title: Pontine-to-midbrain ratio indexes ocular-motor function and illness stage in adult Niemann-Pick disease type C.
abstract: OBJECTIVE
  Niemann-Pick disease type C (NPC) is a progressive neurovisceral disorder associated with dystonia, ataxia and a characteristic gaze palsy. Neuropathological studies have demonstrated brainstem atrophy associated with neuronal inclusions and loss, and neurofibrillary tangles, although it is not known whether this pathology can be detected in vivo or how these changes relate to illness variables, particularly ocular-motor changes. Our aim was to utilize a method for brainstem atrophy, validated in progressive supranuclear palsy (PSP), in a group of adult patients with NPC, and explore its relationship to illness variables and ocular-motor functioning.
  
  
  METHODS
  We calculated the midbrain and pontine area, and pontine-to-midbrain ratio (PMR) from midsagittal images of 10 adult patients with NPC and 27 age- and gender-matched controls. Measures were correlated with illness variables, and measures of horizontal saccadic functioning.
  
  
  RESULTS
  Pontine-to-midbrain ratio was 14% higher in the NPC group, but this difference was not significant. However, PMR showed a significant positive correlation with duration of illness and a measure of illness severity. Furthermore, PMR was significantly negatively correlated with saccadic peak velocity and gain, and self-paced saccadic performance.
  
  
  CONCLUSIONS
  Pontine-to-midbrain ratio was increased in adult patients with NPC compared to controls, although not to the same degree as previously described in PSP, which also presents with significant gaze palsy. These changes were driven predominantly by progressive midbrain atrophy. The strong correlation with illness and ocular-motor variables suggests that it may be a useful marker for illness progression in NPC.
authors.affiliation: Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne.
authors.forename: M
authors.initials: M
authors.lastname: Walterfang
authors.forename: M D
authors.initials: MD
authors.lastname: Macfarlane
authors.forename: J C L
authors.initials: JC
authors.lastname: Looi
authors.forename: L
authors.initials: L
authors.lastname: Abel
authors.forename: E
authors.initials: E
authors.lastname: Bowman
authors.forename: M C
authors.initials: MC
authors.lastname: Fahey
authors.forename: P
authors.initials: P
authors.lastname: Desmond
authors.forename: D
authors.initials: D
authors.lastname: Velakoulis
mesh_terms: D000293:Adolescent; D000328:Adult; D001933:Brain Stem / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D052556:Niemann-Pick Disease, Type C / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D012438:Saccades / Q000502:physiology*; D055815:Young Adult