Applicability of quantitative oculomotor and SARA assessment in children

Background: In clinical practice, eye movements can provide an early diagnostic marker for early onset ataxia (EOA). However, quantitative oculomotor assessment is not included in the most frequently used and age-validated ataxia rating scale in children, the Scale for the Assessment and Rating of Ataxia (SARA). We aimed to investigate the applicability of semi-quantitative eye movement assessment by the International Cooperative Ataxia Rating Scale (ICARSOCM) and Ocular Motion Score (OMS7-10) complementary to SARA measurements in children. Methods: In 52 typically developing children (aged 4-16 years; n = 4 per year of age), three independent assessors scored saccadic eye movements and ocular pursuit according to the ICAR(SOCM) and matching parameters from the OMS7-10. For ICAR(SOCM), we determined 1) construct validity for coordinated eye movements by correlation with OMS7-10, ICARS(EYE-HAND-COORDINATION) and SARA subscale scores, 2) agreement percentage and inter-rater agreement (Fleiss Kappa) and 3) age-dependency. Results: Spearman's rank correlations of ICARS(OCM) with OMS7-10 and ICARS-and SARA subscales were moderate to fair (all p < .001). Inter-rater agreement of ICARS-(OCM) was 80.8%; (Fleiss Kappa: 0.411). ICARS(OCM) scores revealed a similar exponentially decreasing association with age as the other SARA (sub) scores, reaching a plateau at 10 years of age. Interpretation: ICARS(OCM) has a valid construct for the measurement of coordinated eye movement performance and is reliably assessable in children. ICARS(OCM) reveals a similar age-dependent relationship as the other ataxia subscales, reflecting the physiological maturation of the cerebellum. In children, these data may implicate that ICARS(OCM) can reliably contribute to coordination assessment, complementary to the SARA subscales. (C) 2021 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society.

Automated summary

This study aimed to investigate the applicability of semi-quantitative eye movement assessment by ICARSOCM and OMS7-10 complementary to SARA measurements in children. Results showed that ICARS(OCM) has a valid construct for the measurement of coordinated eye movement performance in children and a similar age-dependent relationship as other ataxia subscales.