Comparison of smooth pursuit and combined eye-head tracking in human subjects with deficient labyrinthine function.

The effects of deficient labyrinthine function on smooth visual tracking with the eyes and head were investigated in ten patients with bilateral peripheral vestibular disease. Ten normal subjects served as controls. In the patients active, combined eye-head tracking (EHT) was significantly better than smooth pursuit (SP) with the eyes alone with a target frequency of 1.0 Hz. Normal subjects pursued equally well with SP and with active EHT. The gain of compensatory eye movements during active head rotation in darkness was also measured. Compensatory eye movements in labyrinthine-deficient patients (attributable to residual vestibulo-ocular reflex (VOR), cervico-ocular reflex (COR) and pre-programmed eye movements) were always less than in normal subjects. These data were used to examine current hypotheses that postulate central cancellation of the VOR (or compensatory eye movements) during EHT. A model that proposes summation of an internal smooth pursuit command and VOR/compensatory eye movements accounted for the findings in normal subjects and labyrinthine-deficient patients. In seven labyrinthine-deficient patients and nine normal subjects, passive EHT was measured during en bloc rotation while they viewed a head-fixed target. With a target frequency of 1.0 Hz, both subjects and patients showed significantly better tracking during passive EHT than during SP. Normal subjects also showed superior tracking during passive EHT compared with active EHT. These findings support the notion that during passive EHT, parametric gain changes contribute to modulation of the VOR.