (microphthalmos and persistent hyperplastic primary vitreous), with ten aphakic children treated early for congenital unilateral cataracts (nonprofound unilateral visual deprivation). Eye movements were recorded using dc-electro-oculography, and OKN was elicited using a full-field patterned curtain. Flash and pattern visual-evoked responses were also measured in each subject. RESULTS: Latent nystagmus was present in six children in the nonprofound group, whereas none was detected in the profound group. All children in the nonprofound group showed statistically significant monocular naso-to-temporal asymmetry for either eye. Subjects in the profound group had symmetric OKN. CONCLUSIONS: The authors conclude that unequal input from the two eyes and interocular rivalry lead to OKN asymmetry. Their results suggest that if vision from one eye is so negligible that it does not compete with the neuroanatomic connections of the fellow eye, then the input from this eye remains undisturbed, and OKN remains symmetric.

Adolescent↗

PubMed1995

Neuroradiological and eye movement correlates in children with intermittent saccade failure: "ocular motor apraxia".

Ocular motor apraxia (OMA) is a clinical sign involving the intermittent inability to initiate saccades, and a failure of quick phases during optokinetic nystagmus (OKN) and vestibular nystagmus (VN). Some patients have no other associated abnormalities (idiopathic), whereas others have a variety of neurological conditions. We quantified the severity of the saccade failure and correlated it with neuro-radiological and other oculomotor findings in 62 children (aged 17 days - 14 years). Saccades, smooth pursuit, OKN and VN were recorded using electrooculography and the extent of "locking up" (absent quick phases during OKN and VN) was measured. Saccades were usually hypometric. Pursuit and OKN gains were normal in the majority of the idiopathic cases but were low in those with other neurological conditions. Twenty-four patients had essentially normal scans, whereas 38 had abnormal scans: Delayed myelination, cerebellar abnormalities (particularly involving the vermis), and agenesis of the corpus callosum were the most common findings. A significant positive correlation was present between increasing neuro-radiological deficits and severity of "locking up" during OKN. Principal component analysis showed that brainstem and cerebellar vermis abnormalities were the main factors involved. A pathophysiological basis of OMA is discussed in the light of animal and clinical studies.

Adolescent↗

PubMed1993

Eye movements in children with opsoclonus-polymyoclonus.

The anatomical localisation of the abnormality underlying opsoclonus-polymyoclonus-the "Dancing Eye Syndrome"-is uncertain and both the brainstem and cerebellum have been implicated. We used electrooculographic recordings to assess the eye movements in five children with this syndrome. Overshoot dysmetria was the consistent feature for the saccades of all five cases. One patient was also assessed after the main symptoms of ataxia and opsoclonus (saccadic oscillations, without an intersaccadic interval) had resolved and the saccades were found to remain hypermetric. Smooth pursuit and optokinetic nystagmus were normal, although the opsoclonus occurred throughout the recording session and were superimposed upon the normal eye movement waveforms. The vestibulo-ocular reflex was normal in four patients, but in one case, the time-constant was significantly prolonged: this has only been reported in experimental lesions of the nodulus in monkeys. The presence of saccadic overshoot dysmetria is highly suggestive of a cerebellar origin for the abnormal eye movements in these children. However, the preservation of normal smooth pursuit and the absence of gaze-paretic, rebound and downbeat nystagmus, implies the sparing of the flocculus and paraflocculus. We propose that the origin of these oculomotor deficits could be the cerebellar fastigial nuclei.

Adrenocorticotropic Hormone↗

PubMedDate not supplied

Effects of experimental scotomata on sequential pattern-onset, pattern-reversal and pattern-offset visual evoked potentials.

The effect of experimental scotomata on visual evoked potentials to half-field stimulation using sequential checkerboard onset, reversal and offset was investigated in 10 normal subjects to assess the relative sensitivity of the three stimulus modes, and the contributions of pathways subserving macular and paramacular parts of the visual field. Four scotoma sizes (0-1.5 degrees , 0 degrees - 2 degrees, 0 degrees -3 degrees and 0 degrees -4.5 degrees ) were used to mask the central part of the stimulus field (0 degrees -12 degrees ). Five check sizes (6', 12', 20', 50' and 80') were presented for each scotoma size. Peak-to-peak amplitudes and peak latencies of components on the ipsilateral and contralateral sides of the scalp to the stimulated half-field were measured. Scotoma size was highly significant in influencing component amplitude (p < 0.0001) and latency (p < 0.03) of all ipsilateral and contralateral onset components and all ipsilateral reversal and offset components. Components that were attenuated to the greatest extent with the smallest 0 degrees -1.5 degrees scotoma were the contralateral onset P105 and ipsilateral reversal P100 and N145. Onset CIII, reversal N80, and offset N85 and P110 only showed a significant attenuation after the use of scotomata of 0 degrees -3 degrees and larger. Our results show that scotoma size is a significant factor in influencing all the major visual evoked potential components, with the exception of reversal and offset contralateral potentials (N105 and N115), probably reflecting their paramacular origins. Reversal, ipsilateral P100 and N145, and onset, contralateral P105, appear to be predominantly of macular origin and the most sensitive potentials for detecting effects of small central scotomata.

Adult↗