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Patel P, Castro P, Koohi N, Arshad Q, Gargallo L, Carmona S, Kaski D. Head shaking does not alter vestibulo ocular reflex gain in vestibular migraine. Front Neurol 2022; 13:967521. [PMID: 36247796 PMCID: PMC9561915 DOI: 10.3389/fneur.2022.967521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Vestibular Migraine (VM) is the most common cause of non-positional episodic vestibular symptoms. Patients with VM commonly report increased motion sensitivity, suggesting that vestibular responses to head movement may identify changes specific to VM patients. Here we explore whether the vestibulo-ocular reflex (VOR) gain alters in response to a clinical “headshake” maneuver in patients with VM. Thirty patients with VM in the inter-ictal phase, 16 patients with Benign Positional Paroxysmal Vertigo (BPPV) and 15 healthy controls were recruited. Patients responded to the question “Do you feel sick reading in the passenger seat of a car?” and completed a validated motion sickness questionnaire as a measure of motion sensitivity. Lateral canal vHIT testing was performed before and after headshaking; the change in VOR gain was calculated as the primary outcome. Baseline VOR gain was within normal limits across all participants. There was no significant change in VOR gain after headshaking in any group (p = 0.264). Patients were 4.3 times more likely to be in the VM group than in the BPPV group if they reported nausea when reading in the passenger seat of a car. We postulate that a headshake stimulus may be insufficient to disrupt cortical interactions and induce a change in VOR gain. Alternatively, changes in VOR gain may only be apparent in the acute phase of VM. Reading in the passenger seat of a car was considered uncomfortable in all VM patients suggesting that this specific question may be useful for the diagnosis of VM.
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Affiliation(s)
- Priyani Patel
- Adult Diagnostic Audiology Department, University College London Hospitals, London, United Kingdom
- The Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Patricia Castro
- Adult Diagnostic Audiology Department, University College London Hospitals, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Universidad del Desarrollo, Escuela de Fonoaudiologia, Facultad de Medicina Clinica Alemana, Santiago, Chile
| | - Nehzat Koohi
- The Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
- Department of Clinical and Movement Neurosciences, Centre for Vestibular and Behavioural Neuroscience, Institute of Neurology, University College London, London, United Kingdom
| | - Qadeer Arshad
- Department of Clinical and Movement Neurosciences, Centre for Vestibular and Behavioural Neuroscience, Institute of Neurology, University College London, London, United Kingdom
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Lucia Gargallo
- Fundación San Lucas para la Neurociencia, Rosario, Argentina
- Cátedra Neurofisiología de la Universidad Nacional de Rosario, Rosario, Argentina
| | - Sergio Carmona
- Fundación San Lucas para la Neurociencia, Rosario, Argentina
- Cátedra Neurofisiología de la Universidad Nacional de Rosario, Rosario, Argentina
| | - Diego Kaski
- The Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
- Department of Clinical and Movement Neurosciences, Centre for Vestibular and Behavioural Neuroscience, Institute of Neurology, University College London, London, United Kingdom
- *Correspondence: Diego Kaski
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Tian R, Zhang Y, Pan Q, Wang Y, Wen Q, Fan X, Qin G, Zhang D, Chen L, Zhang Y, Zhou J. Calcitonin gene-related peptide receptor antagonist BIBN4096BS regulates synaptic transmission in the vestibular nucleus and improves vestibular function via PKC/ERK/CREB pathway in an experimental chronic migraine rat model. J Headache Pain 2022; 23:35. [PMID: 35260079 PMCID: PMC8903578 DOI: 10.1186/s10194-022-01403-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/15/2022] [Indexed: 02/07/2023] Open
Abstract
Background Vestibular symptoms are frequently reported in patients with chronic migraine (CM). However, whether vestibular symptoms arise through overlapping neurobiology of migraine remains to be elucidated. The neuropeptide calcitonin gene-related peptide (CGRP) and CGRP1 receptor play important pathological roles in facilitating central sensitization in CM. Therefore, we aimed to investigate whether CGRP1 receptor contributes to vestibular dysfunction after CM by improving synaptic transmission in the vestibular nucleus (VN). Methods A CM rat model was established by recurrent intermittent administration of nitroglycerin (NTG). Migraine- and vestibular-related behaviors were assessed. CGRP1 receptor specific antagonist, BIBN4096BS, and protein kinase C (PKC) inhibitor chelerythrine chloride (CHE) were administered intracerebroventricularly. The expressions of CGRP and CGRP1 receptor components, calcitonin receptor-like receptor (CLR) and receptor activity modifying protein 1 (RAMP1) were evaluated by western blot, immunofluorescent staining and quantitative real-time polymerase chain reaction in the vestibular nucleus (VN). Synaptic associated proteins and synaptic morphological characteristics were explored by western blot, transmission electron microscope, and Golgi-cox staining. The expressions of PKC, phosphorylated extracellular signal regulated kinase (p-ERK), phosphorylated cAMP response element-binding protein at serine 133 site (p-CREB-S133) and c-Fos were detected using western blot or immunofluorescent staining. Results The expressions of CGRP, CLR and RAMP1 were significantly upregulated in CM rats. CLR and RAMP1 were expressed mainly in neurons. BIBN4096BS treatment and PKC inhibition alleviated mechanical allodynia, thermal hyperalgesia and vestibular dysfunction in CM rats. Additionally, BIBN4096BS treatment and PKC inhibition markedly inhibited the overexpression of synaptic associated proteins and restored the abnormal synaptic structure in VN after CM. Furthermore, BIBN4096BS treatment dysregulated the expression levels of PKC, p-ERK and p-CREB-S133, and attenuated neuronal activation in VN after CM. Conclusions The present study demonstrated that CGRP1 receptor inhibition improved vestibular function after CM by reversing the aberrant synaptic transmission via downregulating PKC/ERK/CREB signaling pathway. Therapeutic interventions by inhibiting CGRP/CGRP1 signaling may be a new target for the treatment of vestibular symptoms in CM.
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Liu M, Fan G, Zhang D, Zhu M, Zhang H. Study on Mechanism of Jiawei Chaiqin Wendan Decoction in Treatment of Vestibular Migraine Based on Network Pharmacology and Molecular Docking Technology. Evid Based Complement Alternat Med 2021; 2021:5528403. [PMID: 34754315 DOI: 10.1155/2021/5528403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/10/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022]
Abstract
Objective To predict the main active ingredients, potential targets, and key pathways of Jiawei Chaiqin Wendan decoction treatment in vestibular migraine and explore possible mechanisms by network pharmacology and molecular docking technology. Methods The active ingredients and related targets of Jiawei Chaiqin Wendan decoction were obtained from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). The corresponding genes of the target were queried by UniProt database, and the “drug-compound-target-disease” network was constructed by Cytoscape 3.7.2 software. GO functional enrichment analysis and KEGG pathway enrichment analysis were carried out by R software and Bioconductor, and column chart and bubble chart were drawn by Prism software and OmicShare database for visualization. Finally, the mechanism and potential targets of Jiawei Chaiqin Wendan decoction in the treatment of vestibular migraine were predicted. Results The “drug-compound-target-disease” network contains 154 active ingredients and 85 intersection targets. The key targets include AKT1, IL6, MAPK3, VEGFA, EGFR, CASP3, EGF, MAPK1, PTGS2, and ESR1. A total of 1939 items were obtained by GO functional enrichment analysis (P < 0.05). KEGG pathway enrichment analysis screened 156 signal pathways (P < 0.05), involving PI3K-Akt signal pathway, AGE-RAGE signal pathway in diabetes complications, MAPK signal pathway, HIF-1 signal pathway, IL-17 signal pathway, etc. Molecular docking results showed that quercetin, luteolin, kaempferol, tanshinone IIa, wogonin, naringenin, nobiletin, dihydrotanshinlactone, beta-sitosterol, and salviolone have good affinity with core target proteins IL6, PTGS2, MAPK1, MAPK3, and CGRP1. Conclusion The active ingredients in Jiawei Chaiqin Wendan decoction may regulate the levels of inflammatory factors and neurotransmitters by acting on multiple targets such as IL6, MAPK3, MAPK1, and PTGS2, so as to play a therapeutic role in vestibular migraine.
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Abstract
Vestibular migraine (VM) is one of the most common neurologic causes of vertigo. Symptoms and International Classification of Headache Disorders criteria are used to diagnose VM because no objective tests, imaging or audiologic, have been shown to reliably diagnose this condition. Central auditory, peripheral, and central vestibular pathway involvement has been associated with VM. Although the interaction between migraine and other vestibular disorders can be a challenging scenario for diagnosis and treatment, there are data to show that vestibular rehabilitation and a variety of pharmacologic agents improve reported symptoms and vertigo frequency.
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Affiliation(s)
- Ashley Zaleski-King
- Otolaryngology, GWU Medical Faculty Associates, 2300 M Street Northwest, Washington, DC 20037, USA.
| | - Ashkan Monfared
- Otolaryngology, GWU Medical Faculty Associates, 2300 M Street Northwest, Washington, DC 20037, USA
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Mei C, Dong H, Nisenbaum E, Thielhelm T, Nourbakhsh A, Yan D, Smeal M, Lundberg Y, Hoffer ME, Angeli S, Telischi F, Nie G, Blanton SH, Liu X. Genetics and the Individualized Therapy of Vestibular Disorders. Front Neurol 2021; 12:633207. [PMID: 33613440 PMCID: PMC7892966 DOI: 10.3389/fneur.2021.633207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Vestibular disorders (VDs) are a clinically divergent group of conditions that stem from pathology at the level of the inner ear, vestibulocochlear nerve, or central vestibular pathway. No etiology can be identified in the majority of patients with VDs. Relatively few families have been reported with VD, and so far, no causative genes have been identified despite the fact that more than 100 genes have been identified for inherited hearing loss. Inherited VDs, similar to deafness, are genetically heterogeneous and follow Mendelian inheritance patterns with all modes of transmission, as well as multifactorial inheritance. With advances in genetic sequencing, evidence of familial clustering in VD has begun to highlight the genetic causes of these disorders, potentially opening up new avenues of treatment, particularly in Meniere's disease and disorders with comorbid hearing loss, such as Usher syndrome. In this review, we aim to present recent findings on the genetics of VDs, review the role of genetic sequencing tools, and explore the potential for individualized medicine in the treatment of these disorders. Methods: A search of the PubMed database was performed for English language studies relevant to the genetic basis of and therapies for vestibular disorders, using search terms including but not limited to: “genetics,” “genomics,” “vestibular disorders,” “hearing loss with vestibular dysfunction,” “individualized medicine,” “genome-wide association studies,” “precision medicine,” and “Meniere's syndrome.” Results: Increasing numbers of studies on vestibular disorder genetics have been published in recent years. Next-generation sequencing and new genetic tools are being utilized to unearth the significance of the genomic findings in terms of understanding disease etiology and clinical utility, with growing research interest being shown for individualized gene therapy for some disorders. Conclusions: The genetic knowledge base for vestibular disorders is still in its infancy. Identifying the genetic causes of balance problems is imperative in our understanding of the biology of normal function of the vestibule and the disease etiology and process. There is an increasing effort to use new and efficient genetic sequencing tools to discover the genetic causes for these diseases, leading to the hope for precise and personalized treatment for these patients.
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Affiliation(s)
- Christine Mei
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Hongsong Dong
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States.,Shenzhen Second People's Hospital, Shenzhen, China
| | - Eric Nisenbaum
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Torin Thielhelm
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Aida Nourbakhsh
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Denise Yan
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Molly Smeal
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Yesha Lundberg
- Department of Otolaryngology, Boys Town National Research Hospital, Omaha, NE, United States
| | - Michael E Hoffer
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Simon Angeli
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Fred Telischi
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Guohui Nie
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Susan H Blanton
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Xuezhong Liu
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
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Gallego-Martinez A, Lopez-Escamez JA. Genetic architecture of Meniere’s disease. Hear Res 2020; 397:107872. [DOI: 10.1016/j.heares.2019.107872] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/12/2019] [Accepted: 12/09/2019] [Indexed: 01/26/2023]
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Paz-Tamayo A, Perez-Carpena P, Lopez-Escamez JA. Systematic Review of Prevalence Studies and Familial Aggregation in Vestibular Migraine. Front Genet 2020; 11:954. [PMID: 33110417 PMCID: PMC7489493 DOI: 10.3389/fgene.2020.00954] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/29/2020] [Indexed: 01/09/2023] Open
Abstract
Background: Vestibular migraine (VM) is complex disorder consisting of episodes of migraine and vertigo with an estimated prevalence of 1–3%. As migraine, it is considered that VM has genetic predisposition; however, evidence to support a genetic contribution has not been critically appraised. Objective: The aim of this systematic review is to assess available evidence in scientific publications to determine the role of inheritance in VM. Methods: After performing the quality assessment of the retrieved records, 31 studies were included (24 epidemiological reports and 7 genetic association studies in families or case-control in candidate genes). We gathered data about prevalence of VM in different populations and in families, and also about the genetic findings reported. In addition, other variables were considered to assess the heritability of VM, such as the ancestry, the age of onset or the familial history of vertigo and migraine. Results: The estimated prevalence of VM was different between black (3.13%), white (2.64%) and Asian (1.07%) ethnicities. The reported prevalence of VM in migraine patients is higher in European countries (21%) than in Asian countries (10%). Moreover, the prevalence of the migraine-vertigo association in families is 4–10 times higher than the prevalence reported in the general population (sibling recurrence risk ratio λs = 4.31–10.42). We also found that the age of onset is lower in patients with simultaneous onset of symptoms and in those who have familial history for migraine and/or vertigo, suggesting anticipation. Although some genetic studies have reported few allelic variants associated to MV, replication studies are needed to validate these results. Conclusions: The available evidence to support heritability in VM is limited. Variability in prevalence depending on ethnicity and geographic location suggests a combined genetic and environmental contribution to VM. However, the familial aggregation observed in VM support genetic and shared familial environmental effects that remarks the necessity of twins and adoptees-based epidemiological studies to estimate its heritability.
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Affiliation(s)
- Ana Paz-Tamayo
- Division of Otolaryngology, Department of Surgery, Universidad de Granada, Granada, Spain
| | - Patricia Perez-Carpena
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Universitario San Cecilio, Granada, Spain.,Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta de Andalucía, PTS, Granada, Spain
| | - Jose A Lopez-Escamez
- Division of Otolaryngology, Department of Surgery, Universidad de Granada, Granada, Spain.,Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta de Andalucía, PTS, Granada, Spain.,Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Maita H, Kobayashi T, Akimoto T, Osawa H, Kato H. Vestibular migraine without headache treated with lomerizine: A 35-year-old woman undiagnosed for 10 years. J Gen Fam Med 2020; 21:140-142. [PMID: 32742903 PMCID: PMC7388671 DOI: 10.1002/jgf2.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 02/23/2020] [Indexed: 11/23/2022] Open
Abstract
A 35-year-old woman presented with recurrent vertigo without headache, which had persisted for 10 years. Detailed medical history revealed that she experienced hearing loss, tinnitus, nausea, photophobia, phonophobia, and slight discomfort in the head during vertigo attacks, which often led to absence from work. Based on the diagnostic criteria of the International Classification of Headache Disorders, third edition, she was diagnosed with vestibular migraine and was prescribed lomerizine, as prophylaxis. Her symptoms markedly improved, enabling her to go to work. Accurate diagnosis and treatment are important for improving the quality of life of patients, since vestibular migraine is commonly underdiagnosed.
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Affiliation(s)
- Hiroki Maita
- Development of Community HealthcareHirosaki University Graduate School of MedicineAomoriJapan
- General MedicineHirosaki University Graduate School of MedicineAomoriJapan
| | - Tadashi Kobayashi
- Department of General MedicineHirosaki University School of Medicine & HospitalAomoriJapan
| | - Takashi Akimoto
- Department of General MedicineHirosaki University School of Medicine & HospitalAomoriJapan
| | - Hiroshi Osawa
- Department of General MedicineHirosaki University School of Medicine & HospitalAomoriJapan
| | - Hiroyuki Kato
- Development of Community HealthcareHirosaki University Graduate School of MedicineAomoriJapan
- General MedicineHirosaki University Graduate School of MedicineAomoriJapan
- Department of General MedicineHirosaki University School of Medicine & HospitalAomoriJapan
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Abstract
The diagnosis and management of vertigo remains a challenge for clinicians, including general neurology. In recent years there have been advances in the understanding of established vestibular syndromes, and the development of treatments for existing vestibular diagnoses. In this 'update' I will review how our understanding of previously "unexplained" dizziness in the elderly is changing, explore novel insights into the pathophysiology of vestibular migraine, and its relationship to the newly coined term 'persistent postural perceptual dizziness', and finally discuss how a simple bedside oculomotor assessment may help identify vestibular presentations of stroke.
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Affiliation(s)
- Diego Kaski
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK. .,Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Motor Neurosciences, University College London, 33 Queen Square, London, WC1N 3BG, UK.
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10
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Affiliation(s)
- Jan C Coebergh
- Ashford and St Peter's Hospitals NHS Foundation Trust, St Peter's Hospital, Chertsey KT19 0PZ, UK
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