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Scale for Ocular Motor Disorders in Ataxia (SODA) in Patients with Multiple System Atrophy

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Abstract

A clinical scale fully dedicated to evaluating ocular motor abnormalities is required for now. We investigated the utility of a recently developed Scale for Ocular motor Disorders in Ataxia (SODA) in patients with multiple system atrophy (MSA). We prospectively assessed SODA in consecutive patients with MSA between August 2021 and August 2023 at the Korea University Medical Center. The results of the clinical exam-based SODA were compared with those measured using video-oculography (VOG-guided SODA). We also compared the findings with other established clinical scales targeting patients with MSA, including the Unified Multiple System Atrophy Rating Scale (UMSARS) I-II, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale motor part (UPDRS-III), Scale for Assessment of Rating of Ataxia (SARA), Composite Autonomic Symptom Score-31 (COMPASS-31), and Composite Autonomic Severity Score (CASS). Twenty patients were enrolled in our study (17 with cerebellar-type MSA and three with Parkinson-type MSA). Scores ranged from 1 to 14 (median [interquartile range (IQR)] = 8 [5−10]). Among the subscales, saccades had a median score of 2.5 (IQR = 1–3), followed by ocular pursuit (1 [0–1]), nystagmus (1 [0–2]), saccadic intrusions (1 [0–1]), vestibulo-ocular reflex (VOR) (0.5 [0–1]), ocular alignment (0 [0–1]), and VOR cancellation (1 [0–1]). The clinical-exam-based SODA (p = 0.020) and VOG-guided SODA (p = 0.034) positively correlated with disease duration. No correlation was found between clinical exam-based SODA and other scales. Skew deviation, gaze-evoked nystagmus, VOR cancellation, and smooth pursuit had the highest precision among the items. Ocular misalignment and spontaneous and positional nystagmus were frequently false positive and were poorly detected with clinical exam-based SODA. Six patients with repeated evaluation exhibited higher scores, along with deterioration documented on other clinical scales. The SODA can reliably predict neurodegeneration as an additional clinical surrogate in MSA.

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Funding

This study was supported by the Basic Research Program through the National Research Foundation of Korea (NRF), funded by the MSIT (2022R1A4A1018869).

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Authors and Affiliations

  1. Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea

    Hojin Yoon, Sun-Uk Lee, Chan-Nyoung Lee, Byung-Jo Kim & Kun-Woo Park

  2. Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea

    Hanim Kwon

  3. Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea

    Sun-Uk Lee & Euyhyun Park

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea

    Euyhyun Park

  5. BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea

    Byung-Jo Kim

  6. Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea

    Ji-Soo Kim

  7. Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea

    Ji-Soo Kim

Authors
  1. Hojin Yoon
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  2. Hanim Kwon
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  7. Ji-Soo Kim
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Contributions

Dr. H. Yoon analyzed and interpreted the data and wrote the manuscript.Drs. H. Kwon, E. Park, C.N. Lee, B.J. Kim, J.S. Kim, and K.W. Park analyzed and interpreted the data, and revised the manuscript.Dr. S.U. Lee designed and conceptualized the study, interpreted the data, and revised the manuscript.

Corresponding author

Correspondence to Sun-Uk Lee.

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Ethical Approval

This study followed the tenets of the Declaration of Helsinki and was performed according to the guidelines of the Institutional Review Board of Korea University Anam Hospital (2021AN0173).

Competing Interests

Drs. H. Yoon, H. Kwon, E. Park, S.U. Lee, C.N. Lee, and K.W. Park report no disclosures. BJ Kim serves as an Editor-in-Chief of the Journal of Clinical Neurology. JS Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, Medicine, and Clinical and Translational Neuroscience.

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Yoon, H., Kwon, H., Lee, SU. et al. Scale for Ocular Motor Disorders in Ataxia (SODA) in Patients with Multiple System Atrophy. Cerebellum (2023). https://doi.org/10.1007/s12311-023-01653-y

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