Multimodal eye-tracking reveals impaired inhibitory control and reduced preparatory pupil dilation in essential tremor.
11 affiliations
- 1Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
- 2Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.
- 3Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
- 4Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.
- 5Eye-Tracking Laboratory, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan.
- 6College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
- 7Health Policy Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan.
- 8Department of Anesthesiology, Wang Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
- 9Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
- 10Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
- 11Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei 235, Taiwan.
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.
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BibTeX
@article{hong2026multimodal,
title = {{Multimodal eye-tracking reveals impaired inhibitory control and reduced preparatory pupil dilation in essential tremor.}},
author = {Chien-Tai Hong and Jui-Tai Chen and Audrey Yong and Ta-Liang Chen and Kevin S Xu and Chin-An Wang},
journal = {Brain communications},
year = {2026},
month = oct,
doi = {10.1093/braincomms/fcag389},
url = {https://europepmc.org/article/MED/42953073},
note = {CC BY},
}
RIS
TY - JOUR
TI - Multimodal eye-tracking reveals impaired inhibitory control and reduced preparatory pupil dilation in essential tremor.
AU - Chien-Tai Hong
AU - Jui-Tai Chen
AU - Audrey Yong
AU - Ta-Liang Chen
AU - Kevin S Xu
AU - Chin-An Wang
PY - 2026
DA - 2026/10/15
JO - Brain communications
DO - 10.1093/braincomms/fcag389
UR - https://europepmc.org/article/MED/42953073
AB - 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.
SN - 2632-1297
ER -