ArticleAnnals of clinical and translational neurology2026
Gravity-Dependent Modulation of Downbeat Nystagmus: Insights From Velocity-Storage Dysfunction.
Article in Annals of clinical and translational neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveDownbeat nystagmus varies with head position, a phenomenon termed gravity-dependent modulation. We aimed to clarify its mechanism using a velocity-storage model.
methodsIn 10 patients with downbeat nystagmus due to cerebellar disorders, we recorded eye movements at different pitch- and roll-axis head positions. Sine-wave fitting of the nystagmus intensity as a function of head position decomposed the slow-phase velocity of nystagmus into a gravity-dependent component-the amplitude and phase shift of the sine-wave term-and a gravity-independent constant offset. To probe mechanisms, we applied a velocity-storage model simulating the estimation of rotational velocity, gravity orientation, and inertial acceleration, and incorporated a gravity-estimator lesion that produced a gravity-estimation bias.
resultsThe gravity-dependent component during pitch-axis modulation had a median amplitude of 3.8°/s (interquartile range [IQR] = 2.6) and a phase shift of 158.5° (57.9). During roll-axis modulation, it had an amplitude of 2.1°/s (1.5) and a phase shift of -0.9° (147.6), with two subgroups showing phase shifts near ±90°. The amplitude was significantly larger during pitch- than roll-axis modulation (p < 0.05). The lesion model generated persistent rotational cues that modulated downbeat nystagmus intensity as observed in the patients and additionally explained the interindividual variation in phase shifts and the weaker modulation of downbeat nystagmus during head roll.
interpretationThese findings refine our understanding of cerebellar vestibular processing and provide a computational framework for positional modulation of downbeat nystagmus. The concept of a biased gravity estimate may further account for several clinical phenomena, including atypical patterns of positional nystagmus.
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