An algorithm as a diagnostic tool for central ocular motor disorders, also to diagnose rare disorders.

Kraus, Ludwig; Kremmyda, Olympia; Brémovà-Ertl, Tatiana; Barceló, Sebastià; Feil, Katharina; Strupp, Michael (2019). An algorithm as a diagnostic tool for central ocular motor disorders, also to diagnose rare disorders. Orphanet journal of rare diseases, 14(1), p. 193. BioMed Central 10.1186/s13023-019-1164-8

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Recently an increasing number of digital tools to aid clinical work have been published. This study's aim was to create an algorithm which can assist physicians as a "digital expert" with the differential diagnosis of central ocular motor disorders, in particular in rare diseases.


The algorithm's input consists of a maximum of 60 neurological and oculomotor signs and symptoms. The output is a list of the most probable diagnoses out of 14 alternatives and the most likely topographical anatomical localizations out of eight alternatives. Positive points are given for disease-associated symptoms, negative points for symptoms unlikely to occur with a disease. The accuracy of the algorithm was evaluated using the two diagnoses and two brain zones with the highest scores. In a first step, a dataset of 102 patients (56 males, 48.0 ± 22 yrs) with various central ocular motor disorders and underlying diseases, with a particular focus on rare diseases, was used as the basis for developing the algorithm iteratively. In a second step, the algorithm was validated with a dataset of 104 patients (59 males, 46.0 ± 23 yrs). For 12/14 diseases, the algorithm showed a sensitivity of between 80 and 100% and the specificity of 9/14 diseases was between 82 and 95% (e.g., 100% sensitivity and 75.5% specificity for Niemann Pick type C, and 80% specificity and 91.5% sensitivity for Gaucher's disease). In terms of a topographic anatomical diagnosis, the sensitivity was between 77 and 100% for 4/8 brain zones, and the specificity of 5/8 zones ranged between 79 and 99%.


This algorithm using our knowledge of the functional anatomy of the ocular motor system and possible underlying diseases is a useful tool, in particular for the diagnosis of rare diseases associated with typical central ocular motor disorders, which are often overlooked.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Brémovà-Ertl, Tatiana


600 Technology > 610 Medicine & health




BioMed Central




Chantal Kottler

Date Deposited:

15 Nov 2019 15:12

Last Modified:

28 Nov 2020 02:30

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Algorithm Ataxia teleangiectasia Ataxia with oculomotor apraxia Gaucher’s disease type 3 Niemann pick type C Ocular motor disorder Progressive supranuclear palsy Wernicke encephalopathy




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