By Marcello Cherchi, MD PhD
For clinicians
Dr. Gustav Alexander (Vienna 1873, Vienna 1932) was an otologic surgeon who worked at the Politzer Clinic from 1900 to 1907, and then in the Department of Otology at the Vienna Policlinic until his death. He was killed on April 12, 1932, by a former patient (Goldstein 1932), who had also made a previous attempt on his life (in 1910).
Alexander observed (Alexander 1912) that in patients with spontaneous nystagmus from a peripheral vestibular lesion, the slow-phase velocity of the baseline spontaneous nystagmus increases as gaze moves in the direction of the fast phase, and decreases as gaze moves in the direction of the slow phase (Jeffcoat et al. 2008).
This observation became known as Alexander’s law, and the underlying mechanisms have been a matter of debate (Doslak, Dell’Osso, Daroff 1979, 1982; Jeffcoat et al. 2008; Robinson et al. 1984). Jeffcoat and colleagues (Jeffcoat et al. 2008), using warm and cool water irrigation, provided experimental evidence in support of the hypothesis proposed by Robinson and colleagues (Robinson et al. 1984), namely that the pattern of nystagmus captured by Alexander’s law is the composite result of (1) the direct response of the vestibulo-ocular reflex pathways to the unbalanced canal input which is independent of gaze, and (2) gaze-evoked nystagmus from the effect of unilateral peripheral inhibition on the velocity-to-position neural integrator, which is dependent on gaze.
References
Alexander G (1912) Die Ohrenkrankheiten im Kindesalter [Ear diseases in childhood]. In: Pfaundler M, Schlossman A (eds) Handbuch der Kinderheilkunde [Handbook of Pediatrics]. Vogel, Leipzig, pp 84-96
Doslak MJ, Dell’Osso LF, Daroff RB (1979) A model of Alexander’s law of vestibular nystagmus. Biol Cybern 34: 181-6. doi: 10.1007/BF00336969
Doslak MJ, Dell’Osso LF, Daroff RB (1982) Alexander’s law: a model and resulting study. Ann Otol Rhinol Laryngol 91: 316-22. doi: 10.1177/000348948209100318
Goldstein MA (1932) Gustav Alexander. The Laryngoscope 42: 404-409. doi: https://doi.org/10.1288/00005537-193205000-00013
Jeffcoat B, Shelukhin A, Fong A, Mustain W, Zhou W (2008) Alexander’s Law revisited. J Neurophysiol 100: 154-9. doi: 10.1152/jn.00055.2008
Robinson DA, Zee DS, Hain TC, Holmes A, Rosenberg LF (1984) Alexander’s law: its behavior and origin in the human vestibulo-ocular reflex. Ann Neurol 16: 714-22. doi: 10.1002/ana.410160614
