{
  "abstract": "Essential tremor (ET) is increasingly recognized as a disorder involving cerebello-thalamo-cortical and autonomic processes beyond tremor itself. Oculomotor, pupillary and blink signals provide complementary physiological readouts of these distributed systems, yet they have largely been studied in isolation. Here, we used video-based eye tracking during an interleaved pro- and anti-saccade task to characterize oculomotor performance, pupil dynamics, blink behaviour and trial-by-trial cross-domain coupling in 45 ET patients and 46 controls. ET showed impaired inhibitory oculomotor control, reflected by increased direction errors, prolonged anti-saccade reaction times, extended voluntary override time and reduced generation of express saccades. Preparatory pupil dilation was attenuated and constriction timing delayed despite a preserved tonic baseline. In contrast, blink dynamics were largely preserved. Trial-by-trial pupil-saccade coupling was also largely preserved, indicating maintained cross-domain coordination despite reduced preparatory autonomic modulation. Exploratory machine-learning analyses suggested that combined pupil-saccade features may capture aspects of clinical heterogeneity, particularly early onset status, although these findings did not survive permutation testing. Together, these results indicate that ET is associated with selective impairment of inhibitory oculomotor control and preparatory autonomic responses, with preserved cross-domain coordination. Multimodal eye tracking may therefore provide a scalable, non-invasive framework for characterizing the heterogeneous physiological expression of ET.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.",
    "Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.",
    "Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.",
    "Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.",
    "Eye-Tracking Laboratory, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.",
    "College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.",
    "Health Policy Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan.",
    "Department of Anesthesiology, Wang Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.",
    "Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.",
    "Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.",
    "Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei 235, Taiwan."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Chien-Tai Hong",
      "orcid": "0000-0002-7448-1041"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Jui-Tai Chen"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Audrey Yong",
      "orcid": "0009-0000-3228-5766"
    },
    {
      "affs": [
        2,
        6,
        7
      ],
      "name": "Ta-Liang Chen",
      "orcid": "0000-0002-1156-2389"
    },
    {
      "affs": [
        8
      ],
      "name": "Kevin S Xu"
    },
    {
      "affs": [
        2,
        3,
        4,
        9,
        10
      ],
      "name": "Chin-An Wang",
      "orcid": "0000-0002-6203-7701"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0cjtfehczj380.bib",
  "cited_by": 0,
  "doi": "10.1093/braincomms/fcag389",
  "fulltext_url": "https://europepmc.org/articles/PMC13714541",
  "id": "0cjtfehczj380",
  "issns": [
    "2632-1297"
  ],
  "landing_url": "https://europepmc.org/article/MED/42953073",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00310"
    ],
    [
      "heading",
      "AcademicSubjects/SCI01870"
    ],
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2728|Neurological disorders and treatments"
    ]
  ],
  "openalex": "W7222354179",
  "pdf_url": "https://europepmc.org/articles/PMC13714541?pdf=render",
  "pmcid": "PMC13714541",
  "pmid": "42953073",
  "published": "2026-10-15",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/0cjtfehczj380.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:41Z",
      "native_id": "MED:42953073",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42953073"
    },
    {
      "first_seen": "2026-11-01T12:22:01Z",
      "native_id": "PMC13714541",
      "source": "pmc",
      "url": "https://doi.org/10.1093/braincomms/fcag389"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Neurological disorders and treatments",
      "subfield": "neurology"
    }
  ],
  "title": "Multimodal eye-tracking reveals impaired inhibitory control and reduced preparatory pupil dilation in essential tremor.",
  "title_text": "Multimodal eye-tracking reveals impaired inhibitory control and reduced preparatory pupil dilation in essential tremor.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:22:01Z",
  "url": "https://research.draconitic.com/paper/0cjtfehczj380",
  "venue": "Brain communications",
  "versions": []
}