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Factors influencing clinical outcome in vestibular neuritis - A focussed review and reanalysis of prospective data. J Neurol Sci 2023; 446:120579. [PMID: 36807973 DOI: 10.1016/j.jns.2023.120579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/22/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Following vestibular neuritis (VN), long term prognosis is not dependent on the magnitude of the residual peripheral function as measured with either caloric or the video head-impulse test. Rather, recovery is determined by a combination of visuo-vestibular (visual dependence), psychological (anxiety) and vestibular perceptual factors. Our recent research in healthy individuals has also revealed a strong association between the degree of lateralisation of vestibulo-cortical processing and gating of vestibular signals, anxiety and visual dependence. In the context of several functional brain changes occurring in the interaction between visual, vestibular and emotional cortices, which underpin the aforementioned psycho-physiological features in patients with VN, we re-examined our previously published findings focusing on additional factors impacting long term clinical outcome and function. These included: (i) the role of concomitant neuro-otological dysfunction (i.e. migraine and benign paroxysmal positional vertigo (BPPV)) and (ii) the degree to which brain lateralisation of vestibulo-cortical processing influences gating of vestibular function in the acute stage. We found that migraine and BPPV interfere with symptomatic recovery following VN. That is, dizziness handicap at short-term recovery stage was significantly predicted by migraine (r = 0.523, n = 28, p = .002), BPPV (r = 0.658, n = 31, p < .001) and acute visual dependency (r = 0.504, n = 28, p = .003). Moreover, dizziness handicap in the long-term recovery stage continued to be predicted by migraine (r = 0.640, n = 22, p = .001), BPPV (r = 0.626, n = 24, p = .001) and acute visual dependency (r = 0.667, n = 22, p < .001). Furthermore, surrogate measures of vestibulo-cortical lateralisation were predictive of the amount of cortical suppression exerted over vestibular thresholds. That is, in right-sided VN patients, we observed a positive correlation between visual dependence and acute ipsilesional oculomotor thresholds (R2 0.497; p < .001), but not contralateral thresholds (R2 0.017: p > .05). In left-sided VN patients, we observed a negative correlation between visual dependence and ipsilesional oculomotor thresholds (R2 0.459; p < .001), but not for contralateral thresholds (R2 0.013; p > .05). To surmise, our findings illustrate that in VN, neuro-otological co-morbidities retard recovery, and that measures of the peripheral vestibular system are an aggregate of residual function and cortically mediated gating of vestibular input.
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Diaz-Artiles A, Karmali F. Vestibular Precision at the Level of Perception, Eye Movements, Posture, and Neurons. Neuroscience 2021; 468:282-320. [PMID: 34087393 DOI: 10.1016/j.neuroscience.2021.05.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022]
Abstract
Precision and accuracy are two fundamental properties of any system, including the nervous system. Reduced precision (i.e., imprecision) results from the presence of neural noise at each level of sensory, motor, and perceptual processing. This review has three objectives: (1) to show the importance of studying vestibular precision, and specifically that studying accuracy without studying precision ignores fundamental aspects of the vestibular system; (2) to synthesize key hypotheses about precision in vestibular perception, the vestibulo-ocular reflex, posture, and neurons; and (3) to show that groups of studies that are thoughts to be distinct (e.g., perceptual thresholds, subjective visual vertical variability, neuronal variability) are actually "two sides of the same coin" - because the methods used allow results to be related to the standard deviation of a Gaussian distribution describing the underlying neural noise. Vestibular precision varies with age, stimulus amplitude, stimulus frequency, body orientation, motion direction, pathology, medication, and electrical/mechanical vestibular stimulation, but does not vary with sex. The brain optimizes precision during integration of vestibular cues with visual, auditory, and/or somatosensory cues. Since a common concern with precision metrics is time required for testing, we describe approaches to optimize data collection and provide evidence that fatigue and session effects are minimal. Finally, we summarize how precision is an individual trait that is correlated with clinical outcomes in patients as well as with performance in functional tasks like balance. These findings highlight the importance of studying vestibular precision and accuracy, and that knowledge gaps remain.
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Affiliation(s)
- Ana Diaz-Artiles
- Bioastronautics and Human Performance Laboratory, Department of Aerospace Engineering, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843-3141, USA. https://bhp.engr.tamu.edu
| | - Faisal Karmali
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston MA, USA.
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Bednarczuk NF, Bonsu A, Ortega MC, Fluri AS, Chan J, Rust H, de Melo F, Sharif M, Seemungal BM, Golding JF, Kaski D, Bronstein AM, Arshad Q. Abnormal visuo-vestibular interactions in vestibular migraine: a cross sectional study. Brain 2020; 142:606-616. [PMID: 30759189 PMCID: PMC6391603 DOI: 10.1093/brain/awy355] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/11/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022] Open
Abstract
Vestibular migraine is among the commonest causes of episodic vertigo. Chronically, patients with vestibular migraine develop abnormal responsiveness to both vestibular and visual stimuli characterized by heightened self-motion sensitivity and visually-induced dizziness. Yet, the neural mechanisms mediating such symptoms remain unknown. We postulate that such symptoms are attributable to impaired visuo-vestibular cortical interactions, which in turn disrupts normal vestibular function. To assess this, we investigated whether prolonged, full-field visual motion exposure, which has been previously shown to modulate visual cortical excitability in both healthy individuals and avestibular patients, could disrupt vestibular ocular reflex and vestibular-perceptual thresholds of self-motion during rotations. Our findings reveal that vestibular migraine patients exhibited abnormally elevated reflexive and perceptual vestibular thresholds at baseline. Following visual motion exposure, both reflex and perceptual thresholds were significantly further increased in vestibular migraine patients relative to healthy controls, migraineurs without vestibular symptoms and patients with episodic vertigo due to a peripheral inner-ear disorder. Our results provide support for the notion of altered visuo-vestibular cortical interactions in vestibular migraine, as evidenced by vestibular threshold elevation following visual motion exposure.
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Affiliation(s)
- Nadja F Bednarczuk
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
| | - Angela Bonsu
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
| | - Marta Casanovas Ortega
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
| | - Anne-Sophie Fluri
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
| | - John Chan
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
| | - Heiko Rust
- Department of Neurology, University Hospital Basel, Petersgraben 4, Basel, Switzerland
| | - Fabiano de Melo
- Department of Neurology, Hospital das Clinicas da Faculdade de Medicina de Rebeirao Preto-USP, Campus Universitario s/n Riberao Preto, Sao Paulo, Brazil
| | - Mishaal Sharif
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
| | - Barry M Seemungal
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
| | - John F Golding
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK.,Department of Psychology, School of Social Sciences, University of Westminster, 115 New Cavendish Street, London, UK
| | - Diego Kaski
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK.,Department of Neuro-otology, Royal National Throat Nose and Ear Hospital, University College London, London, UK
| | - Adolfo M Bronstein
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
| | - Qadeer Arshad
- Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, UK
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Kaski D, Rust HM, Ibitoye R, Arshad Q, Allum JHJ, Bronstein AM. Theoretical framework for "unexplained" dizziness in the elderly: The role of small vessel disease. PROGRESS IN BRAIN RESEARCH 2019; 248:225-240. [PMID: 31239134 DOI: 10.1016/bs.pbr.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this paper we postulate that disruption of connectivity in the human brain can lead to dizziness, a symptom normally associated with focal disease of the vestibular system. The specific case that we will examine is the development of "unexplained" dizziness in the elderly-an extremely common clinical problem. Magnetic resonance imaging of the brain in the elderly usually show variable degrees of multifocal micro-angiopathy (small vessel white matter disease, SVD); thus, we review the literature, present a conceptual model and report preliminary quantitative EEG data in support of the hypothesis that such hemispheric SVD leads to central nervous system disconnection that elderly patients report as dizziness. Loss of connectivity by age-related build-up of SVD could lead to dizzy feelings through one or more of the following mechanisms: disconnection of cortical vestibular centers, disconnection between frontal gait centers and the basal ganglia, and disconnection between intended motor action (efference copy) and sensory re-afference. Finally, we propose that SVD-mediated dysregulation of cerebral blood pressure is linked to dizziness during standing and walking in elderly patients with "unexplained" dizziness.
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Affiliation(s)
- Diego Kaski
- Department of Clinical and motor neurosciences, University College London, London, United Kingdom; Division of Brain Sciences, Charing Cross Hospital, London, United Kingdom.
| | - Heiko M Rust
- Division of Brain Sciences, Charing Cross Hospital, London, United Kingdom
| | - Richard Ibitoye
- Division of Brain Sciences, Charing Cross Hospital, London, United Kingdom
| | - Qadeer Arshad
- Division of Brain Sciences, Charing Cross Hospital, London, United Kingdom
| | - John H J Allum
- Department of Otorhinolaryngology, University of Basel Hospital, Basel, Switzerland
| | - Adolfo M Bronstein
- Division of Brain Sciences, Charing Cross Hospital, London, United Kingdom
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Arshad Q, Ortega MC, Goga U, Lobo R, Siddiqui S, Mediratta S, Bednarczuk NF, Kaski D, Bronstein AM. Interhemispheric control of sensory cue integration and self-motion perception. Neuroscience 2019; 408:378-387. [PMID: 31026563 DOI: 10.1016/j.neuroscience.2019.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
Spatial orientation necessitates the integration of visual and vestibular sensory cues, in-turn facilitating self-motion perception. However, the neural mechanisms underpinning sensory integration remain unknown. Recently we have illustrated that spatial orientation and vestibular thresholds are influenced by interhemispheric asymmetries associated with the posterior parietal cortices (PPC) that predominantly house the vestibulo-cortical network. Given that sensory integration is a prerequisite to both spatial orientation and motion perception, we hypothesized that sensory integration is similarly subject to interhemispheric influences. Accordingly, we explored the relationship between vestibulo-cortical dominance - assessed using a biomarker, the degree of vestibular-nystagmus suppression following transcranial direct current stimulation over the PPC - with visual dependence measures obtained during performance of a sensory integration task (the rod-and-disk task). We observed that the degree of visual dependence was correlated with vestibulo-cortical dominance. Specifically, individuals with greater right hemispheric vestibulo-cortical dominance had reduced visual dependence. We proceeded to assess the significance of such dominance on behavior by correlating measures of visual dependence with self-motion perception in healthy subjects. We observed that right-handed individuals experienced illusionary self-motion (vection) quicker than left-handers and that the degree of vestibular cortical dominance was correlated with the time taken to experience vection, only during conditions that induced interhemispheric conflict. To conclude, we demonstrate that interhemispheric asymmetries associated with vestibulo-cortical processing in the PPC functionally and mechanistically link sensory integration and self-motion perception, facilitating spatial orientation. Our findings highlight the importance of dynamic interhemispheric competition upon control of vestibular behavior in humans.
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Affiliation(s)
- Qadeer Arshad
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK; Department of Neuroscience, Psychology and Behaviour, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Marta Casanovas Ortega
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Usman Goga
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Rhannon Lobo
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Shuaib Siddiqui
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Saniya Mediratta
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Nadja F Bednarczuk
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Diego Kaski
- Department of Neuro-otology, Royal National Throat Nose and Ear Hospital, University College London, London, WC1X 8DA, UK
| | - Adolfo M Bronstein
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
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Britton Z, Arshad Q. Vestibular and Multi-Sensory Influences Upon Self-Motion Perception and the Consequences for Human Behavior. Front Neurol 2019; 10:63. [PMID: 30899238 PMCID: PMC6416181 DOI: 10.3389/fneur.2019.00063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/17/2019] [Indexed: 11/16/2022] Open
Abstract
In this manuscript, we comprehensively review both the human and animal literature regarding vestibular and multi-sensory contributions to self-motion perception. This covers the anatomical basis and how and where the signals are processed at all levels from the peripheral vestibular system to the brainstem and cerebellum and finally to the cortex. Further, we consider how and where these vestibular signals are integrated with other sensory cues to facilitate self-motion perception. We conclude by demonstrating the wide-ranging influences of the vestibular system and self-motion perception upon behavior, namely eye movement, postural control, and spatial awareness as well as new discoveries that such perception can impact upon numerical cognition, human affect, and bodily self-consciousness.
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Affiliation(s)
- Zelie Britton
- Department of Neuro-Otology, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Qadeer Arshad
- Department of Neuro-Otology, Charing Cross Hospital, Imperial College London, London, United Kingdom
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Castro P, Kaski D, Schieppati M, Furman M, Arshad Q, Bronstein A. Subjective stability perception is related to postural anxiety in older subjects. Gait Posture 2019; 68:538-544. [PMID: 30634135 DOI: 10.1016/j.gaitpost.2018.12.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/18/2018] [Accepted: 12/31/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Under static conditions, the objective and subjective measures of postural stability correlate well. However, age-related changes in postural control and task-related anxiety may modify the relationship between these subjective and objective measures. Ultimately, patients' symptoms represent subjective reports, thus understanding this relationship has clinical implications. AIMS This study investigates the relationship between subjective-objective measures of postural stability in dynamic conditions and whether this relationship is influenced by age or task-related anxiety. METHODS 50 healthy participants (aged 18-83 years) stood on a platform oscillating at variable amplitudes, with-without a fall-preventing harness to modulate task-related anxiety. Trunk sway path, hip velocity and foot lifts (objective measures) and subjective scores of instability and task-related anxiety were recorded. RESULTS The subjective perception of stability accurately matched objective body sway, following a logarithmic function profile (r2 = 0.72, p < 0.001). This function did not change significantly with age, harness or task presentation order. A strong relationship was observed between subjective measures of stability and task-related anxiety for all subjects (r = 0.81, p < 0.001). Task repetition reduced anxiety in the young, uncoupling anxiety changes from subjective instability, but not in the elderly who retained higher anxiety levels in line with subjective unsteadiness. DISCUSSION Subjects accurately rate their own instability during dynamic postural challenges, irrespective of age and actual fall risk. However, anxiety may selectively modulate the perception of instability in older subjects. The perception of stability relies upon the integration of sensory afferents but also recruits emotional-cognitive processes, particularly in older individuals. The use of a safety harness has no influence on subjective or objective postural stability.
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Affiliation(s)
- Patricia Castro
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK; Escuela de Fonoaudiologia, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Diego Kaski
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Marco Schieppati
- Department of Exercise & Sport Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
| | - Michael Furman
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Qadeer Arshad
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Adolfo Bronstein
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK.
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Bednarczuk NF, Casanovas Ortega M, Fluri AS, Arshad Q. Vestibulo-cortical hemispheric dominance: The link between anxiety and the vestibular system? Eur J Neurosci 2018; 47:1517-1524. [PMID: 29768682 PMCID: PMC6099323 DOI: 10.1111/ejn.13948] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 03/09/2018] [Accepted: 04/04/2018] [Indexed: 11/29/2022]
Abstract
Vestibular processing and anxiety networks are functionally intertwined, as demonstrated by reports of reciprocal influences upon each other. Yet whether there is an underlying link between these two systems remains unknown. Previous findings have highlighted the involvement of hemispheric lateralisation in processing of both anxiety and vestibular signals. Accordingly, we explored the interaction between vestibular cortical processing and anxiety by assessing the relationship between anxiety levels and the degree of hemispheric lateralisation of vestibulo-cortical processing in 64 right-handed, healthy individuals. Vestibulo-cortical hemispheric lateralisation was determined by gaging the degree of caloric-induced nystagmus suppression following modulation of cortical excitability using trans-cranial direct current stimulation targeted over the posterior parietal cortex, an area implicated in the processing of vestibular signals. The degree of nystagmus suppression yields an objective biomarker, allowing the quantification of the degree of right vestibulo-cortical hemisphere dominance. Anxiety levels were quantified using the Trait component of the Spielberger State-Trait Anxiety Questionnaire. Our findings demonstrate that the degree of an individual's vestibulo-cortical hemispheric dominance correlates with their anxiety levels. That is, those individuals with greater right hemispheric vestibulo-cortical dominance exhibited lower levels of anxiety. By extension, our results support the notion that hemispheric lateralisation determines an individual's emotional processing, thereby linking cortical circuits involved in processing anxiety and vestibular signals, respectively.
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Affiliation(s)
- Nadja F Bednarczuk
- Division of Brain Sciences, Academic Department of Neuro-Otology, Department of Medicine, Imperial College London, London, UK
| | - Marta Casanovas Ortega
- Division of Brain Sciences, Academic Department of Neuro-Otology, Department of Medicine, Imperial College London, London, UK
| | - Anne-Sophie Fluri
- Division of Brain Sciences, Academic Department of Neuro-Otology, Department of Medicine, Imperial College London, London, UK
| | - Qadeer Arshad
- Division of Brain Sciences, Academic Department of Neuro-Otology, Department of Medicine, Imperial College London, London, UK
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