Walsh & Hoyt: Ocular Motor Apraxia

Ocular motor apraxia is characterized by an impaired ability to generate saccades on command. Congenital ocular motor apraxia was first described by Cogan in 1965. An abnormality in eye movements may be recognized shortly after birth, when the child does not appear to fixate upon objects normally and may appear blind. Some children with congenital ocular motor apraxia are said to have a transient head and limb tremor in the first few days of life. Between ages 4 and 6 months, characteristic thrusting horizontal head movements develop, sometimes with prominent blinking or even rubbing of the eyelids, when the child attempts to change fixation. In children with poor head control, development of head thrusting may be delayed or absent. Almost all patients also show a defect in generating quick phases of nystagmus, which can usually be appreciated at the bedside by manual spinning of the patient, either when holding the child out at arms length or by rotating the child on a swivel chair (if necessary sitting in an adults lap). Despite difficulties in shifting horizontal gaze, vertical voluntary eye movements are normal.