Gravity dependence of ocular drift in patients with cerebellar downbeat nystagmus

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Abstract
Downbeat nystagmus is a frequent ocular motor sign in patients with lesions of the vestibulocerebellum. The upward drift in downbeat nystagmus is a combination of a gaze‐evoked drift, due to an impaired vertical neural integrator, and a velocity bias. Using a three‐dimensional turntable, we analyzed the influence of gravity on these two mechanisms. Patients with cerebellar downbeat nystagmus (n = 6) and healthy subjects (n = 12) were placed in various whole‐body positions along the roll, pitch, and oblique vertical planes of the head. Ocular drift was monitored with scleral search coils. Although there was no gravity dependence of the vertical gaze‐evoked drift, the vertical velocity bias consisted of two components: a gravity‐dependent component that sinusoidally modulated as a function of body position along the pitch plane, and a gravity‐independent component that was directed upward. The combination of the two components led to an overall drift that was minimal in supine and maximal in prone position. In healthy subjects, only the gravity‐dependent component was present, but in a scaled‐down manner. Our results suggest that the intact vestibulocerebellum minimizes an overacting otolith‐ocular reflex elicited by pitch tilt and cancels an inherent upward ocular drift that is independent of gravity‐modulated otolith signals.