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Peer-reviewedCC BYEuropean journal of neurology

A Data-Driven Operational Definition of Square-Wave Jerks and Its Diagnostic Utility in Progressive Supranuclear Palsy.

  • Duy Duan Nguyen1,2,3
  • Andrea Quattrone4,5
  • Mark Paine6
  • Amir Fazlollahi1
  • Soohyun Lee1
  • Baibin Ben Wang1
  • Tanya Davidson2
  • Felicia Coleman1,2
  • John D O'Sullivan7,8
  • Peter J Nestor1,2,9
9 affiliations
  1. 1Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia.
  2. 2Cognitive Health Program, Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia.
  3. 3University of Medicine and Pharmacy, Hue University, Hue City, Vietnam.
  4. 4Neuroscience Research Centre, University Magna Graecia of Catanzaro, Catanzaro, Italy.
  5. 5Department of Medsical and Surgical Sciences, Institute of Neurology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
  6. 6Neuro-Ophthalmology and Neuro-Otology Clinic, Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
  7. 7Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
  8. 8Faculty of Medicine, Frazer Institute, The University of Queensland, Herston, Queensland, Australia.
  9. 9Department of Neurology, Mater Adult Hospital, Mater Misericordiae Limited, South Brisbane, Queensland, Australia.
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Abstract

Background

The Movement Disorder Society diagnostic criteria for progressive supranuclear palsy (PSP) list frequent square-wave jerks (SWJ) as a suggestive oculomotor feature. A standardised operational definition of SWJ is however presently lacking.Objective

To create a data-driven optimal SWJ definition and to assess its diagnostic utility in PSP.Methods

We prospectively recruited PSP n = 25, Parkinson's disease (PD) n = 32, Alzheimer's disease (AD) n = 35, and controls n = 88. SWJ were recorded with a visual fixation task using video-oculography. Multiple candidate definitions of SWJ were generated by systematically varying morphological features, producing 32 candidate definitions. A nested cross-validation was used to obtain unbiased diagnostic performance and optimised SWJ definition. Results were then externally tested in a fully independent sample of n = 25 PSP, n = 41 PD and n = 25 controls.Results

The optimal selected SWJ definition consisted of saccade amplitude 1°-8°, intra-SWJ intervals 20-600 ms, directional opposition within ±45°, and amplitude similarity ≤ 0.25. Only SWJ rate, and not morphological features, was distinctive for PSP. SWJ rate gave out-of-fold AUCs of 0.81 for PSP versus controls, 0.71 for PSP versus AD, 0.63 for PSP versus PD, and 0.76 for PSP versus all non-PSP groups. Post hoc analyses using this data-driven definition on the external validation cohort yielded relatively comparable results. SWJ rate > 24/min had high specificity, but low sensitivity, for PSP when compared with PD.Conclusions

SWJ rate was significantly increased in PSP but with insufficient discriminant ability for use as a stand-alone diagnostic marker. This data-driven definition may serve as a reproducible operational definition for future research.

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Cite

BibTeXRIS
BibTeX
@article{nguyen2026datadriven,
  title = {{A Data-Driven Operational Definition of Square-Wave Jerks and Its Diagnostic Utility in Progressive Supranuclear Palsy.}},
  author = {Duy Duan Nguyen and Andrea Quattrone and Mark Paine and Amir Fazlollahi and Soohyun Lee and Baibin Ben Wang and Tanya Davidson and Felicia Coleman and John D O'Sullivan and Peter J Nestor},
  journal = {European journal of neurology},
  year = {2026},
  month = oct,
  doi = {10.1111/ene.70790},
  url = {https://europepmc.org/article/MED/42899365},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - A Data-Driven Operational Definition of Square-Wave Jerks and Its Diagnostic Utility in Progressive Supranuclear Palsy.
AU  - Duy Duan Nguyen
AU  - Andrea Quattrone
AU  - Mark Paine
AU  - Amir Fazlollahi
AU  - Soohyun Lee
AU  - Baibin Ben Wang
AU  - Tanya Davidson
AU  - Felicia Coleman
AU  - John D O'Sullivan
AU  - Peter J Nestor
PY  - 2026
DA  - 2026/10/01
JO  - European journal of neurology
DO  - 10.1111/ene.70790
UR  - https://europepmc.org/article/MED/42899365
AB  - Background  The Movement Disorder Society diagnostic criteria for progressive supranuclear palsy (PSP) list frequent square-wave jerks (SWJ) as a suggestive oculomotor feature. A standardised operational definition of SWJ is however presently lacking.Objective  To create a data-driven optimal SWJ definition and to assess its diagnostic utility in PSP.Methods  We prospectively recruited PSP n = 25, Parkinson's disease (PD) n = 32, Alzheimer's disease (AD) n = 35, and controls n = 88. SWJ were recorded with a visual fixation task using video-oculography. Multiple candidate definitions of SWJ were generated by systematically varying morphological features, producing 32 candidate definitions. A nested cross-validation was used to obtain unbiased diagnostic performance and optimised SWJ definition. Results were then externally tested in a fully independent sample of n = 25 PSP, n = 41 PD and n = 25 controls.Results  The optimal selected SWJ definition consisted of saccade amplitude 1°-8°, intra-SWJ intervals 20-600 ms, directional opposition within ±45°, and amplitude similarity ≤ 0.25. Only SWJ rate, and not morphological features, was distinctive for PSP. SWJ rate gave out-of-fold AUCs of 0.81 for PSP versus controls, 0.71 for PSP versus AD, 0.63 for PSP versus PD, and 0.76 for PSP versus all non-PSP groups. Post hoc analyses using this data-driven definition on the external validation cohort yielded relatively comparable results. SWJ rate > 24/min had high specificity, but low sensitivity, for PSP when compared with PD.Conclusions  SWJ rate was significantly increased in PSP but with insufficient discriminant ability for use as a stand-alone diagnostic marker. This data-driven definition may serve as a reproducible operational definition for future research.
SN  - 1351-5101
SN  - 1468-1331
ER  -