Unique compensatory oculomotor behavior in people living with multiple sclerosis

  • Colin R. Grove
    Department of Otolaryngology-Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, Johns Hopkins University, Baltimore, MD, USA
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  • Andrew Wagner
    Otolaryngology – Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43212, USA

    School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43212, USA
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  • Brian J. Loyd
    School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA
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  • Leland E. Dibble
    Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, USA
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  • Michael C. Schubert
    Corresponding author at: Johns Hopkins University, School of Medicine, Department of Otolaryngology Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, 601 North Caroline St, Rm 6245, Baltimore, MD 21287, USA.
    Department of Otolaryngology-Head and Neck Surgery, Laboratory of Vestibular NeuroAdaptation, Johns Hopkins University, Baltimore, MD, USA

    Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
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Published:September 05, 2022DOI:


      • People living with moderate multiple sclerosis often fail to generate compensatory saccades.
      • People living with mild multiple sclerosis tend to over-compensate for gaze position error.
      • The absence of saccades to compensate for low VOR gain may suggest internuclear ophthalmoplegia.



      Globally, there are 3 million people living with multiple sclerosis (PLW-MS). A large proportion of PLW-MS have abnormal vestibular function tests that suggest central vestibular lesions. Yet, data regarding vestibular-ocular control in PLW-MS is limited. Thus, we aimed to further characterize compensatory saccade (CS) behavior in PLW-MS.


      We analyzed video head impulse data from four groups of six age- and sex-matched adults: people living with mild MS (PLW-mild-MS, people living with moderate MS (PLW-moderate-MS), people living with unilateral vestibular deafferentation (PLW-UVD), and healthy controls (HC).


      PLW-moderate-MS had lower lateral canal vestibulo-ocular reflex (VOR) gain bilaterally compared to PLW-mild MS (p < 0.001), HC (p < 0.001), and PLW-UVD (p < 0.001). CS frequency was higher for impulses towards the less affected side in PLW-moderate-MS versus the more (p = 0.01) and less (p < 0.001) affected sides in PLW-mild-MS. CS latency was shorter (p < 0.001) and CS peak velocity was lower (p < 0.001) with impulses towards the more affected side versus the less affected side in PLW-moderate-MS. However, CS peak velocity with impulses towards each side was similar in PLW-mild-MS (p = 0.12). Gaze position error (GPE) was larger after impulses towards the more affected side versus the less affected side in PLW-moderate-MS (p < 0.001) and PLW-mild-MS (p < 0.001). MS-related disability was moderately associated with VOR gain (p < 0.001) and GPE (p < 0.001). Additionally, we identified micro-saccades and position correcting saccades that were uniquely employed by PLW-MS as compensatory gaze stabilizing strategies.


      In PLW-MS, the characteristics of compensatory oculomotor behavior depend on the extent of residual VOR gain.

      Graphical abstract


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