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Saccadic Eye Movements in Mild Traumatic Brain Injury: A Pilot Study OPEN ACCESS

Published online by Cambridge University Press:  23 September 2014

Sarah J. Mullen ,
Yeni H. Yücel ,
Michael Cusimano ,
Tom A. Schweizer ,
Anton Oentoro  and
Neeru Gupta
Sarah J. Mullen
Affiliation:
Ophthalmology & Vision Sciences, St. Michael's Hospital, Toronto, Ontario, Canada Laboratory Medicine & Pathobiology, Surgery, St. Michael's Hospital, Toronto, Ontario, Canada Division of Neurosurgery, Keenan Research Centre at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
Yeni H. Yücel*
Affiliation:
Ophthalmology & Vision Sciences, St. Michael's Hospital, Toronto, Ontario, Canada Division of Neurosurgery, Keenan Research Centre at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
Michael Cusimano
Affiliation:
Laboratory Medicine & Pathobiology, Surgery, St. Michael's Hospital, Toronto, Ontario, Canada Division of Neurosurgery, Keenan Research Centre at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
Tom A. Schweizer
Affiliation:
Laboratory Medicine & Pathobiology, Surgery, St. Michael's Hospital, Toronto, Ontario, Canada Division of Neurosurgery, Keenan Research Centre at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
Anton Oentoro
Affiliation:
Ophthalmology & Vision Sciences, St. Michael's Hospital, Toronto, Ontario, Canada Laboratory Medicine & Pathobiology, Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
Neeru Gupta
Affiliation:
Ophthalmology & Vision Sciences, St. Michael's Hospital, Toronto, Ontario, Canada Glaucoma & Nerve Protection Unit, St. Michael's Hospital, Toronto, Ontario, Canada
*
Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, 209 LKSKI, Room 409, Toronto, Ontario, M5B 1W8, Canada. Email: yucely@smh.ca.
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Abstract

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Objective:

To investigate whether repeat saccadic reaction time (SRT) measurements using a portable saccadometer is useful to monitor patients with mild traumatic brain injury (mTBI).

Methods:

Seven patients with newly-diagnosed mTBI and five agematched controls were prospectively recruited from an emergency Department. Saccadic eye movements, symptom self-reporting and neuropsychological tests were performed within one week of injury and again at follow-up three weeks post-injury. Control patients underwent saccade recordings at similar intervals.

Results:

Median saccade reaction times were significantly prolonged within one week post-injury in mTBI compared to controls. At follow-up assessment there was no significant between-groups difference. Changes in median SRT between the two assessments were not statistically significant. Four of the seven mTBI patients showed significantly increased SRT at follow-up; three of the mTBI patients and all controls showed no significant change. Among the three mTBI patients with persistent decreased SRT, two experienced loss of consciousness and reported the greatest symptoms, while the third was the only subject with significant decrease in neuropsychological testing scores at both assessments.

Conclusion:

In three of seven mTBI patients, saccadic eye movements remained delayed within three weeks post-injury. These three patients also showed persistent symptoms or no improvement on neuropsychological testing. This pilot study using a portable saccadometer suggests that comparing SRT from three weeks post-injury to that within one week of injury may be useful for early detection of a subpopulation at risk of persistent disability from mTBI. This finding suggests that further investigation in a large study population is warranted.

Résumé

RÉSUMÉ

Les saccades oculaires dans le traumatisme cérébral léger : une étude pilote.

Objectif:

Le but de l'étude était d'évaluer si les mesures répétées du temps de réaction saccadique (TRS) au moyen d'un saccadomètre portable est utile pour le suivi des patients atteints d'un traumatisme cérébral léger (TCL).

Méthode:

Sept patients chez qui un diagnostic de TCL venait d'être posé et 5 sujets témoins appariés pour l'âge ont été recrutés prospectivement au département des urgences. Les saccades oculaires, les symptômes rapportés par le patient et les tests neuropsychologiques ont été documentés dans la semaine suivant le traumatisme et de nouveau au moment du suivi, 3 semaines après le traumatisme. L'enregistrement des saccades chez les patients témoins a été fait aux mêmes intervalles.

Résultats:

Les temps médians de réaction saccadique étaient prolongés significativement au cours de la semaine suivant le traumatisme chez les patients ayant subi un TCL par rapport aux témoins. Au moment de l'évaluation de suivi, il n'existait pas de différence significative entre les deux groupes de patients. Les changements dans le TRS médian entre les deux évaluations n'étaient pas significatifs au point de vue statistique. Quatre des 7 patients atteints d'un TCL avaient un TRS augmenté de façon significative au moment du suivi ; aucun changement n'a été observé chez 3 des patients atteints d'un TCL et chez les témoins. Parmi les trois patients atteints d'un TCL qui ont présenté une diminution persistante du TRS, 2 avaient eu une perte de conscience et rapporté les symptômes les plus sévères, alors que le troisième était le seul chez qui une diminution significative des scores aux tests neuropsychologiques lors des deux évaluations avait été notée.

Conclusion:

Chez 3 des 7 patients ayant subi un TCL le retard des saccades oculaires persistait 3 semaines après le traumatisme. Ces 3 patients présentaient également des symptômes persistants ou aucune amélioration lors des tests neuropsychologiques. Cette étude pilote effectuée au moyen d'un saccadomètre portable suggère que la comparaison du TRS evalué 3 semaines après le traumatisme à celui fait dans la semaine suivant le traumatisme pourrait être utile pour détecter précocement la sous-population de patients à risque d'invalidité persistante suite à un TCL. Selon nos observations, il serait justifié de procéder à des recherches sur un échantillon de patients plus considérable.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 1 , January 2014 , pp. 58 - 65
Copyright
Copyright © The Canadian Journal of Neurological 2014

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