Using endogenous saccades to characterize fatigue in multiple sclerosis

Purpose Multiple Sclerosis (MS) is likely to cause dysfunction of neural circuits between brain regions increasing brain working load or a subjective overestimation of such working load leading to fatigue symptoms. The aim of this study was to investigate if saccades can reveal the effect of fatigue in patients with MS. Methods Patients diagnosed with MS (EDSS<=3) and age matched controls were recruited. Eye movements were monitored using an infrared eyetracker. Each participant performed 40 trials in an endogenous generated saccade paradigm (valid and invalid trials). The fatigue severity scale (FSS) was used to assess the severity of fatigue. FSS scores were used to define two subgroups, the MS fatigue group (score above normal range) and the MS non-fatigue. Differences between groups were tested using linear mixed models. Results Thirty-one MS patients and equal number of controls participated in this study. FSS scores were above the normal range in 11 patients. Differences in saccade latency were found according to group (p<0.001) and trial validity (p=0.023). Differences were 16.9 ms, between MS fatigue and MS non-fatigue, 15.5 ms between MS fatigue and control. The mean difference between valid and invalid trials was 7.5 ms. Differences in saccade peak velocity were found according to group (p<0.001), the difference between MS fatigue and control was 22.3°/s and between MS fatigue and non-fatigue was 12.3°/s. Group was a statistically significant predictor for amplitude (p<0.001). FSS scores were correlated with peak velocity (p=0.028) and amplitude (p=0.019). Conclusion Consistent with the initial hypothesis, our study revealed altered saccade latency, peak velocity and amplitude in patients with fatigue symptoms. Eye movement testing can complement the standard inventories when investigating fatigue because they do not share similar limitations. Our findings contribute to the understanding of functional changes induced by MS and might be useful for clinical trials and treatment decisions.We would like to acknowledge that part of this work has been presented at 3rd International Porto Congress of Multiple Sclerosis, February 27–28, 2015, Porto, Portugal and ECEM 2015 | XVIII. European Conference on Eye Movements, August 16–21, 2015, Viena, Austria. We thank the Multiple Sclerosis Association “Todos com a Esclerose Multiple (TEM)” and the Clinical and Academic Centre (CAA-Hospital de Braga) for their support financial support and for providing facilities for data collection, respectively. We also acknowledge: i) Carla Sofia for recruiting all the MS participants and most of the controls, ii) Two anonymous reviewers for their opinion about an early version of this manuscript and iii) Liz Pearce for proofreading the manuscript. Vision Rehabilitation Lab. receives founding from Shamir Portugal and from grant PTDC/DTP-EPI/0412/2012, Fundação para a Ciência e a Tecnologia, co-financiado pelo FEDER através do COMPETE.info:eu-repo/semantics/publishedVersio

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