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Thorman IB, Schrack JA, Schubert MC. Epidemiology and Comorbidities of Vestibular Disorders: Preliminary Findings of the AVOCADO Study. Otol Neurotol 2024; 45:572-579. [PMID: 38728561 DOI: 10.1097/mao.0000000000004185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Studies on incidence and prevalence of vestibular disorders tend to focus on small pockets of patients recruited from specialized clinics and often exclude measures of vestibular function. The objectives of the study were to characterize patients with common vestibular disorders, estimate the prevalence of common vestibular disorders, and ascertain whether patients with vestibular disorders experience increased risks of falls and morbidity. MATERIALS AND METHODS This retrospective cohort study includes both inpatient and outpatient routine clinical care data culled from a nationally representative, population-based sample. Patients were included if their record in the TriNetX Diamond Cohort comprised at least one vestibular function test or vestibular diagnosis. The main outcome measures were diagnosis with a vestibular disorder, a fall, or a common medical comorbidity (e.g., diabetes, cerebrovascular disease). RESULTS The cohort includes n = 4,575,724 patients, of which 55% (n = 2,497,136) had a minimum of one vestibular diagnosis. Patients with vestibular diagnoses were 61.3 ± 16.6 years old (mean ± standard deviation), 67% women, 28% White race (69% unknown race), and 30% of non-Hispanic or Latino ethnicity (66% unknown ethnicity). The prevalence of vestibular disorders was estimated at 2.98% (95% confidence interval [CI]: 2.98-2.98%). Patients with vestibular diagnoses experienced a significantly greater odds of falls (odds ratio [OR] = 1.04; 95% CI: 1.02-1.05), cerebrovascular disease (OR = 1.42; 95% CI: 1.40-1.43), ischemic heart disease (OR = 1.17; 95% CI: 1.16-1.19), and diabetes (OR = 1.14; 95% CI: 1.13-1.15), among others. DISCUSSION Vestibular disorders affect an estimated 3% of the U.S. population, after weighting. Patients with these disorders are at greater risk for many common, consequential medical conditions.
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Gui M, Lv L, Qin L, Wang C. Vestibular dysfunction in Parkinson's disease: a neglected topic. Front Neurol 2024; 15:1398764. [PMID: 38846039 PMCID: PMC11153727 DOI: 10.3389/fneur.2024.1398764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
Dizziness and postural instability are frequently observed symptoms in patient with Parkinson's disease (PD), potentially linked to vestibular dysfunction. Despite their significant impact on quality of life, these symptoms are often overlooked and undertreated in clinical practice. This review aims to summarize symptoms associated with vestibular dysfunction in patients with PD and discusses vestibular-targeted therapies for managing non-specific dizziness and related symptoms. We conducted searches in PubMed and Web of Science using keywords related to vestibular dysfunction, Parkinson's disease, dizziness, and postural instability, alongside the reference lists of relevant articles. The available evidence suggests the prevalence of vestibular dysfunction-related symptoms in patients with PD and supports the idea that vestibular-targeted therapies may be effective in improving PD symptoms.
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Affiliation(s)
- Meilin Gui
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lingling Lv
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lixia Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- China National Clinical Research Center on Mental Disorders, Changsha, China
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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Dastgheib ZA, Lithgow BJ, Moussavi ZK. Evaluating the Diagnostic Value of Electrovestibulography (EVestG) in Alzheimer's Patients with Mixed Pathology: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2091. [PMID: 38138194 PMCID: PMC10744488 DOI: 10.3390/medicina59122091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Diagnosis of dementia subtypes caused by different brain pathophysiologies, particularly Alzheimer's disease (AD) from AD mixed with levels of cerebrovascular disease (CVD) symptomology (AD-CVD), is challenging due to overlapping symptoms. In this pilot study, the potential of Electrovestibulography (EVestG) for identifying AD, AD-CVD, and healthy control populations was investigated. Materials and Methods: A novel hierarchical multiclass diagnostic algorithm based on the outcomes of its lower levels of binary classifications was developed using data of 16 patients with AD, 13 with AD-CVD, and 24 healthy age-matched controls, and then evaluated on a blind testing dataset made up of a new population of 12 patients diagnosed with AD, 9 with AD-CVD, and 8 healthy controls. Multivariate analysis was run to test the between population differences while controlling for sex and age covariates. Results: The accuracies of the multiclass diagnostic algorithm were found to be 85.7% and 79.6% for the training and blind testing datasets, respectively. While a statistically significant difference was found between the populations after accounting for sex and age, no significant effect was found for sex or age covariates. The best characteristic EVestG features were extracted from the upright sitting and supine up/down stimulus responses. Conclusions: Two EVestG movements (stimuli) and their most informative features that are best selective of the above-populations' separations were identified, and a hierarchy diagnostic algorithm was developed for three-way classification. Given that the two stimuli predominantly stimulate the otholithic organs, physiological and experimental evidence supportive of the results are presented. Disruptions of inhibition associated with GABAergic activity might be responsible for the changes in the EVestG features.
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Affiliation(s)
| | | | - Zahra K. Moussavi
- Diagnostic and Neurological Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Winnipeg, MB R3L 2P4, Canada; (Z.A.D.); (B.J.L.)
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Seyedahmadi M, Taherzadeh J, Akbari H. The Effect of 12 Weeks of Cawthorne-Cooksey Exercises on Balance and Quality of Life in Patients with Parkinson's Disease. Med J Islam Repub Iran 2023; 37:125. [PMID: 38318402 PMCID: PMC10843215 DOI: 10.47176/mjiri.37.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 02/07/2024] Open
Abstract
Background Parkinson's disease (PD) is known as the second most destructive central nervous system (CNS) disorder, which leads to movement slowness, tremors, decreased balance, instability, and CNS disorders in affected patients. This study aimed to investigate the effect of 12 weeks of Cawthorne-Cooksey exercises on the balance and the quality of life in patients with PD. Methods This was a quasi-experimental study, and the research population consisted of PD patients in Zahedan City who were present at the Zahedan Elderly Center during May, June, and July 2022. Twenty-four individuals who were 53 to 69 years old volunteered to participate in this study and were assigned to the experimental (N = 12) and control (N = 12) groups. In addition to the usual treatment, the experimental group performed Cawthorne-Cooksey exercises (CCE) exercises for 12 weeks, while the control group only received the usual treatment during this period. The CCE exercises were performed for 60-minute sessions, three days a week, for twelve weeks. The Berg Balance Scale (BBS) was used to evaluate balance, and the Parkinson's Disease Quality of Life Questionnaire (PDQL 37) was used to assess the QOL of PD. The data were analyzed using Wilcoxon and Mann-Whitney U tests. Results The Mann-Whitney U test results revealed that the experimental group exhibited significantly higher scores in all factors of QOL and balance during the post-test when compared to the control group ( P < 0.05). Moreover, the outcomes of the Wilcoxon test demonstrated significant improvements in all components of QOL and balance for the experimental group from pre-test to post-test ( P < 0.05), whereas the control group experienced a notable decline in both balance and QOL during the same period ( P < 0.05). Conclusion The study demonstrates that CCE exercises positively influence the balance and quality of life of Parkinson's disease patients, suggesting their potential as complementary therapy in the treatment of PD.
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Affiliation(s)
- Mohammad Seyedahmadi
- Department of Sport Sciences, Faculty of Humanities, Velayat University, Iranshahr, Iran
| | - Javad Taherzadeh
- Department of Sport Sciences, Naragh Branch, Islamic Azad University, Naragh, Iran
| | - Hadi Akbari
- Department of Sport Sciences, Faculty of Literature and Humanities, University of Zabol, Zabol, Iran
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Padovan L, Becker-Bense S, Flanagin VL, Strobl R, Limburg K, Lahmann C, Decker J, Dieterich M. Anxiety and physical impairment in patients with central vestibular disorders. J Neurol 2023; 270:5589-5599. [PMID: 37550497 PMCID: PMC10576724 DOI: 10.1007/s00415-023-11871-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND There is increasing evidence for close interrelations between vestibular and emotional brain networks. A study in patients with bilateral peripheral vestibulopathy (BVP) showed relatively low vertigo-related anxiety (VRA), despite high physical impairment. The current working hypothesis proposes the integrity of the peripheral vestibular system as a prerequisite for development of VRA. Here we contribute by evaluating VRA and vestibular-related handicap in central vestibular disorders. METHODS Of 6396 patients presenting in a tertiary vertigo centre, 306 were identified with four clear central vestibular disorders: pure cerebellar ocular motor disorder (COD; 61), cerebellar ataxia (CA; 63), atypical parkinsonian syndromes (APS; 28), vestibular migraine (VM; 154). Their results of the Vertigo Handicap Questionnaire (VHQ), with its subscales for anxiety and handicapped activity, were compared to those of 65 BVP patients. Postural instability was measured on a force-plate. Multivariate linear regression was used to adjust for patient demographics. RESULTS Patients with chronic central vestibular disorders (COD, CA, APS) had relatively low VRA levels comparable to those in BVP, independent of increased handicapped activity or postural instability. Only VM patients showed significantly higher VRA, although their activity impairment and postural instability were lowest. No significant differences within chronic central vestibular disorders were found for VRA and subjective activity impairment. CONCLUSIONS Subjective and objective vestibular-related impairment are not necessarily correlated with vestibular-related anxiety in central vestibular disorders. Our findings rather support the hypothesis that, in addition to an intact peripheral, an intact central vestibular system could also serve as a prerequisite to develop specific VRA.
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Affiliation(s)
- Lena Padovan
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany.
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Virginia L Flanagin
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Medical Information Processing Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karina Limburg
- Clinic for Conservative Orthopaedics, Manual Medicine and Pain Medicine, Sana Klinik München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Julian Decker
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Carvalho GF, Luedtke K, Bevilaqua-Grossi D. Balance disorders and migraine. Musculoskelet Sci Pract 2023; 66:102783. [PMID: 37263900 DOI: 10.1016/j.msksp.2023.102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Migraine is associated with motion sensitivity symptoms such as kinetosis, vestibular symptoms and balance alterations. While focus is given to headache management, addressing these symptoms is often neglected, although they are related to additional migraine burden and increased disability. PURPOSE Our aim is to disseminate the current understanding of the motion sensitivity symptoms among patients with migraine, with focus on balance impairments. We discuss the susceptibility of migraine to motion sensitivity, its suggested mechanisms, the balance alterations during quiet standing, mobility tasks and reactions to external perturbations. The role of migraine subdiagnosis, implications for clinical practice and future perspectives are also acknowledged. IMPLICATIONS Balance disorders are one of the signs reflecting a broader and complex spectrum of motion sensitivity, which are present even between attacks. Migraineurs are especially inherent to these symptoms probably due to brain hyperexcitability and to shared pathophysiological mechanisms. Patients, especially with aura and chronic migraine, exhibit balance instability during quiet standing under different surface and visual input conditions. Migraineurs demonstrated reduced limits of stability and lower performance on walk, transposing obstacles and sit to stand tasks. Only patients with aura present impairment of motor control reactions following external perturbations. Balance alterations are associated with falls and are influenced by aura, migraine frequency and psychosocial aspects, but not by vestibular symptoms or vestibular migraine diagnosis. There is a high demand for high quality of evidence regarding the assessment and care of motion sensitivity symptoms in migraineurs, considering approaches to manage not just the pain, but its associated symptoms.
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Affiliation(s)
- Gabriela F Carvalho
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany.
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Germany
| | - Debora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Ravishankar U, Ramesh R, Venkatasubramanian S, Shanmugam S. Bilateral vestibulopathy presaging clinically probable multisystem atrophy. BMJ Case Rep 2023; 16:e254472. [PMID: 37308247 PMCID: PMC10277085 DOI: 10.1136/bcr-2022-254472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Bilateral vestibulopathy is a clinical diagnosis backed by investigative confirmation, which can be masked by the lack of lateralising signs. It has a broad aetiological spectrum including neurodegenerative conditions, though many such cases also have unknown aetiology. We present the case of an elderly gentleman who presented with progressive bilateral vestibulopathy nearly 1.5 years prior to his eventual diagnosis of clinically probable multisystem atrophy. This case highlights the need to serially re-evaluate for parkinsonism and cerebellar signs in idiopathic bilateral vestibulopathy and raises a possibility that bilateral vestibulopathy, similar to constipation or anosmia, could be an early syndrome presaging the onset of overt extrapyramidal or cerebellar symptoms in patients with multisystem atrophy.
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Affiliation(s)
- Uma Ravishankar
- Neurology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Rithvik Ramesh
- Neurology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | | | - Sundar Shanmugam
- Neurology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Cavanagh N, Shrubsole K, Alsop T, Williams K. Exploring impairments and allied health professional utilisation in people with myasthenia gravis: A cross-sectional study. J Clin Neurosci 2023; 114:9-16. [PMID: 37276742 DOI: 10.1016/j.jocn.2023.05.012] [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: 11/13/2022] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
This study aimed to explore how people with myasthenia gravis experience impairments in vision, dizziness, hearing, and fatigue, and how these relate to balance confidence, community participation, and health-related quality of life. Additionally, this study investigated the utilisation and perception of the allied health role in managing these impairments in the Australian context. Visual and hearing impairments, along with fatigue, were found to be correlated with health-related quality of life and community participation to varying degrees, while visual impairment and dizziness were correlated with balance confidence. Perception and utilisation of allied health professionals was variable; common barriers to better utilisation included participant perception of clinicians having poor knowledge around myasthenia gravis, previous poor experiences with clinicians, uncertainty about the clinicians' role, and lack of awareness that symptoms were associated with myasthenia gravis. Further research exploring clinicians' knowledge of myasthenia gravis is recommended, along with education for people with the disease about symptoms associated and how to appropriately access care.
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Affiliation(s)
- Neve Cavanagh
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Kirstine Shrubsole
- School of Health and Human Sciences, Southern Cross University, Gold Coast, Australia.
| | - Tahlia Alsop
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Katrina Williams
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Pawar V, Ashraf H, Dorsala S, Mary P, Hameed N, H DN, Adatia SP, Raj L, Ananthu VR, Shouka M. Motorist's Vestibular Disorientation Syndrome (MVDS)-Proposed Diagnostic Criteria. J Pers Med 2023; 13:jpm13050732. [PMID: 37240902 DOI: 10.3390/jpm13050732] [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: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 05/28/2023] Open
Abstract
Motorist's vestibular disorientation syndrome (MVDS) is a disorder in which patients experience dizziness while driving. MVDS is under-reported in the literature, and in clinical practice, it often goes unrecognized. We identified clinical characteristics of patients with MVDS using data from 24 patients who faced difficulties while driving and were diagnosed with MVDS. Their symptoms, duration of illness, precipitating factors, co-morbidities, history of other neuro-otological disorders, severity of symptoms, and associated anxiety and depression were reviewed. Ocular motor movements were recorded using video-nystagmography. Patients with vestibular disorders that can cause similar symptoms while driving were excluded. The mean age of the patients was 45.7 ± 8.7 years, and most were professional drivers (90.5%). The duration of the illness ranged from eight days to ten years. Most patients presented with disorientation (79.2%) exclusively while driving. The most common triggers for symptoms were higher speeds, i.e., >80 km/h (66.7%), multi-lane roads (58.3%), bends and turns (50%), and looking at other vehicles or signals while driving (41.7%). A history of migraines was reported in 62.5% of the patients, and motion sickness was reported in 50% of the patients. Anxiety was reported in 34.3% of patients, and 15.7% had depression. The video-nystagmography did not show any specific abnormalities. Patients responded to drugs used in prophylactic treatments for migraines such as Amitriptyline, Venlafaxine, Bisoprolol, and Magnesium, and to Pregabalin and Gabapentin. Based on these findings, a classification system and a diagnostic criterion for MVDS were proposed.
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Affiliation(s)
- Vishal Pawar
- Neurology Department, Aster Gardens Specialty Clinic, Building 10, Zen Cluster, Street 1, Discovery Gardens, Dubai P.O. Box 8703, United Arab Emirates
| | - Hanaan Ashraf
- Al Rafa Polyclinic-International City, Internal Medicine Department, Aster DM Healthcare, Dubai P.O. Box 8703, United Arab Emirates
| | - Srinivas Dorsala
- Ear, Nose and Throat (ENT) Department, Jawaharlal Nehru Medical College (JNMC), Belagavi 500010, Karnataka, India
| | - Preethy Mary
- Medical Trust Hospital, Department of Otolaryngology, Cochin 682016, Kerala, India
| | - Nazrin Hameed
- Medical Trust Hospital, Department of Otolaryngology, Cochin 682016, Kerala, India
| | - Divya Nair H
- Indian Institute of Public Health Gandhinagar, Gandhinagar 382042, Gujarat, India
| | - Sweta Prakash Adatia
- Department of Neurology, RAK Hospital, Ras-Al-Khaimah P.O. Box 11393, United Arab Emirates
| | - Leya Raj
- Public Health Consultant, Karipuram 673121, Kerala, India
| | - V R Ananthu
- Al Sharq Hospital Fujairah, ENT Department, Al Sharq Healthcare, Fujairah P.O. Box 8505, United Arab Emirates
| | - M Shouka
- Audiologist, Neurology Department, Garden's Specialty Clinic, Aster DM Healthcare, Dubai P.O. Box 8704, United Arab Emirates
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A Transgenic 5xFAD-M Line of Mice for Dendritic Spine Morphology Analysis in Alzheimer's Disease. Brain Sci 2023; 13:brainsci13020307. [PMID: 36831849 PMCID: PMC9954381 DOI: 10.3390/brainsci13020307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cognitive impairments are closely related to synaptic loss in Alzheimer's disease (AD). Functional changes in synaptic contacts are reflected in dendritic spine morphology. Visualization of neurons for morphological studies in vivo is complicated by the fixed brain slice staining or expensive adeno-associated virus injections. We created a transgenic 5xFAD-M line of mice with AD-associated mutations and expressed GFP protein in single neurons of the brain. This mouse model of AD is a useful tool for the simplified visualization of the hippocampal neurons' morphology in vivo without additional staining manipulations. The progressive elimination of mushroom spines was demonstrated in 5xFAD-M mice between 4 and 5 months of age. Five-month-old 5xFAD-M male and female mice showed change both in the total density and the mushroom spines number compared to sex-matched control. We conclude 5xFAD-M mice can be a useful AD model for studying the mechanisms of synaptic pathology under neurodegenerative conditions and evaluating the effects of potential therapeutic agents on spine morphology as crucial aspect of memory loss in AD.
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Harris G, Rickard JJS, Butt G, Kelleher L, Blanch RJ, Cooper J, Oppenheimer PG. Review: Emerging Eye-Based Diagnostic Technologies for Traumatic Brain Injury. IEEE Rev Biomed Eng 2023; 16:530-559. [PMID: 35320105 PMCID: PMC9888755 DOI: 10.1109/rbme.2022.3161352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/06/2022]
Abstract
The study of ocular manifestations of neurodegenerative disorders, Oculomics, is a growing field of investigation for early diagnostics, enabling structural and chemical biomarkers to be monitored overtime to predict prognosis. Traumatic brain injury (TBI) triggers a cascade of events harmful to the brain, which can lead to neurodegeneration. TBI, termed the "silent epidemic" is becoming a leading cause of death and disability worldwide. There is currently no effective diagnostic tool for TBI, and yet, early-intervention is known to considerably shorten hospital stays, improve outcomes, fasten neurological recovery and lower mortality rates, highlighting the unmet need for techniques capable of rapid and accurate point-of-care diagnostics, implemented in the earliest stages. This review focuses on the latest advances in the main neuropathophysiological responses and the achievements and shortfalls of TBI diagnostic methods. Validated and emerging TBI-indicative biomarkers are outlined and linked to ocular neuro-disorders. Methods detecting structural and chemical ocular responses to TBI are categorised along with prospective chemical and physical sensing techniques. Particular attention is drawn to the potential of Raman spectroscopy as a non-invasive sensing of neurological molecular signatures in the ocular projections of the brain, laying the platform for the first tangible path towards alternative point-of-care diagnostic technologies for TBI.
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Affiliation(s)
- Georgia Harris
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical SciencesUniversity of BirminghamB15 2TTBirminghamU.K.
| | - Jonathan James Stanley Rickard
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical SciencesUniversity of BirminghamB15 2TTBirminghamU.K.
- Department of Physics, Cavendish LaboratoryUniversity of CambridgeCB3 0HECambridgeU.K.
| | - Gibran Butt
- Ophthalmology DepartmentUniversity Hospitals Birmingham NHS Foundation TrustB15 2THBirminghamU.K.
| | - Liam Kelleher
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical SciencesUniversity of BirminghamB15 2TTBirminghamU.K.
| | - Richard James Blanch
- Department of Military Surgery and TraumaRoyal Centre for Defence MedicineB15 2THBirminghamU.K.
- Neuroscience and Ophthalmology, Department of Ophthalmology, University Hospitals Birmingham NHS Foundation TrustcBirminghamU.K.
| | - Jonathan Cooper
- School of Biomedical EngineeringUniversity of GlasgowG12 8LTGlasgowU.K.
| | - Pola Goldberg Oppenheimer
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical SciencesUniversity of BirminghamB15 2TTBirminghamU.K.
- Healthcare Technologies Institute, Institute of Translational MedicineB15 2THBirminghamU.K.
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12
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Chepisheva MK. Spatial orientation, postural control and the vestibular system in healthy elderly and Alzheimer's dementia. PeerJ 2023; 11:e15040. [PMID: 37151287 PMCID: PMC10162042 DOI: 10.7717/peerj.15040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2023] [Indexed: 05/09/2023] Open
Abstract
Background While extensive research has been advancing our understanding of the spatial and postural decline in healthy elderly (HE) and Alzheimer's disease (AD), much less is known about how the vestibular system contributes to the spatial and postural processing in these two populations. This is especially relevant during turning movements in the dark, such as while walking in our garden or at home at night, where the vestibular signal becomes central. As the prevention of falls and disorientation are of serious concern for the medical service, more vestibular-driven knowledge is necessary to decrease the burden for HE and AD patients with vestibular disabilities. Overview of the article The review briefly presents the current "non-vestibular based" knowledge (i.e. knowledge based on research that does not mention the "vestibular system" as a contributor or does not investigate its effects) about spatial navigation and postural control during normal healthy ageing and AD pathology. Then, it concentrates on the critical sense of the vestibular system and explores the current expertise about the aspects of spatial orientation and postural control from a vestibular system point of view. The norm is set by first looking at how healthy elderly change with age with respect to their vestibular-guided navigation and balance, followed by the AD patients and the difficulties they experience in maintaining their balance or during navigation. Conclusion Vestibular spatial and vestibular postural deficits present a considerable disadvantage and are felt not only on a physical but also on a psychological level by all those affected. Still, there is a clear need for more (central) vestibular-driven spatial and postural knowledge in healthy and pathological ageing, which can better facilitate our understanding of the aetiology of these dysfunctions. A possible change can start with the more frequent implementation of the "vestibular system examination/rehabilitation/therapy" in the clinic, which can then lead to an improvement of future prognostication and disease outcome for the patients.
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Alterations in Corticocortical Vestibular Network Functional Connectivity Are Associated with Decreased Balance Ability in Elderly Individuals with Mild Cognitive Impairment. Brain Sci 2022; 13:brainsci13010063. [PMID: 36672045 PMCID: PMC9856347 DOI: 10.3390/brainsci13010063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
The corticocortical vestibular network (CVN) plays an important role in maintaining balance and stability. In order to clarify the specific relationship between the CVN and the balance ability of patients with mild cognitive impairment (MCI), we recruited 30 MCI patients in the community. According to age and sex, they were 1:1 matched to 30 older adults with normal cognitive function. We evaluated balance ability and performed MRI scanning in the two groups of participants. We analyzed functional connectivity within the CVN based on the region of interest. Then, we performed a Pearson correlation analysis between the functional connection and the Berg Balance Scale scores. The research results show that compared with the control group, there were three pairs of functional connections (hMST_R−Premotor_R, PFcm_R−SMA_L, and hMST_L−VIP_R) that were significantly decreased in the CVNs of the MCI group (p < 0.05). Further correlation analysis showed that there was a significant positive correlation between hMST_R−Premotor_R functional connectivity and BBS score (r = 0.364, p = 0.004). The decline in balance ability and increase in fall risk in patients with MCI may be closely related to the change in the internal connection mode of the corticocortical vestibular network.
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The effect of galvanic vestibular stimulation on postural balance in Parkinson's disease: A systematic review and meta-analysis. J Neurol Sci 2022; 442:120414. [PMID: 36116217 DOI: 10.1016/j.jns.2022.120414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/08/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
Abstract
People with Parkinson's disease (PD) develop postural imbalance and falls. Galvanic Vestibular Stimulation (GVS) may potentially improve postural balance in humans and hence reduce falls in PD. This systematic review and meta-analysis investigate the effects of GVS on postural balance in PD. Six separate databases and research registers were searched for cross-over design trials that evaluated the effects of GVS on postural balance in PD. We used standardized mean difference (Hedges' g) as a measure of effect size in all studies. We screened 223 studies, evaluated 14, of which five qualified for the meta-analysis. Among n = 40 patients in five studies (range n = 5 to 13), using a fixed effects model we found an effect size estimate of g = 0.43 (p < 0.001, 95% CI [0.29,0.57]). However, the test for residual heterogeneity was significant (p < 0.001), thus we used a random effects model and found a pooled effect size estimate of 0.62 (p > 0.05, 95% CI [- 0.17, 1.41], I2 = 96.21%). Egger's test was not significant and thus trim and funnel plot indicated no bias. To reduce heterogeneity, we performed sensitivity analysis and by removing one outlier study (n = 7 patients), we found an effect size estimate of 0.16 (p < 0.05, 95% CI [0.01, 0.31], I2 = 0%). Our meta-analysis found GVS has a favourable effect on postural balance in PD patients, but due to limited literature and inconsistent methodologies, this favourable effect must be interpreted with caution.
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Imaoka Y, Hauri L, Flury A, de Bruin ED. Linking cognitive functioning and postural balance control through virtual reality environmental manipulations. Front Aging Neurosci 2022; 14:954050. [PMID: 36118684 PMCID: PMC9476829 DOI: 10.3389/fnagi.2022.954050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Dementia is becoming a relevant problem worldwide. A simple screening at an early stage will be important to detect the risk of developing dementia. Vestibular dysfunction is likely to be associated with cognitive impairment. Since head-mounted display (HMD) virtual reality (VR) technology has the potential to activate the vestibular function, assessing postural sway with visual stimulation using HMD VR technology could be potentially useful for dementia screening. Objective The purpose of this study is to evaluate the effect of HMD-based VR visual stimuli on posture in older adults and the relationship between the stimulated body sway behaviors and cognitive performance. Method Using a cross-sectional study design, we investigated the effect of an optokinetic design-based room with stripes (OKR) VR environment oscillating forwards and backwards at 23/60Hz. Center of pressure (COP) displacement was measured in older adults aged 65 years and over in the OKR VR environment. The frequency response of COP was compared to the cognitive performance of the Montreal Cognitive Assessment (MoCA). Results 20 healthy older adults (70.4 ± 4.9 years; 27.2 ± 1.6 MoCA score) and 3 people with mild cognitive impairment (74.7 ± 4.0 years; 20.3 ± 2.1 MoCA score) were assessed. The results reveal that the oscillating OKR VR environment induced different postural sway in the anterior-posterior direction in the real world. Correlation analysis shows that the cognitive test score was associated with the frequency response of stimulated postural sway in the anterior-posterior direction (frequency Band 1 of 0−0.5Hz related to the visual and vestibular systems: rs = 0.45, P = 0.03). Conclusion Outcomes would suggest that a potential link may emerge between cognition and posture when the HMD-based VR visual stimuli are applied. The simple screening of stimulated postural sway could explain cognitive functioning. Further studies are warranted to clarify the vestibular system and spatial cognitive function more specifically in the proposed assessment system.
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Affiliation(s)
- Yu Imaoka
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- *Correspondence: Yu Imaoka
| | - Laura Hauri
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andri Flury
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- School of Health Professions, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
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Hvingelby VS, Højholt Terkelsen M, Johnsen EL, Møller M, Danielsen EH, Henriksen T, Glud AN, Tai Y, Møller Andersen AS, Meier K, Borghammer P, Moro E, Sørensen JCH, Pavese N. Spinal cord stimulation therapy for patients with Parkinson's disease and gait problems (STEP-PD): study protocol for an exploratory, double-blind, randomised, placebo-controlled feasibility trial. BMJ Neurol Open 2022; 4:e000333. [PMID: 36101543 PMCID: PMC9413283 DOI: 10.1136/bmjno-2022-000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/20/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Gait difficulties are common in Parkinson's disease (PD) and cause significant disability. These symptoms are often resistant to treatment. Spinal cord stimulation (SCS) has been found to improve gait, including freezing of gait, in a small number of patients with PD. The mechanism of action is unclear, and some patients are non-responders. With this double-blind, placebo-controlled efficacy and feasibility clinical and imaging study, we aim to shed light on the mechanism of action of SCS and collect data to inform development of a scientifically sound clinical trial protocol. We also aim to identify clinical and imaging biomarkers at baseline that could be predictive of a favourable or a negative outcome of SCS and improve patient selection. Methods and analysis A total of 14 patients will be assessed with clinical rating scales and gait evaluations at baseline, and at 6 and 12 months after SCS implantation. They will also receive serial 18F-deoxyglucose and 18FEOBV PET scans to assess the effects of SCS on cortical/subcortical activity and brain cholinergic function. The first two patients will be included in an open pilot study while the rest will be randomised to receive active treatment or placebo (no stimulation) for 6 months. From this point, the entire cohort will enter an open label active treatment phase for a subsequent 6 months. Ethics and dissemination This study was reviewed and approved by the Committee on Health Research Ethics, Central Denmark RM. It is funded by the Danish Council for Independent Research. Independent of outcome, the results will be published in peer-reviewed journals and presented at national and international conferences. Trial registration number NCT05110053; ClinicalTrials.gov Identifier.
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Affiliation(s)
- Victor S Hvingelby
- Department of Clinical Medicine—Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
| | - Miriam Højholt Terkelsen
- Department of Clinical Medicine—Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
| | - Erik L Johnsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Møller
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tove Henriksen
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Andreas Nørgaard Glud
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Yen Tai
- Department of Neurosciences, Imperial College Healthcare NHS Trust, London, UK
| | | | - Kaare Meier
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Per Borghammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Elena Moro
- Department of Psychiatry, Neurology, Neurological Rehabilitation and Forensic Medicine, Grenoble Alpes University Hospital, Grenoble, Auvergne-Rhône-Alpes, France
| | - Jens Christian Hedemann Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nicola Pavese
- Department of Clinical Medicine—Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
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Liu F, Zhang M, Chen T, Zhai L, Zhang Z, Xue J. Equilibrium and Vestibular Safety of Modafinil in Healthy Volunteers. Aerosp Med Hum Perform 2022; 93:487-492. [DOI: 10.3357/amhp.6032.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Modafinil, as a wake-promoting agent, is commonly used to relieve fatigue during military operations. However, there is a lack of clarity regarding the effects of modafinil on the equilibrium and vestibular organs, especially when prescribing this drug to flight crewmembers.
The objective of this study was to evaluate the equilibrium- and vestibular-related safety effects of modafinil.METHODS: In a randomized, double-blind, placebo-controlled, crossover study, 10 healthy male volunteers received a single 200-mg oral dose of modafinil or placebo. Equilibrium
and vestibular functions were assessed 2 h after oral administration by the sensory organization test (SOT), adaptation test (ADT), and video head impulse test (v-HIT).RESULTS: There was no change in the equilibrium scores of the six SOT conditions or the composite scores between
the modafinil and placebo groups. Statistically significant differences were not observed for the sway energy score (SES) in the toe-down test. In the toe-up test, the SES decreased by 16.7% in the modafinil group relative to the placebo group in trial 2, while the differences in other trials
were not statistically significant. In the v-HIT, there was no significant difference in the gain of each semicircular canal between the two groups.DISCUSSION: A single 200-mg dose of modafinil did not cause any impairment to vestibular function, equilibrium ability, or adaptive
balance response; in fact, modafinil might have a positive effect on adaptation function in healthy volunteers. These findings preliminarily suggest that there is no hidden risk of vestibular dysfunction among aviation employees using modafinil.Liu F, Zhang M, Chen T, Zhai L, Zhang
Z, Xue J. Equilibrium and vestibular safety of modafinil in healthy volunteers. Aerosp Med Hum Perform. 2022; 93(6):487–492.
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18
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Gam BU, Cho IH, Yeo SS, Kwon JW, Jang SH, Oh S. Comparative study of vestibular projection pathway connectivity in cerebellar injury patients and healthy adults. BMC Neurosci 2022; 23:17. [PMID: 35317746 PMCID: PMC8939126 DOI: 10.1186/s12868-022-00702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Cerebellar injury can not only cause gait and postural instability, nystagmus, and vertigo but also affect the vestibular system. However, changes in connectivity regarding the vestibular projection pathway after cerebellar injury have not yet been reported. Therefore, in the current study, we investigated differences in the connectivity of the vestibular projection pathway after cerebellar injury using diffusion tensor imaging (DTI) tractography. Methods We recruited four stroke patients with cerebellar injury. Neural connectivity in the vestibular nucleus (VN) of the pons and medulla oblongata in patients with cerebellar injury was measured using DTI. Connectivity was defined as the incidence of connection between the VN on the pons and medulla oblongata and target brain regions such as the cerebellum, thalamus, parieto-insular vestibular cortex (PIVC), and parietal lobe. Results At thresholds of 10 and 30, there was lower connectivity in the ipsilateral hemisphere between the VN at the medullar level and thalamus in the patients than in healthy adults. At a threshold of 1 and 10, the patient group showed lower VN connectivity with the PIVC than healthy adults. At a threshold of 1, VN connectivity with the parietal lobe in the contralateral hemisphere was lower in the patients than in healthy adults. Additionally, at a threshold of 30, VN connectivity at the pons level with the cerebellum was lower in healthy adults than in the patients. Conclusion Cerebellar injury seems to be associated with decreased vestibular projection pathway connectivity, especially in the ipsilateral thalamus, PIVC, and contralateral parietal lobe.
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Affiliation(s)
- Byeong Uk Gam
- Department of Health, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea
| | - In Hee Cho
- Department of Health, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae‑ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea
| | - Jung Won Kwon
- Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae‑ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea
| | - Seunghue Oh
- Department of Physical Therapy, Uiduk University, 261, Donghaedae-ro, Gangdong-myeon, Gyeongju, Gyeongsangbuk-do, 38004, Republic of Korea.
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19
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Carvalho GF, Becnel AR, Miske C, Szikszay TM, Adamczyk WM, Luedtke K. Postural control impairment in patients with headaches—A systematic review and meta‐analysis. Headache 2022; 62:241-270. [DOI: 10.1111/head.14281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Gabriela F. Carvalho
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L) Universität zu Lübeck Lübeck Germany
| | - Alena R. Becnel
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L) Universität zu Lübeck Lübeck Germany
| | - Carolin Miske
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L) Universität zu Lübeck Lübeck Germany
| | - Tibor M. Szikszay
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L) Universität zu Lübeck Lübeck Germany
- Laboratory of Pain Research Institute of Physiotherapy and Health Sciences The Jerzy Kukuczka Academy of Physical Education Katowice Poland
| | - Waclaw M. Adamczyk
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L) Universität zu Lübeck Lübeck Germany
- Laboratory of Pain Research Institute of Physiotherapy and Health Sciences The Jerzy Kukuczka Academy of Physical Education Katowice Poland
| | - Kerstin Luedtke
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L) Universität zu Lübeck Lübeck Germany
- Laboratory of Pain Research Institute of Physiotherapy and Health Sciences The Jerzy Kukuczka Academy of Physical Education Katowice Poland
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Kataoka H, Okada Y, Kiriyama T, Kita Y, Nakamura J, Shomoto K, Sugie K. Effect of galvanic vestibular stimulation on axial symptoms in Parkinson’s disease. J Cent Nerv Syst Dis 2022; 14:11795735221081599. [PMID: 35237093 PMCID: PMC8883401 DOI: 10.1177/11795735221081599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/28/2022] [Indexed: 11/15/2022] Open
Abstract
Postural imbalance, abnormal axial posture, and axial rigidity are the characteristic features of Parkinson’s disease (PD), and they are referred to as axial symptoms. The symptoms are difficult to manage since they are often resistant to both L-DOPA and deep brain stimulation. Hence, other treatments that can improve Parkinsonian axial symptoms without adverse effects are required. Vestibular dysfunction occurs in PD since neuropathological changes and reflex abnormalities are involved in the vestibular nucleus complex. Galvanic vestibular stimulation (GVS), which activates the vestibular system, is a noninvasive method. This review aimed to assess the clinical effect of GVS on axial symptoms in PD. To date, studies on the effects of GVS on postural instability, anterior bending posture, lateral bending posture, and trunk rigidity and akinesia in PD had yielded interesting data, and none of the patients presented with severe adverse events, and the others had mild reactions. GVS indicated a possible novel therapy. However, most included a small number of patients, and the sample sizes were not similar in some studies that included controls. In addition, there was only one randomized controlled clinical trial, and it did not perform an objective evaluation of axial symptoms. In this type of research, vestibular contributions to balance should be distinguished from others such as proprioceptive inputs or nonmotor symptoms of PD.
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Affiliation(s)
- Hiroshi Kataoka
- The Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yohei Okada
- Graduate School of Health Science, Kio University, Kashiba, Nara, Japan
| | - Takao Kiriyama
- The Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yorihiro Kita
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Junji Nakamura
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Koji Shomoto
- Graduate School of Health Science, Kio University, Kashiba, Nara, Japan
| | - Kazuma Sugie
- The Department of Neurology, Nara Medical University, Kashihara, Japan
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21
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Bonsu AN, Britton Z, Asif Z, Sharif M, Kaski D, Kheradmand A, Bronstein AM, Arshad Q. Migraine phenotype differentially modulates the attentional network: A cross sectional observation study. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221124264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Signs of distinct brain dysfunction in patients where migraine intersects with vertigo (i.e. vestibular migraine (VM)), remain elusive. As migraine and vertigo can both independently modulate attentional processes, here we seek the utility of the attentional network to functionally differentiate patients. Methods: We used the Attentional Network Task (ANT) to elucidate three separate functional networks: Alerting, orienting and resolving conflict. 120 participants had to attend to the direction of a target visual stimulus, while other parameters were simultaneously manipulated. Reaction times across the networks were assessed in, (i) 30 healthy controls, (ii) 30 VM patients, (iii) 30 patients with migraine without vertigo, and (iv) 30 patients with benign paroxysmal positional vertigo (BPPV) but no migraine. Results: Patients with VM (mean = 737.1 ms, SEM = 28), migraine (mean = 735.3 ms, SEM = 36.4), and BPPV (mean = 720.3 ms SEM = 24.3) all exhibited significantly delayed ANT reaction times compared to healthy controls (mean = 661.3 ms, SEM = 23.4). Specific attentional network deficits were observed for resolving conflict in VM, alerting in migraine and orienting in BPPV. Conclusion: VM patients displayed deficits in executive function characterized by an inability to focus attentional resources and suppress peripheral distractors, whereas migraineurs without vertigo exhibited changes in the alerting network that reflects hypervigilance.
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Affiliation(s)
- Angela N Bonsu
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Zelie Britton
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Zara Asif
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Mishaal Sharif
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Diego Kaski
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
- Department of Clinical and Motor Neurosciences, Institute of Neurology, UCL, UK
| | - Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology and Head & Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adolfo M Bronstein
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Qadeer Arshad
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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22
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Kashezheva AA, Zamergrad MV, Levin OS. [Dizziness in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:64-68. [PMID: 34870916 DOI: 10.17116/jnevro202112110264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study clinical features of vestibular disorders in patients with Parkinson's disease (PD) and to develop methods of their treatment. MATERIAL AND METHODS The study included 90 patients with PD who were divided into two groups: the main group (60 patients with PD and vestibular symptoms (VS)) and the control group (30 patients with PD without VS). All patients underwent clinical neurological examination, assessment of cognitive functions, affective and autonomic disorders as well as neurovestibular examination. RESULTS In some cases, dizziness was due to concomitant diseases of the vestibular system. Among the rest of the patients of the main group, signs of disorders of the central mechanisms of gaze control, otolith dysfunction, anxiety disorder and visuospatial dysfunction were recorded significantly more often than in the control group. The addition of vestibular rehabilitation to the complex treatment of patients of the main group helped to reduce postural instability and decreased the risk of falls. CONCLUSION Vestibular disorders are significantly more common in patients with PD who complain of dizziness. An early detection of these disorders is feasible with the help of neurovestibular research. It is reasonable to add individually selected vestibular exercises to the complex treatment of these disorders.
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Affiliation(s)
- A A Kashezheva
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - M V Zamergrad
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Coto J, Alvarez CL, Cejas I, Colbert BM, Levin BE, Huppert J, Rundek T, Balaban C, Blanton SH, Lee DJ, Loewenstein D, Hoffer M, Liu XZ. Peripheral vestibular system: Age-related vestibular loss and associated deficits. J Otol 2021; 16:258-265. [PMID: 34548873 PMCID: PMC8438634 DOI: 10.1016/j.joto.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Given the interdependence of multiple factors in age-related vestibular loss (e.g., balance, vision, cognition), it is important to examine the individual contributions of these factors with ARVL. While the relationship between the vestibular and visual systems has been well studied (Bronstein et al., 2015), little is known about the association of the peripheral vestibular system with neurodegenerative disorders (Cronin et al., 2017). Further, emerging research developments implicate the vestibular system as an opportunity for examining brain function beyond balance, and into other areas, such as cognition and psychological functioning. Additionally, the bidirectional impact of psychological functioning is understudied in ARVL. Recognition of ARVL as part of a multifaceted aging process will help guide the development of integrated interventions for patients who remain at risk for decline. In this review, we will discuss a wide variety of characteristics of the peripheral vestibular system and ARVL, how it relates to neurodegenerative diseases, and correlations between ARVL and balance, vision, cognitive, and psychological dysfunction. We also discuss clinical implications as well as future directions for research, with an emphasis on improving care for patients with ARVL.
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Affiliation(s)
- Jennifer Coto
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | | | - Ivette Cejas
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Brett M. Colbert
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
- Medical Scientist Training Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie E. Levin
- University of Miami Miller School of Medicine, Department of Neurology and the Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Joshua Huppert
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Tatjana Rundek
- University of Miami Miller School of Medicine, Department of Neurology and the Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Carey Balaban
- University of Pittsburgh, Departments of Otolaryngology, Neurobiology, Communication Sciences & Disorders, and Bioengineering, Pittsburgh, PA, USA
| | - Susan H. Blanton
- University of Miami Miller School of Medicine, Dr. John T. Macdonald Department of Human Genetics, Miami, FL, USA
| | - David J. Lee
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL, USA
| | - David Loewenstein
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA
| | - Michael Hoffer
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Xue Zhong Liu
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
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Beylergil SB, Gupta P, ElKasaby M, Kilbane C, Shaikh AG. Does visuospatial motion perception correlate with coexisting movement disorders in Parkinson's disease? J Neurol 2021; 269:2179-2192. [PMID: 34554323 DOI: 10.1007/s00415-021-10804-2] [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: 05/11/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Postural instability and balance impairment are common in Parkinson's disease (PD). Multiple factors, such as increased tone, bradykinesia, freezing of gait, posture, axial stiffness, and involuntary appendicular movements, can affect balance. The recent studies found that PD patients have abnormal perception of self-motion in vestibular domain. We asked whether measures of balance function, such as perception of one's motion, correlate with specific movement disorders seen in PD. Moving retinal image or self-motion in space triggers the perception of self-motion. We measured one's linear motion (heading) perception when subjects were moved en bloc using a moving platform (vestibular heading). Similar motion perception was generated in the visual domain (visual heading) by having the subjects view a 3D optical flow with immersive virtual reality goggles. During both tasks, the subjects reported the motion direction in the two-alternative-forced-choice paradigm. The accuracy of perceived motion direction was calculated from the responses fitted to the psychometric function curves to estimate how accurately and precisely the subjects can perceive rightward versus leftward motion (i.e., threshold and slope). Response accuracies and psychometric parameters were correlated with the disease duration, disease severity (total Unified Parkinson's Disease Rating Scale-III, UPDRS-III), and tremor, rigidity, axial, gait/posture components of UPRDS-III. We also correlated heading perception with the number of falls and subjective assessment of balance confidence using the Activities-Specific Balance Component (ABC) Scale. Accuracy, threshold, and sensitivity of vestibular heading perception significantly correlated with the disease duration and severity, particularly the tremor. Correlations were stronger for leftward heading perception in the vestibular domain. The visual heading perception was correlated with ABC Scale, especially with its items concerning optic-flow processing. There was asymmetry in leftward versus rightward vestibular heading perception. The level of asymmetry correlated with the axial component of UPDRS-III. Differences in the clinical parameters that correlate with visual versus vestibular heading perception suggest that two heading perception processes have different mechanistic underpinnings. The correlation of discordance between vestibular and visual heading perception with disease severity and duration suggests that visual function can be utilized for balance rehab in PD patients.
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Affiliation(s)
- Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Palak Gupta
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Mohamed ElKasaby
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.,Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA
| | - Camilla Kilbane
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.,Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA. .,National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. .,Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA. .,Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA.
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Paplou V, Schubert NMA, Pyott SJ. Age-Related Changes in the Cochlea and Vestibule: Shared Patterns and Processes. Front Neurosci 2021; 15:680856. [PMID: 34539328 PMCID: PMC8446668 DOI: 10.3389/fnins.2021.680856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/20/2021] [Indexed: 12/16/2022] Open
Abstract
Both age-related hearing loss (ARHL) and age-related loss in vestibular function (ARVL) are prevalent conditions with deleterious consequences on the health and quality of life. Age-related changes in the inner ear are key contributors to both conditions. The auditory and vestibular systems rely on a shared sensory organ - the inner ear - and, like other sensory organs, the inner ear is susceptible to the effects of aging. Despite involvement of the same sensory structure, ARHL and ARVL are often considered separately. Insight essential for the development of improved diagnostics and treatments for both ARHL and ARVL can be gained by careful examination of their shared and unique pathophysiology in the auditory and vestibular end organs of the inner ear. To this end, this review begins by comparing the prevalence patterns of ARHL and ARVL. Next, the normal and age-related changes in the structure and function of the auditory and vestibular end organs are compared. Then, the contributions of various molecular mechanisms, notably inflammaging, oxidative stress, and genetic factors, are evaluated as possible common culprits that interrelate pathophysiology in the cochlea and vestibular end organs as part of ARHL and ARVL. A careful comparison of these changes reveals that the patterns of pathophysiology show similarities but also differences both between the cochlea and vestibular end organs and among the vestibular end organs. Future progress will depend on the development and application of new research strategies and the integrated investigation of ARHL and ARVL using both clinical and animal models.
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Affiliation(s)
- Vasiliki Paplou
- Department of Otorhinolaryngology and Head/Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Nick M A Schubert
- Department of Otorhinolaryngology and Head/Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Research School of Behavioural and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Sonja J Pyott
- Department of Otorhinolaryngology and Head/Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Research School of Behavioural and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
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Chronic Central Vestibulopathies for the Otolaryngologist. Otolaryngol Clin North Am 2021; 54:939-948. [PMID: 34538359 DOI: 10.1016/j.otc.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Central vestibulopathies involve disorders of the central nervous system that lead to problems with balance, often manifested as dizziness, vertigo, and gait difficulty. Central vestibulopathies can be distinguished from peripheral vestibulopathies with the use of certain tests, including nystagmography and posturography. The neuroanatomy of individuals with central vestibulopathies can reveal structural abnormalities in the posterior cerebrum or cerebellum. Various medications can be used to manage central vestibulopathies, including vestibular migraine.
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Stefani SP, Pastras CJ, Serrador JM, Breen PP, Camp AJ. Stochastic and sinusoidal electrical stimuli increase the irregularity and gain of Type A and B medial vestibular nucleus neurons, in vitro. J Neurosci Res 2021; 99:3066-3083. [PMID: 34510506 DOI: 10.1002/jnr.24957] [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: 05/20/2021] [Revised: 07/30/2021] [Accepted: 08/23/2021] [Indexed: 11/05/2022]
Abstract
Galvanic vestibular stimulation (GVS) has been shown to improve vestibular function potentially via stochastic resonance, however, it remains unknown how central vestibular nuclei process these signals. In vivo work applying electrical stimuli to the vestibular apparatus of animals has shown changes in neuronal discharge at the level of the primary vestibular afferents and hair cells. This study aimed to determine the cellular impacts of stochastic, sinusoidal, and stochastic + sinusoidal stimuli on individual medial vestibular nucleus (MVN) neurons of male and female C57BL/6 mice. All stimuli increased the irregularity of MVN neuronal discharge, while differentially affecting neuronal gain. This suggests that the heterogeneous MVN neuronal population (marked by differential expression of ion channels), may influence the impact of electrical stimuli on neuronal discharge. Neuronal subtypes showed increased variability of neuronal firing, where Type A and B neurons experienced the largest gain changes in response to stochastic and sinusoidal stimuli. Type C neurons were the least affected regarding neuronal firing variability and gain changes. The membrane potential (MP) of neurons was altered by sinusoidal and stochastic + sinusoidal stimuli, with Type B and C neuronal MP significantly affected. These results indicate that GVS-like electrical stimuli impact MVN neuronal discharge differentially, likely as a result of heterogeneous ion channel expression.
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Affiliation(s)
- Sebastian P Stefani
- Department of Physiology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Christopher J Pastras
- Department of Physiology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jorge M Serrador
- Department of Pharmacology, Physiology & Neuroscience, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Paul P Breen
- The MARCS Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Aaron J Camp
- Department of Physiology, The University of Sydney, Camperdown, New South Wales, Australia
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Moon S, Huang CK, Sadeghi M, Akinwuntan AE, Devos H. Proof-of-Concept of the Virtual Reality Comprehensive Balance Assessment and Training for Sensory Organization of Dynamic Postural Control. Front Bioeng Biotechnol 2021; 9:678006. [PMID: 34395396 PMCID: PMC8358300 DOI: 10.3389/fbioe.2021.678006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/10/2021] [Indexed: 12/03/2022] Open
Abstract
Accurate quantification of the impact of visual, somatosensory, and vestibular systems on postural control may inform tailor-made balance intervention strategies. The aim of this proof-of-concept study was to determine the safety, sense of presence, system usability, and face validity of a newly developed Virtual Reality Comprehensive Balance Assessment and Training (VR-ComBAT) in healthy young individuals. The VR-ComBAT included six balance condition: (1) stable surface with fixed virtual reality (VR) surroundings; (2) stable surface with blacked out VR surroundings; (3) stable surface with VR visual conflict; (4) unstable surface with fixed VR surroundings; (5) unstable surface with blacked out VR surroundings; and (6) unstable surface with VR visual conflict. Safety was evaluated using the number of adverse events, including scores on the Simulator Sickness Questionnaire. Sense of presence was evaluated using the igroup Presence Questionnaire (iPQ). System usability was assessed using the Systems Usability Scale (SUS). Friedman analyses with post hoc Wilcoxon Signed Rank tests were employed to demonstrate face validity by quantifying center of pressure (COP) changes in mean distance, mean velocity, and mean frequency in the anteroposterior (AP) and mediolateral (ML) direction across the six conditions. Twenty-three participants (27.4 ± 8.0 years old; 13 women) reported no adverse events. Participants scores on average 44.9 ± 9.6 on the iPQ and 79.7 ± 9.9 on the SUS. Post hoc analyses showed significant changes in COP-based measures when compared to baseline. The mean frequency change of COP showed direction-dependence in which increased frequency change in AP was observed while decreased change in ML was noted. The VR-ComBAT provides a safe, feasible, and cost-effective VR environment that demonstrates consistent sensory re-weighting between visual, somatosensory, and vestibular systems. Future studies should investigate whether VR-ComBAT can be used to inform precision rehabilitation of balance and fall prevention in older adults without and with neurological conditions.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy, Ithaca College, Ithaca, NY, United States.,Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
| | - Chun-Kai Huang
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
| | - Maryam Sadeghi
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
| | - Abiodun E Akinwuntan
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States.,Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Hannes Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
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Carvalho GF, Mehnert J, Basedau H, Luedtke K, May A. Brain Processing of Visual Self-Motion Stimuli in Patients With Migraine: An fMRI Study. Neurology 2021; 97:e996-e1006. [PMID: 34290130 DOI: 10.1212/wnl.0000000000012443] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the behavioral and neuronal responses of patients with migraine to a visual simulation of self-motion through a virtual roller coaster ride in comparison to controls. METHODS Twenty consecutive patients with migraine from a university-based hospital headache clinic and 20 controls were included. Participants underwent an experiment where a visually displayed self-motion paradigm was presented based on customized roller coaster videos during fMRI. Within each video, blocks of motion stimulation were interleaved with low-speed upward motion in a random order. In the scanning intervals and after the experiment, participants rated their perceived level of vestibular symptoms and motion sickness during the videos. We hypothesized that patients with migraine will perceive more motion sickness and that it correlates with different central processing and brain responses. RESULTS Compared to controls, patients with migraine reported more dizziness (65% vs 30%; p = 0.03) and motion sickness (Simulator Sickness Questionnaire score 47.3 [95% confidence interval (CI), 37.1, 57.5] vs 24.3 [95% CI, 18.2, 30.4]) as well as longer symptom duration (01:19 minutes [95% CI, 00:51, 01:48] vs 00:27 minutes [95% CI, 00:03, 00:51]) and intensity (visual analogue scale score 0-100, 22.0 [95% CI, 14.8, 29.2] vs 9.9 [95% CI, 4.9, 14.7]) during the virtual roller coaster ride. Neuronal activity in patients with migraine was more pronounced in clusters within the superior (contrast estimate 3.005 [90% CI, 1.817, 4.194]) and inferior occipital gyrus (contrast estimate 1.759 [90% CI, 1.062, 2.456]), pontine nuclei (contrast estimate 0.665 [90% CI, 0.383, 0.946]), and within the cerebellar lobules V/VI (contrast estimate 0.672 [90% CI, 0.380, 0.964]), while decreased activity was seen in the cerebellar lobule VIIb (contrast estimate 0.787 [90% CI, 0.444, 1.130]) and in the middle frontal gyrus (contrast estimate 0.962 [90% CI, 0.557, 1.367]). These activations correlated with migraine disability (r = -0.46, p = 0.04) and motion sickness scores (r = 0.32, p = 0.04). We found enhanced connectivity between the pontine nuclei, cerebellar areas V/VI, and interior and superior occipital gyrus with numerous cortical areas in patients with migraine but not in controls. CONCLUSIONS Migraine is related to abnormal modulation of visual motion stimuli within superior and inferior occipital gyrus, middle frontal gyrus, pontine nuclei, and cerebellar lobules V, VI, and VIIb. These abnormalities relate to migraine disability and motion sickness susceptibility.
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Affiliation(s)
- Gabriela F Carvalho
- From the Institute of Health Sciences (G.F.C., K.L.) Department of Physiotherapy, University of Lübeck, Germany; and Department of Systems Neuroscience (G.F.C., J.M., H.B., K.L., A.M.), University Medical Center Eppendorf, Hamburg, Germany
| | - Jan Mehnert
- From the Institute of Health Sciences (G.F.C., K.L.) Department of Physiotherapy, University of Lübeck, Germany; and Department of Systems Neuroscience (G.F.C., J.M., H.B., K.L., A.M.), University Medical Center Eppendorf, Hamburg, Germany
| | - Hauke Basedau
- From the Institute of Health Sciences (G.F.C., K.L.) Department of Physiotherapy, University of Lübeck, Germany; and Department of Systems Neuroscience (G.F.C., J.M., H.B., K.L., A.M.), University Medical Center Eppendorf, Hamburg, Germany
| | - Kerstin Luedtke
- From the Institute of Health Sciences (G.F.C., K.L.) Department of Physiotherapy, University of Lübeck, Germany; and Department of Systems Neuroscience (G.F.C., J.M., H.B., K.L., A.M.), University Medical Center Eppendorf, Hamburg, Germany
| | - Arne May
- From the Institute of Health Sciences (G.F.C., K.L.) Department of Physiotherapy, University of Lübeck, Germany; and Department of Systems Neuroscience (G.F.C., J.M., H.B., K.L., A.M.), University Medical Center Eppendorf, Hamburg, Germany.
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30
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Physiological separation of Alzheimer's disease and Alzheimer's disease with significant levels of cerebrovascular symptomology and healthy controls. Med Biol Eng Comput 2021; 59:1597-1610. [PMID: 34263439 DOI: 10.1007/s11517-021-02409-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/04/2021] [Indexed: 01/14/2023]
Abstract
Most dementia patients with a mixed dementia (MxD) diagnosis have a mix of Alzheimer's disease (AD) and vascular dementia. Electrovestibulography (EVestG) records vestibuloacoustic afferent activity. We hypothesize EVestG recordings of AD and MxD patients are different. All patients were assessed with the Montreal cognitive assessment (MoCA) and Hachinski ischemic scale (HIS) (> 4 HIS score < 7 is representative of MxD cerebrovascular symptomology). EVestG recordings were made from 26 AD, 21 MxD and 44 healthy (control) participants. Features were derived from the EVestG recordings of the average field potential and field potential interval histogram to classify the AD, MxD and control groups. Multivariate analysis was used to test the features' significance. Using a leave-one-out cross-validated linear discriminant analysis with 3 EVestG features yielded accuracies > 80% for separating pairs of AD/MxD/control. Using the MoCA assessment and 2 EVestG features, a best accuracy of 81 to 91% depending on the classifier was obtained for the 3-way identification of AD, MxD and controls. EVestG measures provide a physiological basis for identifying AD from MxD. EVestG measures are hypothesized to be partly related to channelopathies and changes in the descending input to the vestibular periphery. Four of the five AD or MxD versus control features used had significant correlations with the MoCA. This supports assertions that the pathologic changes associated with AD impact the vestibular system and further are suggestive that the postulated physiological changes behind these features have an association with cognitive decline severity.
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31
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Plescia F, Salvago P, Dispenza F, Messina G, Cannizzaro E, Martines F. Efficacy and Pharmacological Appropriateness of Cinnarizine and Dimenhydrinate in the Treatment of Vertigo and Related Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4787. [PMID: 33946152 PMCID: PMC8125582 DOI: 10.3390/ijerph18094787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023]
Abstract
Vertigo is not itself a disease, but rather a symptom of various syndromes and disorders that jeopardize balance function, which is essential for daily activities. It is an abnormal sensation of motion that usually occurs in the absence of motion, or when a motion is sensed inaccurately. Due to the complexity of the etiopathogenesis of vertigo, many pharmacological treatments have been tested for efficacy on vertigo. Among these drugs, cinnarizine, usually given together with dimenhydrinate, appears to be the first-line pharmacotherapy for the management of vertigo and inner ear disorders. Based on these considerations, the present non-interventional study aimed to investigate the clinical efficacy and tolerability of a fixed combination of cinnarizine (20 mg) and dimenhydrinate (40 mg) in patients suffering from vertigo-related symptoms. To this end, we enrolled 120 adults-70 males, and 50 females-with an average age of 64 years. Before beginning pharmacological treatment, all patients were screened for the intensity of vertigo, dizziness, and concomitant symptoms through the Visual Scale of Dizziness Disorders and Dizziness Handicap Inventory scales. At the end of the anamnestic evaluation, patients received the fixed-dose combination of cinnarizine (20 mg) plus dimenhydrinate (40 mg) 3 times daily, for 60 days. The results of this study provide further insight regarding the efficacy of the fixed combination when used to reduce symptoms of vestibular vertigo of central and/or peripheral origin, after both the 15- and 60-day therapies. Independent of the type of vertigo, the fixed combination was able to reduce dizziness- and vertigo-associated symptoms in more than 75% of all patients treated, starting from 15 days of therapy, and improving 60 days after starting the therapy. Interestingly, we also found differences between male and female patients in the framework of the pharmacological effects of therapy. This study provides further details concerning the therapeutic efficacy of the fixed combination of cinnarizine and dimenhydrinate, and also focuses attention on the possibility that these drugs could act in a gender-specific manner, paving the way for further research.
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Affiliation(s)
- Fulvio Plescia
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (F.P.); (E.C.)
| | - Pietro Salvago
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università Degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy;
| | - Francesco Dispenza
- UOC Otorinolaringoiatria, A.O.U.P. “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy;
| | - Giuseppe Messina
- Department of Psychological, Pedagogical and Human Movement Sciences, University of Palermo, Via Giovanni Pascoli 6, Palermo 90144, Italy;
- PosturaLab Center, 90127 Palermo, Italy
| | - Emanuele Cannizzaro
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (F.P.); (E.C.)
| | - Francesco Martines
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università Degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy;
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Calzolari E, Chepisheva M, Smith RM, Mahmud M, Hellyer PJ, Tahtis V, Arshad Q, Jolly A, Wilson M, Rust H, Sharp DJ, Seemungal BM. Vestibular agnosia in traumatic brain injury and its link to imbalance. Brain 2021; 144:128-143. [PMID: 33367536 PMCID: PMC7880674 DOI: 10.1093/brain/awaa386] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/21/2020] [Accepted: 09/05/2020] [Indexed: 12/16/2022] Open
Abstract
Vestibular dysfunction, causing dizziness and imbalance, is a common yet poorly understood feature in patients with TBI. Damage to the inner ear, nerve, brainstem, cerebellum and cerebral hemispheres may all affect vestibular functioning, hence, a multi-level assessment—from reflex to perception—is required. In a previous report, postural instability was the commonest neurological feature in ambulating acute patients with TBI. During ward assessment, we also frequently observe a loss of vertigo sensation in patients with acute TBI, common inner ear conditions and a related vigorous vestibular-ocular reflex nystagmus, suggesting a ‘vestibular agnosia’. Patients with vestibular agnosia were also more unbalanced; however, the link between vestibular agnosia and imbalance was confounded by the presence of inner ear conditions. We investigated the brain mechanisms of imbalance in acute TBI, its link with vestibular agnosia, and potential clinical impact, by prospective laboratory assessment of vestibular function, from reflex to perception, in patients with preserved peripheral vestibular function. Assessment included: vestibular reflex function, vestibular perception by participants’ report of their passive yaw rotations in the dark, objective balance via posturography, subjective symptoms via questionnaires, and structural neuroimaging. We prospectively screened 918 acute admissions, assessed 146 and recruited 37. Compared to 37 matched controls, patients showed elevated vestibular-perceptual thresholds (patients 12.92°/s versus 3.87°/s) but normal vestibular-ocular reflex thresholds (patients 2.52°/s versus 1.78°/s). Patients with elevated vestibular-perceptual thresholds [3 standard deviations (SD) above controls’ average], were designated as having vestibular agnosia, and displayed worse posturography than non-vestibular-agnosia patients, despite no difference in vestibular symptom scores. Only in patients with impaired postural control (3 SD above controls’ mean), whole brain diffusion tensor voxel-wise analysis showed elevated mean diffusivity (and trend lower fractional anisotropy) in the inferior longitudinal fasciculus in the right temporal lobe that correlated with vestibular agnosia severity. Thus, impaired balance and vestibular agnosia are co-localized to the inferior longitudinal fasciculus in the right temporal lobe. Finally, a clinical audit showed a sevenfold reduction in clinician recognition of a common peripheral vestibular condition (benign paroxysmal positional vertigo) in acute patients with clinically apparent vestibular agnosia. That vestibular agnosia patients show worse balance, but without increased dizziness symptoms, explains why clinicians may miss treatable vestibular diagnoses in these patients. In conclusion, vestibular agnosia mediates imbalance in traumatic brain injury both directly via white matter tract damage in the right temporal lobe, and indirectly via reduced clinical recognition of common, treatable vestibular diagnoses.
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Affiliation(s)
- Elena Calzolari
- Brain and Vestibular Group, Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, W6 8RF, UK
| | - Mariya Chepisheva
- Brain and Vestibular Group, Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, W6 8RF, UK
| | - Rebecca M Smith
- Brain and Vestibular Group, Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, W6 8RF, UK
| | - Mohammad Mahmud
- Brain and Vestibular Group, Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, W6 8RF, UK
| | - Peter J Hellyer
- Centre for Neuroimaging Sciences, King's College London, London WC2R 2LS, UK
| | - Vassilios Tahtis
- Brain and Vestibular Group, Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, W6 8RF, UK.,King's College Hospital NHS Foundation Trust, SE5 9RS, UK
| | - Qadeer Arshad
- InAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, UK
| | - Amy Jolly
- C3NL, Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, W12 0NN, UK
| | - Mark Wilson
- St Mary's Hospital Major Trauma Centre, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Heiko Rust
- Brain and Vestibular Group, Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, W6 8RF, UK
| | - David J Sharp
- C3NL, Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, W12 0NN, UK
| | - Barry M Seemungal
- Brain and Vestibular Group, Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, W6 8RF, UK.,St Mary's Hospital Major Trauma Centre, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
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Abstract
PURPOSE OF REVIEW Determining the etiology of disorders that manifest with chronic dizziness can seem a daunting task, but extracting some basic elements of the patient's history can reduce the differential diagnosis significantly. This includes determining initial triggers, timing of symptoms, associated features, and exacerbating factors. This article covers distinct causes of chronic dizziness including persistent postural perceptual dizziness, mal de débarquement syndrome, motion sickness and visually induced motion sickness, bilateral vestibulopathy, and persistent dizziness after mild concussion. RECENT FINDINGS To date, none of the disorders above has a cure but are considered chronic syndromes with fluctuations that are both innate and driven by environmental stressors. As such, the mainstay of therapy for chronic disorders of dizziness involves managing factors that exacerbate symptoms and adding vestibular rehabilitation or cognitive-behavioral therapy alone or in combination, as appropriate. These therapies are supplemented by serotonergic antidepressants that modulate sensory gating and reduce anxiety. Besides expectation management, ruling out concurrent disorders and recognizing behavioral and lifestyle factors that affect symptom severity are critical issues in reducing morbidity for each disorder. SUMMARY Many syndromes of chronic dizziness can be diagnosed by recognition of key features, although many symptoms overlap between these groups. Symptoms may be manageable and improve with time, but they are often incompletely relieved.
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Aharoni MMH, Lubetzky AV, Arie L, Krasovsky T. Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test. J Neuroeng Rehabil 2021; 18:55. [PMID: 33766072 PMCID: PMC7993529 DOI: 10.1186/s12984-021-00852-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background Persistent postural-perceptual dizziness (PPPD) is a condition characterized by chronic subjective dizziness and exacerbated by visual stimuli or upright movement. Typical balance tests do not replicate the environments known to increase symptoms in people with PPPD—crowded places with moving objects. Using a virtual reality system, we quantified dynamic balance in people with PPPD and healthy controls in diverse visual conditions. Methods Twenty-two individuals with PPPD and 29 controls performed a square-shaped fast walking task (Four-Square Step Test Virtual Reality—FSST-VR) using a head-mounted-display (HTC Vive) under 3 visual conditions (empty train platform; people moving; people and trains moving). Head kinematics was used to measure task duration, movement smoothness and anterior–posterior (AP) and medio-lateral (ML) ranges of movement (ROM). Heart rate (HR) was monitored using a chest-band. Participants also completed a functional mobility test (Timed-Up-and-Go; TUG) and questionnaires measuring anxiety (State-Trait Anxiety Inventory; STAI), balance confidence (Activities-Specific Balance Confidence; ABC), perceived disability (Dizziness Handicap Inventory) and simulator sickness (Simulator Sickness Questionnaire). Main effects of visual load and group and associations between performance, functional and self-reported outcomes were examined. Results State anxiety and simulator sickness did not increase following testing. AP-ROM and HR increased with high visual load in both groups (p < 0.05). There were no significant between-group differences in head kinematics. In the high visual load conditions, high trait anxiety and longer TUG duration were moderately associated with reduced AP and ML-ROM in the PPPD group and low ABC and high perceived disability were associated with reduced AP-ROM (|r| = 0.47 to 0.53; p < 0.05). In contrast, in controls high STAI-trait, low ABC and longer TUG duration were associated with increased AP-ROM (|r| = 0.38 to 0.46; p < 0.05) and longer TUG duration was associated with increased ML-ROM (r = 0.53, p < 0.01). Conclusions FSST-VR may shed light on movement strategies in PPPD beyond task duration. While no main effect of group was observed, the distinct associations with self-reported and functional outcomes, identified using spatial head kinematics, suggest that some people with PPPD reduce head degrees of freedom when performing a dynamic balance task. This supports a potential link between spatial perception and PPPD symptomatology.
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Affiliation(s)
- Moshe M H Aharoni
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Anat V Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA
| | - Liraz Arie
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA
| | - Tal Krasovsky
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel. .,Pediatric Rehabilitation Department, Sheba Medical Center, Ramat Gan, Israel.
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Lee S, Liu A, McKeown MJ. Current perspectives on galvanic vestibular stimulation in the treatment of Parkinson's disease. Expert Rev Neurother 2021; 21:405-418. [PMID: 33621149 DOI: 10.1080/14737175.2021.1894928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Galvanic vestibular stimulation (GVS) is a noninvasive technique that activates vestibular afferents, influencing activity and oscillations in a broad network of brain regions. Several studies have suggested beneficial effects of GVS on motor symptoms in Parkinson's Disease (PD).Areas covered: A comprehensive overview of the stimulation techniques, potential mechanisms of action, challenges, and future research directions.Expert opinion: This emerging technology is not currently a viable therapy. However, a complementary therapy that is inexpensive, easily disseminated, customizable, and portable is sufficiently enticing that continued research and development is warranted. Future work utilizing biomedical engineering approaches, including concomitant functional neuroimaging, have the potential to significantly increase efficacy. GVS could be explored for other PD symptoms including orthostatic hypotension, dyskinesia, and sleep disorders.
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Affiliation(s)
- Soojin Lee
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada.,Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford UK
| | - Aiping Liu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Martin J McKeown
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
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Anatomical Location of the Vestibulocerebellar Tract in the Healthy Human Brain: A Diffusion Tensor Imaging Study. Brain Sci 2021; 11:brainsci11020199. [PMID: 33562805 PMCID: PMC7914725 DOI: 10.3390/brainsci11020199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
The vestibulocerebellar tract (VCT) is regarded as an important pathway of the central vestibular system. We identified the anatomical characteristics of the primary and secondary VCTs in a normal human brain using diffusion tensor imaging (DTI) tractography. Thirty-one healthy adults were recruited. A 1.5 T scanner was used for DTI tractography. A seed region of interest (ROI) was placed on the superior and medial vestibular nuclei at the pons level and a target ROI was placed on the uvula–nodulus of the cerebellum for reconstructing the primary VCT. In the secondary VCTs, the seed ROI was placed on the inferior and medial vestibular nuclei at the medulla oblongata level, and target ROIs were placed on the bilateral uvula–nodulus of the cerebellum. The primary VCT originated from the superior and medial vestibular nuclei at the pons level and terminated at the ipsilateral uvula–nodulus of the cerebellum. The component of the secondary VCTs originated from the inferior and medial vestibular nuclei at the level of the medulla oblongata and terminated at the bilateral uvula–nodulus of the cerebellum. Among them, 70.97% in the contralateral secondary VCT crossed at the vermis of the cerebellum. In addition, the fractional anisotropies (FAs) and mean diffusivity (MD) values of the primary VCT were significantly higher and lower, respectively, compared to those of the secondary VCTs (p < 0.05). The contralateral secondary VCT was significantly higher and lower in the MD and tract volume, respectively (p < 0.05), compared to the ipsilateral VCT. Therefore, we believe that the results will be useful for future studies of the vestibular projection pathway in the human brain injury aspect of central vestibular syndrome.
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Pinto JO, Dores AR, Geraldo A, Peixoto B, Barbosa F. Sensory stimulation programs in dementia: a systematic review of methods and effectiveness. Expert Rev Neurother 2020; 20:1229-1247. [PMID: 32940543 DOI: 10.1080/14737175.2020.1825942] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Dementia is characterized by the presence of cognitive decline and can lead to sensory-perceptual alterations, compromising the functionality in activities of daily living. The main objective of this work is to review the characteristics of sensory stimulation programs in dementia and its effectiveness. AREAS COVERED Studies were identified through a literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration Guidelines. Twenty studies were included in this review. The studies used multisensory stimulation at different stages of dementia. The results show a lack of consensus regarding frequency, duration, and number of sessions, as well as the duration of the interventions and assessment instruments used to evaluate the results. Multisensory stimulation, particularly Snoezelen, was the most widely used approach. Vision, hearing, touch, and smell were the most frequently stimulated senses. Most studies comprised pre- and post-intervention assessment, but few studies performed follow-up assessment. The interventions that revealed positive results in dementia were Snoezelen, multisensory environment other than Snoezelen, and Multi-sensory Behavior Therapy. EXPERT OPINION This review weakly supports sensory stimulation in dementia, providing useful information for rehabilitation and future investigations.
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Affiliation(s)
- Joana O Pinto
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
| | - Artemisa R Dores
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal.,School of Health, Polytechnic Institute of Porto , Porto, Portugal
| | - Andreia Geraldo
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
| | - Bruno Peixoto
- Department of Social and Behaviour Sciences, CESPU, University Institute of Health Sciences , Gandra, Portugal.,Center for Health Technology and Services Research (CINTESIS), NeuroGen research group , Porto, Portugal
| | - Fernando Barbosa
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
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Carvalho GF, Schwarz A, Szikszay TM, Adamczyk WM, Bevilaqua-Grossi D, Luedtke K. Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice. Braz J Phys Ther 2019; 24:306-317. [PMID: 31813696 DOI: 10.1016/j.bjpt.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Migraine is a primary headache with high levels of associated disability that can be related to a variety of symptoms and comorbidities. The role of physical therapy in the management of migraine is largely unknown. Therefore, the aim of this review is to highlight and critically discuss the current literature and evidence for physical therapy interventions in individuals with migraines. METHODS A narrative review of the literature was performed. RESULTS Physical therapists assessing and treating patients with migraine should focus on two primary aspects: (1) musculoskeletal dysfunctions, and (2) vestibular symptoms/postural control impairment. Signs and symptoms of musculoskeletal and/or vestibular dysfunctions are prevalent among individuals with migraines and different disability levels can be observed depending on the presence of aura or increment of the migraine attacks. CONCLUSION A proper physical examination and interview of the patients will lead to a tailored treatment plan. The primary aim regarding musculoskeletal dysfunctions is to reduce pain and sensitization, and physical therapy interventions may include a combination of manual therapy, exercise therapy, and education. The aim regarding postural control impairment is to optimize function and reduce vestibular symptoms, and interventions should include balance exercises and vestibular rehabilitation. However, consistent evidence of benefits is still lacking due to the lack of and therefore need for tailored and pragmatic clinical trials with high methodological quality.
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Affiliation(s)
- Gabriela Ferreira Carvalho
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Department of Systems Neuroscience, University of Hamburg-Eppendorf, Hamburg, Germany; Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Annika Schwarz
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Tibor Maximilian Szikszay
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany
| | - Waclaw Marceli Adamczyk
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Laboratory of Pain Research, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Kerstin Luedtke
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Laboratory of Pain Research, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
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39
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Messa LV, Ginanneschi F, Momi D, Monti L, Battisti C, Cioncoloni D, Pucci B, Santarnecchi E, Rossi A. Functional and Brain Activation Changes Following Specialized Upper-Limb Exercise in Parkinson's Disease. Front Hum Neurosci 2019; 13:350. [PMID: 31749690 PMCID: PMC6843060 DOI: 10.3389/fnhum.2019.00350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
For the management of Parkinson's disease (PD), the concept of forced exercise (FE) has drawn interest. In PD subjects, the FE executed with lower limbs has been shown to lessen symptoms and to promote brain adaptive changes. Our study is aimed to investigate the effect of an upper-limb exercise, conceptually comparable with the FE, in PD. Upper-limb exercise was achieved in a sitting position by using a specially designed device (Angel's Wings®). Clinical data, computerized dynamic posturography, magnetic resonance imaging (MRI) (resting-state MRI and arterial spin labeling), and neuropsychological tests were used before and after 2 months' exercise training. We found a significant long-lasting improvement in Unified Parkinson Disease Rating Scale (UPDRS)-III and cognitive scales, along with improvement in balance and postural control (better alignment of the gravity center and improvement in weight symmetry and in anticipatory motor strategies). Computerized dynamic posturography pointed out an enhanced central ability to integrate the vestibular signals with afferents from other sensory systems. Neuroimaging analyses after 2 months' exercise training showed, with respect to pretraining condition, many changes. An increase of the cerebral blood flow was evident in the left primary motor cortex (M1), left supplementary motor cortical area, and left cerebellar cortex. The bilateral globus pallidus showed an increased functional connectivity to the right central operculum, right posterior cingulate gyrus, and left sensorimotor cortex. Seed-to-voxel analysis demonstrated a functional connectivity between M1 and the left superior frontal gyrus. Left crus II showed strengthened connections with the left pre-rolandic area, left post-rolandic area, and left supramarginal area. These findings likely reflect compensatory mechanisms to the neuropathological hallmark of PD. Overall, our results show that this upper-limb exercise model, conceptually comparable with the FE already tested in the lower limbs, leads to a global improvement (involving non-exercised limbs) likely consistent with the functional changes observed in the central nervous system.
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Affiliation(s)
- Luca Valerio Messa
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Davide Momi
- Siena Brain Investigation and Neuromodulation Lab, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Lucia Monti
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Neurosensorial Sciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Carla Battisti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - David Cioncoloni
- U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Barbara Pucci
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.,Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,The Center for Complex Network Research, Department of Physics, Northeastern University, Boston, MA, United States
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Bohne P, Schwarz MK, Herlitze S, Mark MD. A New Projection From the Deep Cerebellar Nuclei to the Hippocampus via the Ventrolateral and Laterodorsal Thalamus in Mice. Front Neural Circuits 2019; 13:51. [PMID: 31447652 PMCID: PMC6695568 DOI: 10.3389/fncir.2019.00051] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022] Open
Abstract
The cerebellar involvement in cognitive functions such as attention, language, working memory, emotion, goal-directed behavior and spatial navigation is constantly growing. However, an exact connectivity map between the hippocampus and cerebellum in mice is still unknown. Here, we conducted a tracing study to identify the sequence of transsynaptic, cerebellar-hippocampal connections in the mouse brain using combinations of Recombinant adeno-associated virus (rAAV) and pseudotyped deletion-mutant rabies (RABV) viruses. Stereotaxic injection of a primarily anterograde rAAV-WGA (wheat germ agglutinin)-Cre tracer virus in the deep cerebellar nuclei (DCN) of a Cre-dependent tdTomato reporter mouse resulted in strong tdTomato labeling in hippocampal CA1 neurons, retrosplenial cortex (RSC), rhinal cortex (RC) as well as thalamic and cerebellar areas. Whereas hippocampal injections with the retrograde tracer virus rAAV-TTC (tetanus toxin C fragment)-eGFP, displayed eGFP positive cells in the rhinal cortex and subiculum. To determine the sequence of mono-transsynaptic connections between the cerebellum and hippocampus, we used the retrograde tracer RABVΔG-eGFP(EnvA). The tracing revealed a direct connection from the dentate gyrus (DG) in the hippocampus to the RSC, RC and subiculum (S), which are monosynaptically connected to thalamic laterodorsal and ventrolateral areas. These thalamic nuclei are directly connected to cerebellar fastigial (FN), interposed (IntP) and lateral (Lat) nuclei, discovering a new projection route from the fastigial to the laterodorsal thalamic nucleus in the mouse brain. Collectively, our findings suggest a new cerebellar-hippocampal connection via the laterodorsal and ventrolateral thalamus to RSC, RC and S. These results strengthen the notion of the cerebellum's involvement in cognitive functions such as spatial navigation via a polysynaptic circuitry.
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Affiliation(s)
- Pauline Bohne
- Department of General Zoology and Neurobiology, Ruhr-University Bochum, Bochum, Germany
| | - Martin K Schwarz
- Institute of Experimental Epileptology and Cognition Research (EECR), University of Bonn Medical School, Bonn, Germany
| | - Stefan Herlitze
- Department of General Zoology and Neurobiology, Ruhr-University Bochum, Bochum, Germany
| | - Melanie D Mark
- Department of General Zoology and Neurobiology, Ruhr-University Bochum, Bochum, Germany
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41
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Cullen KE. Vestibular processing during natural self-motion: implications for perception and action. Nat Rev Neurosci 2019; 20:346-363. [PMID: 30914780 PMCID: PMC6611162 DOI: 10.1038/s41583-019-0153-1] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
How the brain computes accurate estimates of our self-motion relative to the world and our orientation relative to gravity in order to ensure accurate perception and motor control is a fundamental neuroscientific question. Recent experiments have revealed that the vestibular system encodes this information during everyday activities using pathway-specific neural representations. Furthermore, new findings have established that vestibular signals are selectively combined with extravestibular information at the earliest stages of central vestibular processing in a manner that depends on the current behavioural goal. These findings have important implications for our understanding of the brain mechanisms that ensure accurate perception and behaviour during everyday activities and for our understanding of disorders of vestibular processing.
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Affiliation(s)
- Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
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42
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Kamil RJ, Bilgel M, Wong DF, Resnick SM, Agrawal Y. Vestibular Function and Beta-Amyloid Deposition in the Baltimore Longitudinal Study of Aging. Front Aging Neurosci 2018; 10:408. [PMID: 30618715 PMCID: PMC6297212 DOI: 10.3389/fnagi.2018.00408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/28/2018] [Indexed: 12/02/2022] Open
Abstract
Beta-amyloid (Aβ) plaque deposition is a key feature of Alzheimer’s disease (AD), and occurs years before the onset of symptoms. Aβ plaque deposition has been shown to be present in ~30% of cognitively normal older adults using amyloid C-11 labeled Pittsburgh Compound B (11C-PiB) Positron Emission Tomography (PET) imaging. Prior studies have reported a link between reduced vestibular function and poorer cognition in healthy older adults. It is unknown whether vestibular impairment occurs in association with AD pathology among individuals in the preclinical phase of AD, which could contribute to the observed association between vestibular and cognitive function in healthy older adults. Using the Baltimore Longitudinal Study of Aging (BLSA), we analyzed the association between a comprehensive set of vestibular function measures and PiB status in 98 healthy participants with a mean age of 77.3 (±8.26). We did not observe a significant relationship between any vestibular function measure and PiB status in cognitively-intact older adults in the BLSA. This finding suggests that Aβ deposition does not explain the observed association between reduced vestibular function and poorer cognition in healthy older adults.
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Affiliation(s)
- Rebecca J Kamil
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, United States
| | - Dean F Wong
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, United States
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States.,Department of Otolaryngology-Head and Neck Surgery, Division of Otology, Neurotology, and Skull Base Surgery, Johns Hopkins University, Baltimore, MD, United States
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Abstract
For decades it has been speculated that Parkinson's Disease (PD) is associated with dysfunction of the vestibular system, especially given that postural instability is one of the major symptoms of the disorder. Nonetheless, clear evidence of such a connection has been slow to emerge. There are still relatively few studies of the vestibulo-ocular reflexes (VORs) in PD. However, substantial evidence of vestibulo-spinal reflex deficits, in the form of abnormal vestibular-evoked myogenic potentials (VEMPs), now exists. The evidence for abnormalities in the subjective visual vertical is less consistent. However, some studies suggest that the integration of visual and vestibular information may be abnormal in PD. In the last few years, a number of studies have been published which demonstrate that the neuropathology associated with PD, such as Lewy bodies, is present in the central vestibular system. Increasingly, stochastic or noisy galvanic vestibular stimulation (nGVS) is being investigated as a potential treatment for PD, and a number of studies have presented evidence in support of this idea. The aim of this review is to summarize and critically evaluate the human and animal evidence relating to the connection between the vestibular system and PD.
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Affiliation(s)
- Paul F Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences and The Brain Health Research Centre, University of Otago, Dunedin, New Zealand.,Brain Research New Zealand Centre of Research Excellence, Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
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Goebel S, Mehdorn HM. A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle. J Neurooncol 2018; 140:145-153. [PMID: 29982872 DOI: 10.1007/s11060-018-2944-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group. METHODS Forty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning. RESULTS The majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients' Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors. CONCLUSIONS Although patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.
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Affiliation(s)
- Simone Goebel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Olshausenstraße 62, 24118, Kiel, Germany.
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45
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Gergova AA, Zamergrad MV, Artemiev DV, Levin OS. Vestibular disorders in patients with Parkinson's disease. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:73-76. [DOI: 10.17116/jnevro201811806273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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