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Ciocca M, Jameel A, Yousif N, Patel N, Smith J, Akgun S, Jones B, Gedroyc W, Nandi D, Tai Y, Seemungal BM, Bain P. Illusions of Self-Motion during Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Tremor. Ann Neurol 2024; 96:121-132. [PMID: 38709569 DOI: 10.1002/ana.26945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Brain networks mediating vestibular perception of self-motion overlap with those mediating balance. A systematic mapping of vestibular perceptual pathways in the thalamus may reveal new brain modulation targets for improving balance in neurological conditions. METHODS Here, we systematically report how magnetic resonance-guided focused ultrasound surgery of the nucleus ventralis intermedius of the thalamus commonly evokes transient patient-reported illusions of self-motion. In 46 consecutive patients, we linked the descriptions of self-motion to sonication power and 3-dimensional (3D) coordinates of sonication targets. Target coordinates were normalized using a standard atlas, and a 3D model of the nucleus ventralis intermedius and adjacent structures was created to link sonication target to the illusion. RESULTS A total of 63% of patients reported illusions of self-motion, which were more likely with increased sonication power and with targets located more inferiorly along the rostrocaudal axis. Higher power and more inferiorly targeted sonications increased the likelihood of experiencing illusions of self-motion by 4 and 2 times, respectively (odds ratios = 4.03 for power, 2.098 for location). INTERPRETATION The phenomenon of magnetic vestibular stimulation is the most plausible explanation for these illusions of self-motion. Temporary unilateral modulation of vestibular pathways (via magnetic resonance-guided focused ultrasound) unveils the central adaptation to the magnetic field-induced peripheral vestibular bias, leading to an explicable illusion of motion. Consequently, systematic mapping of vestibular perceptual pathways via magnetic resonance-guided focused ultrasound may reveal new intracerebral targets for improving balance in neurological conditions. ANN NEUROL 2024;96:121-132.
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Affiliation(s)
- Matteo Ciocca
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Ayesha Jameel
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nada Yousif
- School of Engineering and Computer Science, University of Hertfordshire, Hatfield, United Kingdom
| | - Neekhil Patel
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Joely Smith
- Faculty of Engineering, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Sena Akgun
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Brynmor Jones
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Wlayslaw Gedroyc
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dipankar Nandi
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Yen Tai
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Barry M Seemungal
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Peter Bain
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
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2
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Chen Z, Liu Y, Lin C, Li Z, Shan J, Duan Z, Rong L, Wei X, Xiao L, Liu H. Aberrant cerebral blood flow and functional connectivity in patients with vestibular migraine: a resting-state ASL and fMRI study. J Headache Pain 2024; 25:84. [PMID: 38773396 PMCID: PMC11107056 DOI: 10.1186/s10194-024-01792-5] [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] [Received: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Prior neuroimaging studies on vestibular migraine (VM) have extensively certified the functional and structural alterations in multiple brain regions and networks. However, few studies have assessed the cerebral blood flow (CBF) in VM patients using arterial spin labeling (ASL). The present study aimed to investigate CBF and functional connectivity (FC) alterations in VM patients during interictal periods. METHODS We evaluated 52 VM patients and 46 healthy controls (HC) who received resting-state pseudo-continuous ASL and functional magnetic resonance imaging (fMRI) scanning. Comparisons of voxel-based CBF and seed-based FC were performed between the two groups. Brain regions showed significant group differences in CBF analyses were chosen as seeds in FC analyses. Additionally, the associations between abnormal imaging results and clinical features were explored. RESULTS Compared with HC, VM patients showed higher normalized CBF in the right precentral gyrus (PreCG), left postcentral gyrus (PostCG), left superior frontal gyrus and bilateral insular (p < 0.05, FDR corrected). Furthermore, VM patients exhibited increased FC between the right PreCG and areas of the left PostCG, left cuneus and right lingual gyrus (p < 0.05, FDR corrected). In addition, we observed decreased FC between the left insular and regions of the left thalamus and right anterior cingulate cortex, as well as increased FC between the left insular and right fusiform gyrus in VM patients (p < 0.05, FDR corrected). Moreover, these variations in brain perfusion and FC were significantly correlated with multiple clinical features including frequency of migraine symptoms, frequency of vestibular symptoms and disease duration of VM (all p < 0.05). CONCLUSIONS Patients with VM during interictal period showed hyperperfusion and abnormal resting-state FC in brain regions potentially contributed to disrupted multi-sensory and autonomic processing, as well as impaired ocular motor control, pain modulation and emotional regulation. Our study provided novel insights into the complex neuropathology of VM from a CBF perspective.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Yueji Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Cunxin Lin
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Zhining Li
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Junjun Shan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Zuowei Duan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Xiue Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China.
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China.
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3
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Émard-Lamy C, Bergé L, Saj A. Body representation after a stroke in the brainstem. J Neurol Sci 2024; 460:123013. [PMID: 38653116 DOI: 10.1016/j.jns.2024.123013] [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] [Received: 02/08/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Lesion occurring in the brainstem may cause a postural tilt and balance disorders, which could be due to an inaccurate perception of the body orientation. The objective of this study was to determine the effects of a brainstem stroke on body representation in horizontal and frontal plane, and links with impaired posture and neuroanatomy. METHODS Forty patients with stroke in left brainstem (L-BS) or right (R-BS) were compared with 15 matched control subjects (C). The subjective straight-ahead (SSA) was investigated using a method disentangling lateral deviation and tilt components of error. RESULTS The L-BS patients had contralesional lateral deviation of SSA. In addition, they showed an ipsilesional tilt, more severe for the trunk than for the head. By contrast, in R-BS patients, the representation of the body midline was fairly accurate in both the horizontal and frontal planes and did not differ from that of control subjects. CONCLUSION This work highlights an asymmetry of representation of body associated with left brainstem lesions extending to the right cerebral hemisphere. This deviation appears only after a left lesion, which may point to a vestibular dominance. These results open a new perspective of neuro-rehabilitation of postural disorders after a stroke, with the correction of the representation of body orientation.
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Affiliation(s)
- Chloé Émard-Lamy
- Psychology Department, University of Montreal, Montreal, QC, Canada
| | - Laura Bergé
- Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, Geneva, Switzerland
| | - Arnaud Saj
- Psychology Department, University of Montreal, Montreal, QC, Canada; CRIR/Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada; Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, Geneva, Switzerland; University Hospital of Geneva, Neuropsychology Unit, Geneva, Switzerland.
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4
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Beylergil SB, Noecker AM, Kilbane C, McIntyre CC, Shaikh AG. Does Vestibular Motion Perception Correlate with Axonal Pathways Stimulated by Subthalamic Deep Brain Stimulation in Parkinson's Disease? CEREBELLUM (LONDON, ENGLAND) 2024; 23:554-569. [PMID: 37308757 DOI: 10.1007/s12311-023-01576-8] [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] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
Perception of our linear motion - heading - is critical for postural control, gait, and locomotion, and it is impaired in Parkinson's disease (PD). Deep brain stimulation (DBS) has variable effects on vestibular heading perception, depending on the location of the electrodes within the subthalamic nucleus (STN). Here, we aimed to find the anatomical correlates of heading perception in PD. Fourteen PD participants with bilateral STN DBS performed a two-alternative forced-choice discrimination task where a motion platform delivered translational forward movements with a heading angle varying between 0 and 30° to the left or to the right with respect to the straight-ahead direction. Using psychometric curves, we derived the heading discrimination threshold angle of each patient from the response data. We created patient-specific DBS models and calculated the percentages of stimulated axonal pathways that are anatomically adjacent to the STN and known to play a major role in vestibular information processing. We performed correlation analyses to investigate the extent of these white matter tracts' involvement in heading perception. Significant positive correlations were identified between improved heading discrimination for rightward heading and the percentage of activated streamlines of the contralateral hyperdirect, pallido-subthalamic, and subthalamo-pallidal pathways. The hyperdirect pathways are thought to provide top-down control over STN connections to the cerebellum. In addition, STN may also antidromically activate collaterals of hyperdirect pathway that projects to the precerebellar pontine nuclei. In select cases, there was strong activation of the cerebello-thalamic projections, but it was not consistently present in all participants. Large volumetric overlap between the volume of tissue activation and the STN in the left hemisphere positively impacted rightward heading perception. Altogether, the results suggest heavy involvement of basal ganglia cerebellar network in STN-induced modulation of vestibular heading perception in PD.
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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
| | - Angela M Noecker
- Department of Biomedical Engineering, Case Western Reserve University, 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
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, 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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5
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Hadi Z, Mahmud M, Seemungal BM. Brain Mechanisms Explaining Postural Imbalance in Traumatic Brain Injury: A Systematic Review. Brain Connect 2024; 14:144-177. [PMID: 38343363 DOI: 10.1089/brain.2023.0064] [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: 03/27/2024] Open
Abstract
Introduction: Persisting imbalance and falls in community-dwelling traumatic brain injury (TBI) survivors are linked to reduced long-term survival. However, a detailed understanding of the impact of TBI upon the brain mechanisms mediating imbalance is lacking. To understand the state of the art concerning the brain mechanisms mediating imbalance in TBI, we performed a systematic review of the literature. Methods: PubMed, Web of Science, and Scopus were searched and peer-reviewed research articles in humans, with any severity of TBI (mild, moderate, severe, or concussion), which linked a postural balance assessment (objective or subjective) with brain imaging (through computed tomography, T1-weighted imaging, functional magnetic resonance imaging [fMRI], resting-state fMRI, diffusion tensor imaging, magnetic resonance spectroscopy, single-photon emission computed tomography, electroencephalography, magnetoencephalography, near-infrared spectroscopy, and evoked potentials) were included. Out of 1940 articles, 60 were retrieved and screened, and 25 articles fulfilling inclusion criteria were included. Results: The most consistent finding was the link between imbalance and the cerebellum; however, the regions within the cerebellum were inconsistent. Discussion: The lack of consistent findings could reflect that imbalance in TBI is due to a widespread brain network dysfunction, as opposed to focal cortical damage. The inconsistency in the reported findings may also be attributed to heterogeneity of methodology, including data analytical techniques, small sample sizes, and choice of control groups. Future studies should include a detailed clinical phenotyping of vestibular function in TBI patients to account for the confounding effect of peripheral vestibular disorders on imbalance and brain imaging.
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Affiliation(s)
- Zaeem Hadi
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mohammad Mahmud
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Arshad Q, Moreno-Ajona D, Goadsby PJ, Kheradmand A. What visuospatial perception has taught us about the pathophysiology of vestibular migraine. Curr Opin Neurol 2024; 37:32-39. [PMID: 38018799 PMCID: PMC11090135 DOI: 10.1097/wco.0000000000001232] [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] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW A decade has passed since vestibular migraine (VM) was formally established as a clinical entity. During this time, VM has emerged amongst the most common cause of episodic vertigo. Like all forms of migraine, VM symptoms are most prominent during individual attacks, however many patients may also develop persistent symptoms that are less prominent and can still interfere with daily activities. RECENT FINDINGS Vestibular inputs are strongly multimodal, and because of extensive convergence with other sensory information, they do not result in a distinct conscious sensation. Here we review experimental evidence that supports VM symptoms are linked to multisensory mechanisms that control body motion and position in space. SUMMARY Multisensory integration is a key concept for understanding migraine. In this context, VM pathophysiology may involve multisensory processes critical for motion perception, spatial orientation, visuospatial attention, and spatial awareness.
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Affiliation(s)
- Qadeer Arshad
- InAmind Laboratory, College of Life Sciences, University of Leicester, Leicester, UK
| | - David Moreno-Ajona
- Department of Neurology, Queen Elizabeth Hospital, London UK
- NIHR King’s Clinical Research Facility, King’s College London, UK
| | - Peter J. Goadsby
- NIHR King’s Clinical Research Facility, King’s College London, UK
- Department of Neurology, University of California, Los Angeles, CA USA
| | - 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-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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7
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Chen Z, Liu Y, Lin C, Liu D, Xiao L, Liu H, Wei X, Rong L. Altered parietal operculum cortex 2 functional connectivity in benign paroxysmal positional vertigo patients with residual dizziness: A resting-state fMRI study. CNS Neurosci Ther 2024; 30:e14570. [PMID: 38421104 PMCID: PMC10850607 DOI: 10.1111/cns.14570] [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: 08/18/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS To investigate changes in functional connectivity (FC) focusing on parietal operculum cortex 2 (OP2) in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning procedure (CRP). METHODS High-resolution three-dimensional T1 and resting-state functional magnetic resonance imaging (fMRI) were performed on 55 healthy controls (HCs), 55 BPPV patients with RD, and 55 patients without RD after successful CRP. Seed-based (bilateral OP2) FC was calculated to investigate the changes in FC among the three groups. Additionally, we further explored the associations between abnormal FC and clinical symptoms. RESULTS One-way analysis of covariance showed significant FC differences among the three groups. Post-hoc analysis showed that patients with RD exhibited decreased FC between left OP2 and regions of left angular gyrus (AG), thalamus, precuneus, middle frontal gyrus (MFG), and right cerebellum posterior lobe (CPL) in comparison with HCs. In addition, compared with patients without RD, patients with RD showed decreased FC between left OP2 and regions of left MFG, AG, middle temporal gyrus, and right CPL. Moreover, in patients with RD, the FC between left thalamus and OP2 was negatively correlated with duration of RD, and the FC between left AG and OP2 was negatively correlated with duration of BPPV. CONCLUSION BPPV patients with RD showed reduced FC between brain regions involved in vestibular processing and spatial cognition; These results suggested that BPPV patients with RD might have diminished central processing of vestibular information and impaired spatial cognition.
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Affiliation(s)
- Zhengwei Chen
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Yueji Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Cunxin Lin
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Dan Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Lijie Xiao
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Haiyan Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Xiu‐e Wei
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Liangqun Rong
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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Smith LJ, Wilkinson D, Bodani M, Surenthiran SS. Cognition in vestibular disorders: state of the field, challenges, and priorities for the future. Front Neurol 2024; 15:1159174. [PMID: 38304077 PMCID: PMC10830645 DOI: 10.3389/fneur.2024.1159174] [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: 02/05/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.
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Affiliation(s)
- Laura J. Smith
- Centre for Preventative Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
| | - David Wilkinson
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
| | - Mayur Bodani
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
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Chen KT, Huang SY, Chen YJ, Chen YY. Primary Graviceptive System and Astasia: A Case Report and Literature Review. Brain Sci 2023; 13:1371. [PMID: 37891740 PMCID: PMC10605824 DOI: 10.3390/brainsci13101371] [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: 08/02/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Astasia refers to the inability to maintain upright posture during standing, despite having full motor strength. Impairment of the vestibulocerebellar pathway, graviceptive system, and cingulate motor area have been proposed to be related to astasia. However, the responsible neural pathways remain unclear. We hypothesize that there is a common neural network behind astasia. To test the hypothesis, we reviewed all reported cases with astasia, including ours, and focused on the correlation between anatomical destruction and symptom presentation. A total of 26, including ours, non-psychogenic astasia patients were identified in the English literature. Seventy-three percent of them were associated with other neurologic symptoms and sixty-two percent of reported lesions were on the right side. Contralateral lateropulsion was very common, followed by retropulsion, when describing astasia. Infarction (54%) was the most reported cause. The thalamus (65%) was the most reported location. Infarctions were the fastest to recover (mean: 10.6 days), while lesions at the brainstem needed a longer time (mean: 61.6 days). By combining the character of lateropulsion in astasia and the presentation of an interrupted graviceptive system, we concluded that the primary graviceptive system may be the common neural network behind astasia. Future studies on astasia should focus on the pathological changes in the perception of verticality in the visual world and the body.
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Affiliation(s)
- Ko-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Sheng-Yao Huang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yi-Jye Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung 402, Taiwan;
| | - Ying-Yun Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Keelung 204, Taiwan;
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Oh SY, Nguyen TT, Kang JJ, Kirsch V, Boegle R, Kim JS, Dieterich M. Visuospatial cognition in acute unilateral peripheral vestibulopathy. Front Neurol 2023; 14:1230495. [PMID: 37789890 PMCID: PMC10542894 DOI: 10.3389/fneur.2023.1230495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
Background This study aims to investigate the presence of spatial cognitive impairments in patients with acute unilateral peripheral vestibulopathy (vestibular neuritis, AUPV) during both the acute phase and the recovery phase. Methods A total of 72 AUPV patients (37 with right-sided AUPV and 35 with left-sided AUPV; aged 34-80 years, median 60.5; 39 males, 54.2%) and 35 healthy controls (HCs; aged 43-75 years, median 59; 20 males, 57.1%) participated in the study. Patients underwent comprehensive neurotological assessments, including video-oculography, video head impulse and caloric tests, ocular and cervical vestibular-evoked myogenic potentials, and pure-tone audiometry. Additionally, the Visual Object and Space Perception (VOSP) battery was used to evaluate visuospatial perception, while the Block design test and Corsi block-tapping test assessed visuospatial memory within the first 2 days (acute phase) and 4 weeks after symptom onset (recovery phase). Results Although AUPV patients were able to successfully perform visuospatial perception tasks within normal parameters, they demonstrated statistically worse performance on the visuospatial memory tests compared to HCs during the acute phase. When comparing right versus left AUPV groups, significant decreased scores in visuospatial perception and memory were observed in the right AUPV group relative to the left AUPV group. In the recovery phase, patients showed substantial improvements even in these previously diminished visuospatial cognitive performances. Conclusion AUPV patients showed different spatial cognition responses, like spatial memory, depending on the affected ear, improving with vestibular compensation over time. We advocate both objective and subjective visuospatial assessments and the development of tests to detect potential cognitive deficits after unilateral vestibular impairments.
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Affiliation(s)
- Sun-Young Oh
- Jeonbuk National University College of Medicine, Jeonju, Republic of Korea
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Thanh Tin Nguyen
- Jeonbuk National University College of Medicine, Jeonju, Republic of Korea
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, Republic of Korea
- Department of Pharmacology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Jin-Ju Kang
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, Republic of Korea
| | - Valerie Kirsch
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Rainer Boegle
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital & School of Medicine, Seoul, Republic of Korea
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Cheron G, Ris L, Cebolla AM. Nucleus incertus provides eye velocity and position signals to the vestibulo-ocular cerebellum: a new perspective of the brainstem-cerebellum-hippocampus network. Front Syst Neurosci 2023; 17:1180627. [PMID: 37304152 PMCID: PMC10248067 DOI: 10.3389/fnsys.2023.1180627] [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: 03/06/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
The network formed by the brainstem, cerebellum, and hippocampus occupies a central position to achieve navigation. Multiple physiological functions are implicated in this complex behavior. Among these, control of the eye-head and body movements is crucial. The gaze-holding system realized by the brainstem oculomotor neural integrator (ONI) situated in the nucleus prepositus hypoglossi and fine-tuned by the contribution of different regions of the cerebellum assumes the stability of the image on the fovea. This function helps in the recognition of environmental targets and defining appropriate navigational pathways further elaborated by the entorhinal cortex and hippocampus. In this context, an enigmatic brainstem area situated in front of the ONI, the nucleus incertus (NIC), is implicated in the dynamics of brainstem-hippocampus theta oscillation and contains a group of neurons projecting to the cerebellum. These neurons are characterized by burst tonic behavior similar to the burst tonic neurons in the ONI that convey eye velocity-position signals to the cerebellar flocculus. Faced with these forgotten cerebellar projections of the NIC, the present perspective discusses the possibility that, in addition to the already described pathways linking the cerebellum and the hippocampus via the medial septum, these NIC signals related to the vestibulo-ocular reflex and gaze holding could participate in the hippocampal control of navigation.
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Affiliation(s)
- Guy Cheron
- Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles, Brussels, Belgium
- ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Neuroscience, Université de Mons, Mons, Belgium
- UMONS Research Institute for Health and Technology, Université de Mons, Mons, Belgium
| | - Laurence Ris
- Laboratory of Neuroscience, Université de Mons, Mons, Belgium
- UMONS Research Institute for Health and Technology, Université de Mons, Mons, Belgium
| | - Ana Maria Cebolla
- Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles, Brussels, Belgium
- ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
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12
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Neumann N, Fullana MA, Radua J, Brandt T, Dieterich M, Lotze M. Common neural correlates of vestibular stimulation and fear learning: an fMRI meta-analysis. J Neurol 2023; 270:1843-1856. [PMID: 36723684 PMCID: PMC10025232 DOI: 10.1007/s00415-023-11568-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND A bidirectional functional link between vestibular and fear-related disorders has been previously suggested. OBJECTIVE To test a potential overlap of vestibular and fear systems with regard to their brain imaging representation maps. METHODS By use of voxel-based mapping permutation of subject images, we conducted a meta-analysis of earlier functional magnetic resonance imaging (fMRI) studies applying vestibular stimulation and fear conditioning in healthy volunteers. RESULTS Common clusters of concordance of vestibular stimulation and fear conditioning were found in the bilateral anterior insula cortex, ventrolateral prefrontal cortex and the right temporal pole, bilaterally in the adjacent ventrolateral prefrontal cortex, cingulate gyrus, secondary somatosensory cortex, superior temporal and intraparietal lobe, supplementary motor area and premotor cortex, as well as subcortical areas, such as the bilateral thalamus, mesencephalic brainstem including the collicular complex, pons, cerebellar vermis and bilateral cerebellar hemispheres. Peak areas of high concordance for activations during vestibular stimulation but deactivations during fear conditioning were centered on the posterior insula and S2. CONCLUSIONS The structural overlap of both networks allows the following functional interpretations: first, the amygdala, superior colliculi, and antero-medial thalamus might represent a release of preprogramed sensorimotor patterns of approach or avoidance. Second, the activation (vestibular system) and deactivation (fear system) of the bilateral posterior insula is compatible with the view that downregulation of the fear network by acute vestibular disorders or unfamiliar vestibular stimulation makes unpleasant perceived body accelerations less distressing. This also fits the clinical observation that patients with bilateral vestibular loss suffer from less vertigo-related anxiety.
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Affiliation(s)
- Nicola Neumann
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Str. 46, 17475, Greifswald, Germany
| | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, University of Barcelona, Barcelona, Spain
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- SyNergy-Munich Cluster for Systems Neurology, Munich, Germany
| | - Martin Lotze
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Str. 46, 17475, Greifswald, Germany.
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13
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Park JY, Choi JH, Kwon JH, Weon YC, Lee SM, Kim HJ, Choi SY, Oh EH, Kim HA, Lee H, Kim JS, Choi KD. Incidence, characteristics, and neuroanatomical substrates of vestibular symptoms in supratentorial stroke. J Neurol 2023; 270:2174-2183. [PMID: 36633670 DOI: 10.1007/s00415-023-11566-9] [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] [Received: 10/25/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
The incidence and characteristics of acute vestibular symptoms, responsible structures, and lateralization of the causative lesions in supratentorial stroke remain unknown. This study aimed to determine the incidence, clinical features, and anatomical correlation of acute vestibular symptoms in supratentorial stroke. We performed a prospective, multicenter, observational study that had recruited patients with supratentorial stroke from the neurology clinics of referral-based four university hospitals in Korea. All patients received a constructed neuro-otological evaluations, and neuroimaging. We analyzed the incidence of acute vestibular symptoms, abnormal ocular motor and vestibular function tests, and stroke lesions. Of 1301 patients with supratentorial stroke, 48 (3.7%) presented with acute vestibular symptoms, and 13 of them (1%) had the vestibular symptoms in isolation. In patients with acute vestibular symptoms, abnormal findings included spontaneous nystagmus (5%), impaired horizontal smooth pursuit (41%), and abnormal tilt of the subjective visual vertical (SVV) (20%). Video head impulse and caloric tests were normal in all the patients. There was no clear correlation between acute vestibular symptoms and involvement of specific vestibular cortex. In patients with unilateral stroke, there was also no lateralization of the causative lesions of acute vestibular symptoms (left vs. right; 52 vs. 48%), even in patients with vertigo (left vs. right; 58 vs. 42%). This study demonstrates that the incidence of acute vestibular symptoms in supratentorial stroke is 3.7%, with being isolated in 1%. The widespread lesions responsible for acute vestibular symptoms implicate diffuse multisensory cortical-subcortical networks in the cerebral hemispheres without a lateralization.
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Affiliation(s)
- Ji-Yun Park
- Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young Cheol Weon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Suk-Min Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
| | - Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea.
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14
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Chen Z, Rong L, Xiao L, Wang Q, Liu Y, Lin C, Wang J, Liu H, Wei XE. Altered brain function in patients with vestibular migraine: a study on resting state functional connectivity. Neuroradiology 2023; 65:579-590. [PMID: 36447059 DOI: 10.1007/s00234-022-03086-6] [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: 07/11/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To characterize the altered brain function in patients with vestibular migraine (VM) using resting-state functional magnetic resonance imaging (fMRI). METHODS In this prospective study, fMRI images as well as clinical characteristics and behavioral scales were collected from 40 VM patients and 40 healthy controls (HC). All patients received neurological, neuro-otological, and conventional MRI examinations to exclude peripheral vestibular lesions, focal lesions, and other neurological diseases. Seed-based (bilateral parietal operculum cortex 2, OP2) functional connectivity (FC) and independent component analysis (ICA)-based functional network connectivity (FNC) were performed to investigate the brain functional changes in patients with VM. Additionally, the correlations between the altered FC/FNC and behavioral results were analyzed. RESULTS Compared with HC, patients with VM showed increased FC between the left OP2 and right precuneus and exhibited decreased FC between the left OP2 and left anterior cingulate cortex. We also observed increased FC between the right OP2 and regions of the right middle frontal gyrus and bilateral precuneus, as well as decreased FC between the bilateral OP2. Furthermore, patients with VM showed decreased FNC between visual network (VN) and networks of auditory and default mode, and exhibited increased FNC between VN and executive control network. A correlation analysis found that FC between the left OP2 and right precuneus was positively correlated with scores of dizziness handicap inventory (DHI) in patients with VM. CONCLUSION The present study demonstrated altered brain function in patients with VM.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Quan Wang
- Medical Imaging Department, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Yueji Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Cunxin Lin
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Jianing Wang
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China.
| | - Xiu-E Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, 221006, Jiangsu Province, China.
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15
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Kwon KJ, Byun JY. Asymmetry of Gray- and White-Matter Volume and Metabolites in the Central-Vestibular System in Healthy Individuals. J Clin Med 2023; 12:jcm12041272. [PMID: 36835808 PMCID: PMC9967821 DOI: 10.3390/jcm12041272] [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: 12/26/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023] Open
Abstract
This study was designed to determine whether there was an asymmetry of structure and neurochemical activity of the interhemispheric vestibular-cortical system between healthy individuals and patients with vestibular failure. Previous studies have identified differences in gray-matter-volume (GMV) and white-matter-volume (WMV) asymmetry in the central-vestibular system and in concentrations of brain metabolites in the parietal lobe 2 (PO2) between patients with vestibulopathy and healthy controls. However, a comparison of the left and right sides in the healthy controls has not been made conclusively. This study included 23 healthy right-handed volunteers, and was carried out between March 2016 and March 2020. A three-dimensional T1-weighted image was used to calculate the GMV and WMV of the central-vestibular network on both sides, and proton magnetic resonance spectroscopy (H1MRS) was employed to analyze the brain metabolites in the PO2 area. The relative ratios of N-acetylaspartate (NAA)/tCr, tNAA/tCr, glycerophosphocholine (GPC)/tCr, Glx/tCr, and myo-inositol/tCr were quantified from the proton-MRS data. GMV and WMV differed significantly between the right and left vestibular-cortical regions. The GMVs of the right PO2, caudate, insula, and precuneus were significantly higher than those of the same locations on the left side; however, in the Rolandic operculum, the GMV on the left was significantly higher than on the right. In the PO2, Rolandic operculum, thalamus, and insula, the WMV on the left side was higher than on the right side of the corresponding location. However, the right caudate and precuneus WMV were higher than the left at the same location. In the H1MRS study, the Glx/tCr and GPC/tCr ratios on the left side were significantly higher than on the right. In comparison, the NAA/tCr and tNAA/tCr ratios showed contrasting results. The NAA/tCr ratio (r = -0.478, p = 0.021), tNAA/tCr ratio (r = -0.537, p = 0.008), and Glx/tCr ratio (r = -0.514, p = 0.012) on the right side showed a significant negative correlation with the participants' age. There was no relationship between GMV and metabolites on either side. Brain structure and concentrations of brain metabolites related to the vestibular system may differ between the two hemispheres in healthy individuals. Therefore, the asymmetry of the central-vestibular system should be considered when performing imaging.
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16
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Becker-Bense S, Kaiser L, Becker R, Feil K, Muth C, Albert NL, Unterrainer M, Bartenstein P, Strupp M, Dieterich M. Acetyl-DL-leucine in cerebellar ataxia ([ 18F]-FDG-PET study): how does a cerebellar disorder influence cortical sensorimotor networks? J Neurol 2023; 270:44-56. [PMID: 35876876 PMCID: PMC9813104 DOI: 10.1007/s00415-022-11252-2] [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: 02/19/2022] [Revised: 05/27/2022] [Accepted: 06/20/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of the study was to deepen our insights into central compensatory processes of brain networks in patients with cerebellar ataxia (CA) before and with treatment with acetyl-DL-leucine (AL) by means of resting-state [18F]-FDG-PET brain imaging. METHODS Retrospective analyses of [18F]-FDG-PET data in 22 patients with CA (with vestibular and ocular motor disturbances) of different etiologies who were scanned before (PET A) and on AL treatment (PET B). Group subtraction analyses, e.g., for responders and non-responders, comparisons with healthy controls and correlation analyses of regional cerebral glucose metabolism (rCGM) with symptom duration, ataxia (SARA) and quality of life (QoL) scores were calculated. RESULTS Prior to treatment rCGM was consistently downregulated at the cerebellar level and increased in multisensory cortical areas, e.g., somatosensory, primary and secondary visual (including V5, precuneus), secondary vestibular (temporal gyrus, anterior insula), and premotor/supplementary motor areas. With AL (PET B vs. A) cerebellar hypometabolism was deepened and sensorimotor hypermetabolism increased only in responders with clinical benefit, but not for the non-responders and the whole CA group. A positive correlation of ataxia improvement with rCGM was found in visual and vestibular cortices, a negative correlation in cerebellar and brainstem areas. QoL showed a positive correlation with rCGM in the cerebellum and symptom duration in premotor and somatosensory areas. CONCLUSIONS Central compensatory processes in CA mainly involve multisensory visual, vestibular, and somatosensory networks as well as premotor/primary motor areas at the cortical level. The enhanced divergence of cortical sensorimotor up- and cerebellar downregulation with AL in responders could reflect amplification of inhibitory cerebellar mechanisms.
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Affiliation(s)
- Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Lena Kaiser
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Regina Becker
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Feil
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Carolin Muth
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Unterrainer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Michael Strupp
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
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17
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Hadi Z, Mahmud M, Pondeca Y, Calzolari E, Chepisheva M, Smith RM, Rust HM, Sharp DJ, Seemungal BM. The human brain networks mediating the vestibular sensation of self-motion. J Neurol Sci 2022; 443:120458. [PMID: 36332321 DOI: 10.1016/j.jns.2022.120458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/18/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Vestibular Agnosia - where peripheral vestibular activation triggers the usual reflex nystagmus response but with attenuated or no self-motion perception - is found in brain disease with disrupted cortical network functioning, e.g. traumatic brain injury (TBI) or neurodegeneration (Parkinson's Disease). Patients with acute focal hemispheric lesions (e.g. stroke) do not manifest vestibular agnosia. Thus, brain network mapping techniques, e.g. resting state functional MRI (rsfMRI), are needed to interrogate functional brain networks mediating vestibular agnosia. Hence, we prospectively recruited 39 acute TBI patients with preserved peripheral vestibular function and obtained self-motion perceptual thresholds during passive yaw rotations in the dark and additionally acquired whole-brain rsfMRI in the acute phase. Following quality-control checks, 26 patient scans were analyzed. Using self-motion perceptual thresholds from a matched healthy control group, 11 acute TBI patients were classified as having vestibular agnosia versus 15 with normal self-motion perception thresholds. Using independent component analysis on the rsfMRI data, we found altered functional connectivity in bilateral lingual gyrus and temporo-occipital fusiform cortex in the vestibular agnosia patients. Moreover, regions of interest analyses showed both inter-hemispheric and intra-hemispheric network disruption in vestibular agnosia. In conclusion, our results show that vestibular agnosia is mediated by bilateral anterior and posterior network dysfunction and reveal the distributed brain mechanisms mediating vestibular self-motion perception.
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Affiliation(s)
- Zaeem Hadi
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK.
| | - Mohammad Mahmud
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Yuscah Pondeca
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Elena Calzolari
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Mariya Chepisheva
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Rebecca M Smith
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK
| | - Heiko M Rust
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK; Neurology, Universitätsspital Basel, Basel, Switzerland
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, UK
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, UK.
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18
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Gerb J, Becker-Bense S, Zwergal A, Huppert D. Vestibular syndromes after COVID-19 vaccination: a prospective cohort study. Eur J Neurol 2022; 29:3693-3700. [PMID: 36056895 PMCID: PMC9538778 DOI: 10.1111/ene.15546] [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: 06/01/2022] [Revised: 07/05/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Dizziness and vertigo are common symptoms after COVID‐19‐vaccination. We aimed to prospectively evaluate objective central or peripheral vestibular function in patients with dizziness, vertigo, and postural symptoms that started or worsened after COVID‐19‐vaccination. Methods Of 4137 patients who presented between January 2021 and April 2022 at the German Center for Vertigo and Balance Disorders, Ludwig Maximilian University of Munich, we identified 72 patients (mean age = 47 years) with enduring vestibular symptoms following COVID‐19 vaccination. All underwent medical history‐taking, and neurological and neuro‐otological workup with bithermal caloric test, video head‐impulse test, orthoptics, and audiometry. Diagnoses were based on international criteria. The distribution of diagnoses was compared to a cohort of 39,964 patients seen before the COVID‐19 pandemic. Results Symptom onset was within the first 4 weeks postvaccination. The most prevalent diagnoses were somatoform vestibular disorders (34.7%), vestibular migraine (19.4%), and overlap syndromes of both (18.1%). These disorders were significantly overrepresented compared to the prepandemic control cohort. Thirty‐six percent of patients with somatoform complaints reported a positive history of depressive or anxiety disorders. Nine patients presented with benign paroxysmal positional vertigo, three with acute unilateral vestibulopathy, and seven with different entities (vestibular paroxysmia, Ménière disease, polyneuropathy, ocular muscular paresis). Causally related central vestibular deficits were lacking. Novel peripheral vestibular deficits were found in four patients. Conclusions Newly induced persistent vestibular deficits following COVID‐19 vaccination were rare. The predominant causes of prolonged vestibular complaints were somatoform vestibular disorders and vestibular migraine, possibly triggered or aggravated by stress‐related circumstances due to the COVID‐19 pandemic or vaccination. An increase of other central or peripheral vestibular syndromes after COVID‐19 vaccination was not observed.
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Affiliation(s)
- Johannes Gerb
- German Center for Vertigo and Balance Disorders-DSGZ, Ludwig-Maximilians University Munich, Munich, Germany.,Department of Neurology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders-DSGZ, Ludwig-Maximilians University Munich, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders-DSGZ, Ludwig-Maximilians University Munich, Munich, Germany.,Department of Neurology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders-DSGZ, Ludwig-Maximilians University Munich, Munich, Germany
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19
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Chang DHF, Thinnes D, Au PY, Maziero D, Stenger VA, Sinnett S, Vibell J. Sound-modulations of visual motion perception implicate the cortico-vestibular brain. Neuroimage 2022; 257:119285. [PMID: 35537600 DOI: 10.1016/j.neuroimage.2022.119285] [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: 03/07/2022] [Revised: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
A widely used example of the intricate (yet poorly understood) intertwining of multisensory signals in the brain is the audiovisual bounce inducing effect (ABE). This effect presents two identical objects moving along the azimuth with uniform motion and towards opposite directions. The perceptual interpretation of the motion is ambiguous and is modulated if a transient (sound) is presented in coincidence with the point of overlap of the two objects' motion trajectories. This phenomenon has long been written-off to simple attentional or decision-making mechanisms, although the neurological underpinnings for the effect are not well understood. Using behavioural metrics concurrently with event-related fMRI, we show that sound-induced modulations of motion perception can be further modulated by changing motion dynamics of the visual targets. The phenomenon engages the posterior parietal cortex and the parieto-insular-vestibular cortical complex, with a close correspondence of activity in these regions with behaviour. These findings suggest that the insular cortex is engaged in deriving a probabilistic perceptual solution through the integration of multisensory data.
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Affiliation(s)
- Dorita H F Chang
- Department of Psychology and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
| | - David Thinnes
- Department of Psychology, University of Hawai'i at Mānoa, Hawaii, USA; Faculty of Medicine, Systems Neuroscience & Neurotechnology Unit, Saarland University & HTW Saar, Germany
| | - Pak Yam Au
- Department of Psychology and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Danilo Maziero
- Department of Medicine, MR Research Program, John A. Burns School of Medicine, University of Hawai'i, HI, USA
| | - Victor Andrew Stenger
- Department of Medicine, MR Research Program, John A. Burns School of Medicine, University of Hawai'i, HI, USA
| | - Scott Sinnett
- Department of Psychology, University of Hawai'i at Mānoa, Hawaii, USA
| | - Jonas Vibell
- Department of Psychology, University of Hawai'i at Mānoa, Hawaii, USA.
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Conrad J, Boegle R, Ruehl RM, Dieterich M. Evaluating the rare cases of cortical vertigo using disconnectome mapping. Brain Struct Funct 2022; 227:3063-3073. [PMID: 35838791 DOI: 10.1007/s00429-022-02530-w] [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: 02/17/2022] [Accepted: 06/26/2022] [Indexed: 12/26/2022]
Abstract
In rare cases, cortical infarcts lead to vertigo. We evaluated structural and functional disconnection in patients with acute vertigo due to unilateral ischemic cortical infarcts compared to infarcts without vertigo in a similar location with a focus on the connectivity of the vestibular cortex, i.e., the parieto-opercular (retro-)insular cortex (PIVC). Using lesion maps from the ten published case reports, we computed lesion-functional connectivity networks in a set of healthy individuals from the human connectome project. The probability of lesion disconnection was evaluated by white matter disconnectome mapping. In all ten cases with rotational vertigo, disconnections of interhemispheric connections via the corpus callosum were present but were spared in lesions of the PIVC without vertigo. Further, the arcuate fascicle was affected in 90% of the lesions that led to vertigo and spared in lesions that did not lead to vertigo. The lesion-functional connectivity network included vestibulo-cerebellar hubs, the vestibular nuclei, the PIVC, the retro-insular and posterior insular cortex, the multisensory vestibular ventral intraparietal area, motion-sensitive areas (temporal area MT+ and cingulate visual sulcus) as well as hubs for ocular motor control (lateral intraparietal area, cingulate and frontal eye fields). However, this was not sufficient to differentiate between lesions with and without vertigo. Disruption of interhemispheric connections of both PIVC via the corpus callosum and intra-hemispheric disconnection via the arcuate fascicle might be the distinguishing factor between vestibular cortical network lesions that manifest with vertigo compared to those without vertigo.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), Munich University Hospital, LMU Munich, Munich, Germany.
| | - Rainer Boegle
- Department of Neurology, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN-LMU), LMU Munich, Munich, Germany
| | - Ria Maxine Ruehl
- Department of Neurology, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Munich University Hospital, LMU Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Munich University Hospital, LMU Munich, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN-LMU), LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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21
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Dieterich M. Editorial: Imaging of the Vestibular System. Front Neurol 2022; 13:937955. [PMID: 35812085 PMCID: PMC9260683 DOI: 10.3389/fneur.2022.937955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
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Kwon E, Lee JY, Song JM, Kim HJ, Lee JH, Choi JY, Kim JS. Impaired Duration Perception in Patients With Unilateral Vestibulopathy During Whole-Body Rotation. Front Integr Neurosci 2022; 16:818775. [PMID: 35719188 PMCID: PMC9204839 DOI: 10.3389/fnint.2022.818775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/22/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to evaluate vestibular perception in patients with unilateral vestibulopathy. We recruited 14 patients (9 women, mean age = 59.3 ± 14.3) with unilateral vestibulopathy during the subacute or chronic stage (disease duration = 6 days to 25 years). For the evaluation of position perception, the patients had to estimate the position after whole-body rotation in the yaw plane. The velocity/acceleration perception was evaluated by acquiring decisions of patients regarding which direction would be the faster rotation after a pair of ipsi- and contra-lesional rotations at various velocity/acceleration settings. The duration perception was assessed by collecting decisions of patients for longer rotation directions at each pair of ipsi- and contra-lesional rotations with various velocities and amplitudes. Patients with unilateral vestibulopathy showed position estimates and velocity/acceleration discriminations comparable to healthy controls. However, in duration discrimination, patients had a contralesional bias such that they had a longer perception period for the healthy side during the equal duration and same amplitude rotations. For the complex duration task, where a longer duration was assigned to a smaller rotation amplitude, the precision was significantly lower in the patient group than in the control group. These results indicate persistent impairments of duration perception in unilateral vestibulopathy and favor the intrinsic and distributed timing mechanism of the vestibular system. Complex perceptual tasks may be helpful to disclose hidden perceptual disturbances in unilateral vestibular hypofunction.
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Affiliation(s)
- Eunjin Kwon
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
| | - Ju-Young Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jung-Mi Song
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jong-Hee Lee
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, South Korea
- Department of Neurology, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seoul, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seongnam-si, South Korea
- *Correspondence: Jeong-Yoon Choi,
| | - Ji-Soo Kim
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam-si, South Korea
- Department of Neurology, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seoul, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seongnam-si, South Korea
- Ji-Soo Kim,
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23
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Ahmadi SA, Frei J, Vivar G, Dieterich M, Kirsch V. IE-Vnet: Deep Learning-Based Segmentation of the Inner Ear's Total Fluid Space. Front Neurol 2022; 13:663200. [PMID: 35645963 PMCID: PMC9130477 DOI: 10.3389/fneur.2022.663200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
Background In-vivo MR-based high-resolution volumetric quantification methods of the endolymphatic hydrops (ELH) are highly dependent on a reliable segmentation of the inner ear's total fluid space (TFS). This study aimed to develop a novel open-source inner ear TFS segmentation approach using a dedicated deep learning (DL) model. Methods The model was based on a V-Net architecture (IE-Vnet) and a multivariate (MR scans: T1, T2, FLAIR, SPACE) training dataset (D1, 179 consecutive patients with peripheral vestibulocochlear syndromes). Ground-truth TFS masks were generated in a semi-manual, atlas-assisted approach. IE-Vnet model segmentation performance, generalizability, and robustness to domain shift were evaluated on four heterogenous test datasets (D2-D5, n = 4 × 20 ears). Results The IE-Vnet model predicted TFS masks with consistently high congruence to the ground-truth in all test datasets (Dice overlap coefficient: 0.9 ± 0.02, Hausdorff maximum surface distance: 0.93 ± 0.71 mm, mean surface distance: 0.022 ± 0.005 mm) without significant difference concerning side (two-sided Wilcoxon signed-rank test, p>0.05), or dataset (Kruskal-Wallis test, p>0.05; post-hoc Mann-Whitney U, FDR-corrected, all p>0.2). Prediction took 0.2 s, and was 2,000 times faster than a state-of-the-art atlas-based segmentation method. Conclusion IE-Vnet TFS segmentation demonstrated high accuracy, robustness toward domain shift, and rapid prediction times. Its output works seamlessly with a previously published open-source pipeline for automatic ELS segmentation. IE-Vnet could serve as a core tool for high-volume trans-institutional studies of the inner ear. Code and pre-trained models are available free and open-source under https://github.com/pydsgz/IEVNet.
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Affiliation(s)
- Seyed-Ahmad Ahmadi
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- NVIDIA GmbH, Munich, Germany
| | - Johann Frei
- IT-Infrastructure for Translational Medical Research, University of Augsburg, Augsburg, Germany
| | - Gerome Vivar
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Computer Aided Medical Procedures (CAMP), Technical University of Munich (TUM), Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Valerie Kirsch
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
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Retention Effects of Long-Term Balance Training with Vibrotactile Sensory Augmentation in Healthy Older Adults. SENSORS 2022; 22:s22083014. [PMID: 35459000 PMCID: PMC9027305 DOI: 10.3390/s22083014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/25/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023]
Abstract
Vibrotactile sensory augmentation (SA) decreases postural sway during real-time use; however, limited studies have investigated the long-term effects of training with SA. This study assessed the retention effects of long-term balance training with and without vibrotactile SA among community-dwelling healthy older adults, and explored brain-related changes due to training with SA. Sixteen participants were randomly assigned to the experimental group (EG) or control group (CG), and trained in their homes for eight weeks using smart-phone balance trainers. The EG received vibrotactile SA. Balance performance was assessed before, and one week, one month, and six months after training. Functional MRI (fMRI) was recorded before and one week after training for four participants who received vestibular stimulation. Both groups demonstrated significant improvement of SOT composite and MiniBESTest scores, and increased vestibular reliance. Only the EG maintained a minimal detectable change of 8 points in SOT scores six months post-training and greater improvements than the CG in MiniBESTest scores one month post-training. The fMRI results revealed a shift from activation in the vestibular cortex pre-training to increased activity in the brainstem and cerebellum post-training. These findings showed that additional balance improvements were maintained for up to six months post-training with vibrotactile SA for community-dwelling healthy older adults.
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25
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Longitudinal [18]UCB-H/[18F]FDG imaging depicts complex patterns of structural and functional neuroplasticity following bilateral vestibular loss in the rat. Sci Rep 2022; 12:6049. [PMID: 35411002 PMCID: PMC9001652 DOI: 10.1038/s41598-022-09936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
Neuronal lesions trigger mechanisms of structural and functional neuroplasticity, which can support recovery. However, the temporal and spatial appearance of structure–function changes and their interrelation remain unclear. The current study aimed to directly compare serial whole-brain in vivo measurements of functional plasticity (by [18F]FDG-PET) and structural synaptic plasticity (by [18F]UCB-H-PET) before and after bilateral labyrinthectomy in rats and investigate the effect of locomotor training. Complex structure–function changes were found after bilateral labyrinthectomy: in brainstem-cerebellar circuits, regional cerebral glucose metabolism (rCGM) decreased early, followed by reduced synaptic density. In the thalamus, increased [18F]UCB-H binding preceded a higher rCGM uptake. In frontal-basal ganglia loops, an increase in synaptic density was paralleled by a decrease in rCGM. In the group with locomotor training, thalamic rCGM and [18F]UCB-H binding increased following bilateral labyrinthectomy compared to the no training group. Rats with training had considerably fewer body rotations. In conclusion, combined [18F]FDG/[18F]UCB-H dual tracer imaging reveals that adaptive neuroplasticity after bilateral vestibular loss is not a uniform process but is composed of complex spatial and temporal patterns of structure–function coupling in networks for vestibular, multisensory, and motor control, which can be modulated by early physical training.
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Zwergal A, Lindner M, Grosch M, Dieterich M. In vivo neuroplasticity in vestibular animal models. Mol Cell Neurosci 2022; 120:103721. [PMID: 35338004 DOI: 10.1016/j.mcn.2022.103721] [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: 02/12/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 12/21/2022] Open
Abstract
An acute unilateral vestibulopathy leads to symptoms of vestibular tone imbalance, which gradually decrease over days to weeks due to central vestibular compensation. Animal models of acute peripheral vestibular lesions are optimally suited to investigate the mechanisms underlying this lesion-induced adaptive neuroplasticity. Previous studies applied ex vivo histochemical techniques or local in vivo electrophysiological recordings mostly in the vestibular nucleus complex to delineate the mechanisms involved. Recently, the use of imaging methods, such as positron emission tomography (PET) or magnetic resonance imaging (MRI), in vestibular animal models have opened a complementary perspective by depicting whole-brain structure and network changes of neuronal activity over time and in correlation to behaviour. Here, we review recent multimodal imaging studies in vestibular animal models with a focus on PET-based measurements of glucose metabolism, glial activation and synaptic plasticity. [18F]-FDG-PET studies indicate dynamic alterations of regional glucose metabolism in brainstem-cerebellar, thalamic, cortical sensory and motor, as well as limbic areas starting early after unilateral labyrinthectomy (UL) in the rat. Sequential whole-brain analysis of the metabolic connectome during vestibular compensation shows a significant increase of connections mostly in the contralesional hemisphere after UL, which reaches a maximum at day 3 and thereby parallels the course of vestibular recovery. Glial activation in the ipsilesional vestibular nerve and nucleus peak between days 7 and 15 after UL. Synaptic density in brainstem-cerebellar circuits decreases until 8 weeks after UL, while it increases in frontal, motor and sensory cortical areas. We finally report how pharmacological compounds modulate the functional and structural plasticity mechanisms during vestibular compensation.
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Affiliation(s)
- Andreas Zwergal
- Department of Neurology, University Hospital, LMU Munich, Germany; German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Germany.
| | - Magdalena Lindner
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Germany; Department of Nuclear Medicine, LMU Munich, Germany
| | - Maximilian Grosch
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, LMU Munich, Germany; German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Germany; Munich Cluster of Systems Neurology, SyNergy, Munich, Germany
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27
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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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White matter volume loss drives cortical reshaping after thalamic infarcts. Neuroimage Clin 2022; 33:102953. [PMID: 35139478 PMCID: PMC8844789 DOI: 10.1016/j.nicl.2022.102953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/10/2022] [Accepted: 02/01/2022] [Indexed: 11/24/2022]
Abstract
White matter volume loss after unilateral thalamic infarcts shows the trajectories of sensory and ocular motor input from the brainstem to the thalamus and their thalamocortical connections. The extensive volume loss drives reshaping of the cortex more than grey matter atrophy. Associated ocular motor and vestibular symptoms are compensated over time due to their redundant and intermingled connectivity and an early integration with other sensory modalities. Associated ocular motor and vestibular symptoms are compensated over time due to their redundant and intermingled connectivity and an early integration with other sensory modalities.
Objective The integration of somatosensory, ocular motor and vestibular signals is necessary for self-location in space and goal-directed action. We aimed to detect remote changes in the cerebral cortex after thalamic infarcts to reveal the thalamo-cortical connections necessary for multisensory processing and ocular motor control. Methods Thirteen patients with unilateral ischemic thalamic infarcts presenting with vestibular, somatosensory, and ocular motor symptoms were examined longitudinally in the acute phase and after six months. Voxel- and surface-based morphometry were used to detect changes in vestibular and multisensory cortical areas and known hubs of central ocular motor processing. The results were compared with functional connectivity data in 50 healthy volunteers. Results Patients with paramedian infarcts showed impaired saccades and vestibular perception, i.e., tilts of the subjective visual vertical (SVV). The most common complaint in these patients was double vision or vertigo / dizziness. Posterolateral thalamic infarcts led to tilts of the SVV and somatosensory deficits without vertigo. Tilts of the SVV were higher in paramedian compared to posterolateral infarcts (median 11.2° vs 3.8°). Vestibular and ocular motor symptoms recovered within six months. Somatosensory deficits persisted. Structural longitudinal imaging showed significant volume reduction in subcortical structures connected to the infarcted thalamic nuclei (vestibular nuclei region, dentate nucleus region, trigeminal root entry zone, medial lemniscus, superior colliculi). Volume loss was evident in connections to the frontal, parietal and cingulate lobes. Changes were larger in the ipsilesional hemisphere but were also detected in homotopical regions contralesionally. The white matter volume reduction led to deformation of the cortical projection zones of the infarcted nuclei. Conclusions White matter volume loss after thalamic infarcts reflects sensory input from the brainstem as well the cortical projections of the main affected nuclei for sensory and ocular motor processing. Changes in the cortical geometry seem not to reflect gray matter atrophy but rather reshaping of the cortical surface due to the underlying white matter atrophy.
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Conrad J, Habs M, Ruehl RM, Boegle R, Ertl M, Kirsch V, Eren O, Becker-Bense S, Stephan T, Wollenweber F, Duering M, Dieterich M, Zu Eulenburg P. Reorganization of sensory networks after subcortical vestibular infarcts - A longitudinal symptom-related VBM study. Eur J Neurol 2022; 29:1514-1523. [PMID: 35098611 DOI: 10.1111/ene.15263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to delineate common principles of reorganization after infarcts of the subcortical vestibular circuitry related to the clinical symptomatology. Our hypothesis was that the recovery of specific symptoms is associated with changes in distinct regions within the core vestibular, somatosensory and visual cortical and subcortical networks. METHODS We used voxel- and surface-based morphometry to investigate structural reorganization of subcortical and cortical brain areas in 42 patients with a unilateral, subcortical infarct with vestibular and ocular motor deficits in the acute phase. The patients received structural neuroimaging and clinical monitoring twice (acute phase and after 6 months) to detect within-subject changes over time. RESULTS In patients with vestibular signs such as tilts of the subjective visual vertical (SVV) and ocular torsion in the acute phase, significant volumetric increases in the superficial white matter around the parieto-(retro-)insular vestibular cortex (PIVC) were found at follow-up. In patients with SVV tilts, spontaneous nystagmus and rotatory vertigo in the acute phase gray matter volume decreases were located in the cerebellum and the visual cortex bilaterally at follow-up. Patients with saccade pathology demonstrated volumetric decreases in cerebellar, thalamic and cortical centers for ocular motor control. CONCLUSIONS The findings support the role of the PIVC as the key hub for vestibular processing and reorganization. The volumetric decreases represent the reciprocal interaction of the vestibular, visual and ocular motor systems during self-location and egomotion detection. A modulation in vestibular and ocular motor as well as visual networks was induced independent of the vestibular lesion site.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Maximilian Habs
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Ria Maxine Ruehl
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Rainer Boegle
- Department of Neurology, University Hospital, LMU Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany
| | - Matthias Ertl
- Department of Psychology, University of Bern, Switzerland
| | - Valerie Kirsch
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany
| | - Ozan Eren
- Department of Neurology, University Hospital, LMU Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany
| | - Thomas Stephan
- Department of Neurology, University Hospital, LMU Munich, Germany
| | - Frank Wollenweber
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany.,Department of Neurology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany.,Medical Image Analysis Center (MIAC) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Marianne Dieterich
- Department of Neurology, University Hospital, LMU Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Germany.,Institute for Neuroradiology LMU Munich, Germany
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30
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Cauzzo S, Singh K, Stauder M, García-Gomar MG, Vanello N, Passino C, Staab J, Indovina I, Bianciardi M. Functional connectome of brainstem nuclei involved in autonomic, limbic, pain and sensory processing in living humans from 7 Tesla resting state fMRI. Neuroimage 2022; 250:118925. [PMID: 35074504 DOI: 10.1016/j.neuroimage.2022.118925] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/24/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
Despite remarkable advances in mapping the functional connectivity of the cortex, the functional connectivity of subcortical regions is understudied in living humans. This is the case for brainstem nuclei that control vital processes, such as autonomic, limbic, nociceptive and sensory functions. This is because of the lack of precise brainstem nuclei localization, of adequate sensitivity and resolution in the deepest brain regions, as well as of optimized processing for the brainstem. To close the gap between the cortex and the brainstem, on 20 healthy subjects, we computed a correlation-based functional connectome of 15 brainstem nuclei involved in autonomic, limbic, nociceptive, and sensory function (superior and inferior colliculi, ventral tegmental area-parabrachial pigmented nucleus complex, microcellular tegmental nucleus-prabigeminal nucleus complex, lateral and medial parabrachial nuclei, vestibular and superior olivary complex, superior and inferior medullary reticular formation, viscerosensory motor nucleus, raphe magnus, pallidus, and obscurus, and parvicellular reticular nucleus - alpha part) with the rest of the brain. Specifically, we exploited 1.1mm isotropic resolution 7 Tesla resting-state fMRI, ad-hoc coregistration and physiological noise correction strategies, and a recently developed probabilistic template of brainstem nuclei. Further, we used 2.5mm isotropic resolution resting-state fMRI data acquired on a 3 Tesla scanner to assess the translatability of our results to conventional datasets. We report highly consistent correlation coefficients across subjects, confirming available literature on autonomic, limbic, nociceptive and sensory pathways, as well as high interconnectivity within the central autonomic network and the vestibular network. Interestingly, our results showed evidence of vestibulo-autonomic interactions in line with previous work. Comparison of 7 Tesla and 3 Tesla findings showed high translatability of results to conventional settings for brainstem-cortical connectivity and good yet weaker translatability for brainstem-brainstem connectivity. The brainstem functional connectome might bring new insight in the understanding of autonomic, limbic, nociceptive and sensory function in health and disease.
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Affiliation(s)
- Simone Cauzzo
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Life Sciences Institute, Sant'Anna School of Advanced Studies, Pisa, Italy.
| | - Kavita Singh
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Matthew Stauder
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - María Guadalupe García-Gomar
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Nicola Vanello
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, Pisa, Italy
| | - Claudio Passino
- Life Sciences Institute, Sant'Anna School of Advanced Studies, Pisa, Italy; Dipartimento di Ingegneria dell'Informazione, University of Pisa, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Jeffrey Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Iole Indovina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy; Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marta Bianciardi
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Sleep Medicine, Harvard University, Boston, MA.
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Nguyen TT, Nam GS, Kang JJ, Han GC, Kim JS, Dieterich M, Oh SY. The Differential Effects of Acute Right- vs. Left-Sided Vestibular Deafferentation on Spatial Cognition in Unilateral Labyrinthectomized Mice. Front Neurol 2021; 12:789487. [PMID: 34956067 PMCID: PMC8692718 DOI: 10.3389/fneur.2021.789487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the disparity in locomotor and spatial memory deficits caused by left- or right-sided unilateral vestibular deafferentation (UVD) using a mouse model of unilateral labyrinthectomy (UL) and to examine the effects of galvanic vestibular stimulation (GVS) on the deficits over 14 days. Five experimental groups were established: the left-sided and right-sided UL (Lt.-UL and Rt.-UL) groups, left-sided and right-sided UL with bipolar GVS with the cathode on the lesion side (Lt.-GVS and Rt.-GVS) groups, and a control group with sham surgery. We assessed the locomotor and cognitive-behavioral functions using the open field (OF), Y maze, and Morris water maze (MWM) tests before (baseline) and 3, 7, and 14 days after surgical UL in each group. On postoperative day (POD) 3, locomotion and spatial working memory were more impaired in the Lt.-UL group compared with the Rt.-UL group (p < 0.01, Tamhane test). On POD 7, there was a substantial difference between the groups; the locomotion and spatial navigation of the Lt.-UL group recovered significantly more slowly compared with those of the Rt.-UL group. Although the differences in the short-term spatial cognition and motor coordination were resolved by POD 14, the long-term spatial navigation deficits assessed by the MWM were significantly worse in the Lt.-UL group compared with the Rt.-UL group. GVS intervention accelerated the vestibular compensation in both the Lt.-GVS and Rt.-GVS groups in terms of improvement of locomotion and spatial cognition. The current data imply that right- and left-sided UVD impair spatial cognition and locomotion differently and result in different compensatory patterns. Sequential bipolar GVS when the cathode (stimulating) was assigned to the lesion side accelerated recovery for UVD-induced spatial cognition, which may have implications for managing the patients with spatial cognitive impairment, especially that induced by unilateral peripheral vestibular damage on the dominant side.
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Affiliation(s)
- Thanh Tin Nguyen
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, South Korea.,Department of Pharmacology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Gi-Sung Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonju, South Korea
| | - Jin-Ju Kang
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, South Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonju, South Korea
| | - Gyu Cheol Han
- Department of Otolaryngology-Head and Neck Surgery, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital & School of Medicine, Seoul, South Korea
| | - Marianne Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Sun-Young Oh
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, South Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonju, South Korea
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32
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Park SY, Yeo SS, Jang SH, Cho IH, Oh S. Associations Between Injury of the Parieto-Insular Vestibular Cortex and Changes in Motor Function According to the Recovery Process: Use of Diffusion Tensor Imaging. Front Neurol 2021; 12:740711. [PMID: 34819909 PMCID: PMC8607691 DOI: 10.3389/fneur.2021.740711] [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: 07/13/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: Parieto-insular vestibular cortex (PIVC) injury can cause symptoms such as abnormal gait and affects the integration and processing of sensory inputs contributing to self-motion perception. Therefore, this study investigated the association of the vestibular pathway in the gait and motor function recovery process in patients with PIVC injury using diffusion tensor imaging (DTI). Methods: We recruited 28 patients with stroke with only PIVC injury and reconstructed the PIVC using a 1.5-T scanner for DTI. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The functional ambulatory category (FAC) test was conducted, and motricity index (MI) score was determined. These were conducted and determined at the start (phase 1), end of rehabilitation (phase 2), and during the follow-up 6 months after onset. Results: Although the tract volume of PIVC showed a decrease in subgroup A, all of DTI parameters were not different between two subgroups in affected side (p > 0.05). The results of MI and FAC were significantly different according to the recovery process (p < 0.05). In addition, FA of the PIVC showed a positive correlation with FAC in phase 2 of the recovery process on the affected side. On the unaffected side, FA of the PIVC showed a significant negative correlation with MI in all processes (p < 0.05). Conclusion: The degree of projection pathways to PIVC injury at onset time seems to be related to early restoration of gait function. Moreover, we believe that early detection of the projection pathway for PIVC injury using DTI would be helpful in the clinical evaluation and prediction of the prognosis of patients with PIVC injury.
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Affiliation(s)
- Seo Yoon Park
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan, South Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan, South Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - In Hee Cho
- Department of Health, Graduate School, Dankook University, Cheonan, South Korea
| | - Seunghue Oh
- Department of Physical Therapy, Yeungnam University College, Daegu, South Korea
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33
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Jang SH, Bae CH, Kim JW, Kwon HG. Relationship between Dizziness and the Core Vestibular Projection Injury in Patients with Mild Traumatic Brain Injury. Diagnostics (Basel) 2021; 11:diagnostics11112070. [PMID: 34829416 PMCID: PMC8618454 DOI: 10.3390/diagnostics11112070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022] Open
Abstract
Some studies have reported that a core vestibular projection (CVP) injury is associated with dizziness following a brain injury using diffusion tensor tractography (DTT). On the other hand, there has been no DTT study on dizziness caused by a CVP injury in patients with mild traumatic brain injury (TBI). In this study, DTT was used to examine the relationship between dizziness and CVP injury in patients with mild TBI. Forty-three patients with mild TBI and twenty-nine normal subjects were recruited. The patients were classified into two groups based on the dizziness score: group A, patients with a dizziness score less than 2 on the sub-item score for dizziness in the Rivermead Post-concussion Symptoms Questionnaire; group B, patients with a dizziness score above 2. The tract volume (TV) in group B was significantly lower than group A and the control group (p < 0.05). By contrast, the TV in group A was similar to the control group (p > 0.05). Regarding the correlation, the dizziness score of all patients showed a strong negative correlation with the TV of the CVP (r = −0.711, p < 0.05). DTT revealed the CVP injury in patients with dizziness after mild TBI. In addition, the severity of dizziness of these patients was closely related to the injury severity of the CVP.
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Affiliation(s)
- Sung-Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Chang-Hoon Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Jae-Woon Kim
- Department of Radiology, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Hyeok-Gyu Kwon
- Department of Physical Therapy, College of Health Science, Eulji University, Sungnam-si 13135, Korea
- Correspondence: ; Tel.: +82-31-740-7127; Fax: +82-31-740-7367
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34
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Nakul E, Bartolomei F, Lopez C. Vestibular-Evoked Cerebral Potentials. Front Neurol 2021; 12:674100. [PMID: 34621231 PMCID: PMC8490637 DOI: 10.3389/fneur.2021.674100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
The human vestibular cortex has mostly been approached using functional magnetic resonance imaging and positron emission tomography combined with artificial stimulation of the vestibular receptors or nerve. Few studies have used electroencephalography and benefited from its high temporal resolution to describe the spatiotemporal dynamics of vestibular information processing from the first milliseconds following vestibular stimulation. Evoked potentials (EPs) are largely used to describe neural processing of other sensory signals, but they remain poorly developed and standardized in vestibular neuroscience and neuro-otology. Yet, vestibular EPs of brainstem, cerebellar, and cortical origin have been reported as early as the 1960s. This review article summarizes and compares results from studies that have used a large range of vestibular stimulation, including natural vestibular stimulation on rotating chairs and motion platforms, as well as artificial vestibular stimulation (e.g., sounds, impulsive acceleration stimulation, galvanic stimulation). These studies identified vestibular EPs with short latency (<20 ms), middle latency (from 20 to 50 ms), and late latency (>50 ms). Analysis of the generators (source analysis) of these responses offers new insights into the neuroimaging of the vestibular system. Generators were consistently found in the parieto-insular and temporo-parietal junction-the core of the vestibular cortex-as well as in the prefrontal and frontal areas, superior parietal, and temporal areas. We discuss the relevance of vestibular EPs for basic research and clinical neuroscience and highlight their limitations.
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Affiliation(s)
- Estelle Nakul
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Neurosciences Cognitives (LNC), FR3C, Aix Marseille Univ, Marseille, France
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Inserm, Aix Marseille Univ, Marseille, France
- Service de Neurophysiologie Clinique, Hôpital Timone, Aix Marseille Univ, Marseille, France
| | - Christophe Lopez
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Neurosciences Cognitives (LNC), FR3C, Aix Marseille Univ, Marseille, France
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35
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Black RD, Bell RP, Riska KM, Spankovich C, Peters RW, Lascola CD, Whitlow CT. The Acute Effects of Time-Varying Caloric Vestibular Stimulation as Assessed With fMRI. Front Syst Neurosci 2021; 15:648928. [PMID: 34434093 PMCID: PMC8381736 DOI: 10.3389/fnsys.2021.648928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
We describe preliminary results from the application of time-varying caloric vestibular stimulation (tvCVS) to volunteers during a continuous blood oxygen level dependent (BOLD) functional MRI (fMRI) acquisition, recording baseline, during-tvCVS and post-tvCVS epochs. The modifications necessary to enable the use of this novel device in a 3-Tesla magnetic field are discussed. Independent component analysis (ICA) was used as a model-free method to highlight spatially and temporally coherent brain networks. The ICA results are consistent with tvCVS induction being mediated principally by thermoconvection in the vestibular labyrinth and not by direct thermal effects. The activation of hub networks identified by ICA is consistent with the concept of sensory neuromodulation, which posits that a modulatory signal introduced to a sensory organ is able to traverse the regions innervated (directly and indirectly) by that organ, while being transformed so as to be “matched” to regional neuronal dynamics. The data suggest that regional neurovascular coupling and a systemic cerebral blood flow component account for the BOLD contrast observed. The ability to modulate cerebral hemodynamics is of significant interest. The implications of these initial findings for the use of tvCVS therapeutically are discussed.
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Affiliation(s)
| | - Ryan P Bell
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Kristal M Riska
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Christopher Spankovich
- Department of Otolaryngology & Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, United States
| | | | - Christopher D Lascola
- Department of Radiology and Neurobiology, Duke University School of Medicine, Durham, NC, United States
| | - Christopher T Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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36
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Clinical features of definite vestibular migraine through the lens of central sensitization: a cross-sectional study. Acta Neurol Belg 2021; 122:1511-1519. [PMID: 34370217 DOI: 10.1007/s13760-021-01772-5] [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] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vestibular migraine (VM) commonly causes episodic vertigo/dizziness; however, its clinical features are unknown. Based on the evidence that central sensitization is related to VM pathogenesis, we hypothesized that cutaneous allodynia is frequently associated with patients with VM compared with patients without VM. This study aims to (1) elucidate the clinical features of patients with VM and (2) evaluate whether patients with VM were more frequently associated with cutaneous allodynia than patients without VM. METHODS This cross-sectional study enrolled consecutive patients with migraine aged 18-65 years. The comprehensive interview form included diagnostic questions regarding migraine and VM, demographic characteristics, migraine-specific variables, migraine-associated symptoms, and cutaneous allodynia. RESULTS A total of 245 consecutive patients with migraine (mean age = 39.5 years, 81.2% women) were enrolled; 65 (26.5%) patients with VM were assigned to the VM group, 74 (30.2%) with migraine with vestibular symptoms not meeting the VM criteria (MwVS) were assigned to the MwVS group, and 106 (43.3%) patients with episodic migraine without vestibular symptoms (EM) were assigned to the EM group, respectively. Pairwise comparisons demonstrated no significant differences between the VM and MwVS groups, except for severe disability in the VM group. Compared with EM group, VM group had significant aura, severe disability, depression, tinnitus, sleep disorders, and widespread multimodal cutaneous allodynia. CONCLUSIONS VM and MwVS may be on the same spectrum of disorders. The VM group had significantly associated widespread multimodal cutaneous allodynia compared with the EM group, indicating that thalamic sensitization plays a key role in VM pathogenesis. Widespread allodynia may be a useful diagnostic aid for VM.
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37
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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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38
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Noohi F, Kinnaird C, De Dios Y, Kofman IS, Wood SJ, Bloomberg J, Mulavara A, Sienko KH, Polk TA, Seidler RD. Age Differences in Vestibular Brain Connectivity Are Associated With Balance Performance. Front Aging Neurosci 2020; 12:566331. [PMID: 33312123 PMCID: PMC7703342 DOI: 10.3389/fnagi.2020.566331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022] Open
Abstract
Visual and auditory brain network connectivity decline with age, but less is known about age effects on vestibular functional connectivity and its association with behavior. We assessed age differences in the connectivity of the vestibular cortex with other sensory brain regions, both during rest and during vestibular stimulation. We then assessed the relationship between vestibular connectivity and postural stability. A sample of seventeen young and fifteen older adults participated in our study. We assessed the amount of body sway in performing the Romberg balance task, with degraded somatosensory and visual inputs. The results showed no significant difference in balance performance between age groups. However, functional connectivity analyses revealed a main effect of age and condition, suggesting that vestibular connectivity was higher in young adults than older adults, and vestibular connectivity increased from resting state to stimulation trials. Surprisingly, young adults who exhibited higher connectivity during stimulation also had greater body sway. This suggests that young adults who exhibit better balance are those who respond more selectively to vestibular inputs. This correlation is non-significant in older adults, suggesting that the relationship between vestibular functional connectivity and postural stability differs with age.
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Affiliation(s)
- Fatemeh Noohi
- Department of Kinesiology, University of Michigan, Ann Arbor, MI, United States.,Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Catherine Kinnaird
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Scott J Wood
- NASA Johnson Space Center, Houston, TX, United States
| | | | | | - Kathleen H Sienko
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Thad A Polk
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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39
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Functional connectivity within the network of verticality. Ann Phys Rehabil Med 2020; 64:101463. [PMID: 33285295 DOI: 10.1016/j.rehab.2020.101463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/24/2020] [Accepted: 11/07/2020] [Indexed: 11/22/2022]
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40
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Boegle R, Kirsch V, Gerb J, Dieterich M. Modulatory effects of magnetic vestibular stimulation on resting-state networks can be explained by subject-specific orientation of inner-ear anatomy in the MR static magnetic field. J Neurol 2020; 267:91-103. [PMID: 32529576 PMCID: PMC7718185 DOI: 10.1007/s00415-020-09957-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/26/2022]
Abstract
Strong static magnetic fields, as used in magnetic resonance imaging (MRI), stimulate the vestibular inner ear leading to a state of imbalance within the vestibular system that causes nystagmus. This magnetic vestibular stimulation (MVS) also modulates fluctuations of resting-state functional MRI (RS-fMRI) networks. MVS can be explained by a Lorentz force model, indicating that MVS is the result of the interaction of the static magnetic field strength and direction (called "B0 magnetic field" in MRI) with the inner ear's continuous endolymphatic ionic current. However, the high variability between subjects receiving MVS (measured as nystagmus slow-phase velocity and RS-fMRI amplitude modulations) despite matching head position, remains to be explained. Furthermore, within the imaging community, an "easy-to-acquire-and-use" proxy accounting for modulatory MVS effects in RS-fMRI fluctuations is needed. The present study uses MRI data of 60 healthy volunteers to examine the relationship between RS-fMRI fluctuations and the individual orientation of inner-ear anatomy within the static magnetic field of the MRI. The individual inner-ear anatomy and orientation were assessed via high-resolution anatomical CISS images and related to fluctuations of RS-fMRI networks previously associated with MVS. More specifically, we used a subject-specific proxy for MVS (pMVS) that corresponds to the orientation of the individual inner-ear anatomy within the static magnetic field direction (also called "z-direction" in MR imaging). We found that pMVS explained a considerable fraction of the total variance in RS-fMRI fluctuations (for instance, from 11% in the right cerebellum up to 36% in the cerebellar vermis). In addition to pMVS, we examined the angle of Reid's plane, as determined from anatomical imaging as an alternative and found that this angle (with the same sinus transformation as for pMVS) explained considerably less variance, e.g., from 2 to 16%. In our opinion, an excess variability due to MVS should generally be addressed in fMRI research analogous to nuisance regression for movement, pulsation, and respiration effects. We suggest using the pMVS parameter to deal with modulations of RS-fMRI fluctuations due to MVS. MVS-induced variance can easily be accounted by using high-resolution anatomical imaging of the inner ear and including the proposed pMVS parameter in fMRI group-level analysis.
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Affiliation(s)
- R Boegle
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders DSGZ-IFB LMU, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.
| | - V Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Vertigo and Balance Disorders DSGZ-IFB LMU, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - J Gerb
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany
| | - M Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Vertigo and Balance Disorders DSGZ-IFB LMU, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Munich Cluster for Systems Neurology (Synergy), Munich, Germany
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41
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Raiser T, Flanagin V, Duering M, van Ombergen A, Ruehl R, zu Eulenburg P. The human corticocortical vestibular network. Neuroimage 2020; 223:117362. [DOI: 10.1016/j.neuroimage.2020.117362] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/31/2022] Open
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Dynamic whole-brain metabolic connectivity during vestibular compensation in the rat. Neuroimage 2020; 226:117588. [PMID: 33249212 DOI: 10.1016/j.neuroimage.2020.117588] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/05/2020] [Accepted: 11/19/2020] [Indexed: 12/16/2022] Open
Abstract
Unilateral damage to the inner ear results in an acute vestibular syndrome, which is compensated within days to weeks due to adaptive cerebral plasticity. This process, called central vestibular compensation (VC), involves a wide range of functional and structural mechanisms at the cellular and network level. The short-term dynamics of whole-brain functional network recruitment and recalibration during VC has not been depicted in vivo. The purpose of this study was to investigate the interplay of separate and distinct brain regions and in vivo networks in the course of VC by sequential [18F]-FDG-PET-based statistical and graph theoretical analysis with the aim of revealing the metabolic connectome before and 1, 3, 7, and 15 days post unilateral labyrinthectomy (UL) in the rat. Temporal changes in metabolic brain connectivity were determined by Pearson's correlation (|r| > 0.5, p < 0.001) of regional cerebral glucose metabolism (rCGM) in 57 segmented brain regions. Metabolic connectivity analysis was compared to univariate voxel-wise statistical analysis of rCGM over time and to behavioral scores of static and dynamic sensorimotor recovery. Univariate statistical analysis revealed an ipsilesional relative rCGM decrease (compared to baseline) and a contralesional rCGM increase in vestibular and limbic networks and an increase in bilateral cerebellar and sensorimotor networks. Quantitative analysis of the metabolic connections showed a maximal increase from baseline to day 3 post UL (interhemispheric: 2-fold, ipsilesional: 3-fold, contralesional: 12-fold) and a gradual decline until day 15 post UL, which paralleled the dynamics of vestibular symptoms. In graph theoretical analysis, an increase in connectivity occurred especially within brain regions associated with brainstem-cerebellar and thalamocortical vestibular networks and cortical sensorimotor networks. At the symptom peak (day 3 post UL), brain networks were found to be organized in large ensembles of distinct and highly connected hubs of brain regions, which separated again with progressing VC. Thus, we found rapid changes in network organization at the subcortical and cortical level and in both hemispheres, which may indicate an initial functional substitution of vestibular loss and subsequent recalibration and reorganization of sensorimotor networks during VC.
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Indovina I, Bosco G, Riccelli R, Maffei V, Lacquaniti F, Passamonti L, Toschi N. Structural connectome and connectivity lateralization of the multimodal vestibular cortical network. Neuroimage 2020; 222:117247. [PMID: 32798675 PMCID: PMC7779422 DOI: 10.1016/j.neuroimage.2020.117247] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 01/05/2023] Open
Abstract
Unlike other sensory systems, the structural connectivity patterns of the human vestibular cortex remain a matter of debate. Based on their functional properties and hypothesized centrality within the vestibular network, the ‘core’ cortical regions of this network are thought to be areas in the posterior peri-sylvian cortex, in particular the retro-insula (previously named the posterior insular cortex-PIC), and the subregion OP2 of the parietal operculum. To study the vestibular network, structural connectivity matrices from n=974 healthy individuals drawn from the public Human Connectome Project (HCP) repository were estimated using multi-shell diffusion-weighted data followed by probabilistic tractography and spherical-deconvolution informed filtering of tractograms in combination with subject-specific grey-matter parcellations. Weighted graph-theoretical measures, modularity, and ‘hubness’ of the multimodal vestibular network were then estimated, and a structural lateralization index was defined in order to assess the difference in fiber density of homonym regions in the right and left hemisphere. Differences in connectivity patterns between OP2 and PIC were also estimated. We found that the bilateral intraparietal sulcus, PIC, and to a lesser degree OP2, are key ‘hub’ regions within the multimodal vestibular network. PIC and OP2 structural connectivity patterns were lateralized to the left hemisphere, while structural connectivity patterns of the posterior peri-sylvian supramarginal and superior temporal gyri were lateralized to the right hemisphere. These lateralization patterns were independent of handedness. We also found that the structural connectivity pattern of PIC is consistent with a key role of PIC in visuo-vestibular processing and that the structural connectivity pattern of OP2 is consistent with integration of mainly vestibular somato-sensory and motor information. These results suggest an analogy between PIC and the simian visual posterior sylvian (VPS) area and OP2 and the simian parieto-insular vestibular cortex (PIVC). Overall, these findings may provide novel insights to the current models of vestibular function, as well as to the understanding of the complexity and lateralized signs of vestibular syndromes.
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Affiliation(s)
- Iole Indovina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy.
| | - Gianfranco Bosco
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy; Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, 00173 Rome, Italy
| | - Roberta Riccelli
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy
| | - Vincenzo Maffei
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy; Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, 00173 Rome, Italy
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, UK; Institute of Bioimaging & Molecular Physiology, National Research Council, Milano, Italy; IRCCS San Camillo Hospital, Venice, Italy.
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, USA
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44
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Agrawal Y, Merfeld DM, Horak FB, Redfern MS, Manor B, Westlake KP, Holstein GR, Smith PF, Bhatt T, Bohnen NI, Lipsitz LA. Aging, Vestibular Function, and Balance: Proceedings of a National Institute on Aging/National Institute on Deafness and Other Communication Disorders Workshop. J Gerontol A Biol Sci Med Sci 2020; 75:2471-2480. [PMID: 32617555 PMCID: PMC7662183 DOI: 10.1093/gerona/glaa097] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 12/27/2022] Open
Abstract
Balance impairment and falls are among the most prevalent and morbid conditions affecting older adults. A critical contributor to balance and gait function is the vestibular system; however, there remain substantial knowledge gaps regarding age-related vestibular loss and its contribution to balance impairment and falls in older adults. Given these knowledge gaps, the National Institute on Aging and the National Institute on Deafness and Other Communication Disorders convened a multidisciplinary workshop in April 2019 that brought together experts from a wide array of disciplines, such as vestibular physiology, neuroscience, movement science, rehabilitation, and geriatrics. The goal of the workshop was to identify key knowledge gaps on vestibular function and balance control in older adults and develop a research agenda to make substantial advancements in the field. This article provides a report of the proceedings of this workshop. Three key questions emerged from the workshop, specifically: (i) How does aging impact vestibular function?; (ii) How do we know what is the contribution of age-related vestibular impairment to an older adult's balance problem?; and more broadly, (iii) Can we develop a nosology of balance impairments in older adults that can guide clinical practice? For each of these key questions, the current knowledge is reviewed, and the critical knowledge gaps and research strategies to address them are discussed. This document outlines an ambitious 5- to 10-year research agenda for increasing knowledge related to vestibular impairment and balance control in older adults, with the ultimate goal of linking this knowledge to more effective treatment.
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Affiliation(s)
- Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Merfeld
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland
| | - Mark S Redfern
- Department of Bioengineering, University of Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh, Pennsylvania
| | - Brad Manor
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Gay R Holstein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul F Smith
- Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
- Brain Research New Zealand, Dunedin, New Zealand
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Radiology, University of Michigan, Ann Arbor
| | - Lewis A Lipsitz
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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45
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Conrad J, Habs M, Boegle R, Ertl M, Kirsch V, Stefanova-Brostek I, Eren O, Becker-Bense S, Stephan T, Wollenweber F, Duering M, Zu Eulenburg P, Dieterich M. Global multisensory reorganization after vestibular brain stem stroke. Ann Clin Transl Neurol 2020; 7:1788-1801. [PMID: 32856758 PMCID: PMC7545594 DOI: 10.1002/acn3.51161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/25/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Patients with acute central vestibular syndrome suffer from vertigo, spontaneous nystagmus, postural instability with lateral falls, and tilts of visual vertical. Usually, these symptoms compensate within months. The mechanisms of compensation in vestibular infarcts are yet unclear. This study focused on structural changes in gray and white matter volume that accompany clinical compensation. METHODS We studied patients with acute unilateral brain stem infarcts prospectively over 6 months. Structural changes were compared between the acute phase and follow-up with a group of healthy controls using voxel-based morphometry. RESULTS Restitution of vestibular function following brain stem infarcts was accompanied by downstream structural changes in multisensory cortical areas. The changes depended on the location of the infarct along the vestibular pathways in patients with pathological tilts of the SVV and on the quality of the vestibular percept (rotatory vs graviceptive) in patients with pontomedullary infarcts. Patients with pontomedullary infarcts with vertigo or spontaneous nystagmus showed volumetric increases in vestibular parietal opercular multisensory and (retro-) insular areas with right-sided preference. Compensation of graviceptive deficits was accompanied by adaptive changes in multiple multisensory vestibular areas in both hemispheres in lower brain stem infarcts and by additional changes in the motor system in upper brain stem infarcts. INTERPRETATION This study demonstrates multisensory neuroplasticity in both hemispheres along with the clinical compensation of vestibular deficits following unilateral brain stem infarcts. The data further solidify the concept of a right-hemispheric specialization for core vestibular processing. The identification of cortical structures involved in central compensation could serve as a platform to launch novel rehabilitative treatments such as transcranial stimulations.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Habs
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany
| | - Rainer Boegle
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany
| | - Matthias Ertl
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Valerie Kirsch
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany
| | | | - Ozan Eren
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany
| | - Thomas Stephan
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Frank Wollenweber
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany.,Institute for Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Zwergal A, Möhwald K, Salazar López E, Hadzhikolev H, Brandt T, Jahn K, Dieterich M. A Prospective Analysis of Lesion-Symptom Relationships in Acute Vestibular and Ocular Motor Stroke. Front Neurol 2020; 11:822. [PMID: 32849250 PMCID: PMC7424024 DOI: 10.3389/fneur.2020.00822] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Diagnosing stroke as a cause of acute vertigo, dizziness, or double vision remains a challenge, because symptom characteristics can be variable. The purpose of this study was to prospectively investigate lesion-symptom relationships in patients with acute vestibular or ocular motor stroke. Methods: Three hundred and fifty one patients with acute and isolated vestibular or ocular motor symptoms of unclear etiology were enrolled in the EMVERT lesion trial. Symptom quality was assessed by the chief complaint (vertigo, dizziness, double vision), symptom intensity by the visual analog scale, functional impairment by EQ-5D-5L, and symptom duration by daily rating. Acute vestibular and ocular motor signs were registered by videooculography. A standardized MRI (DWI-/FLAIR-/T2-/T2*-/3D-T1-weighted sequences) was recorded within 7 days of symptom onset. MRIs with DWI lesions were further processed for voxel-based lesion-symptom mapping (VLSM). Results: In 47 patients, MRI depicted an acute unilateral stroke (13.4%). The chief complaints were dizziness (42.5%), vertigo (40.4%) and double vision (17.0%). Lesions in patients with vertigo or dizziness showed a large overlap in the cerebellar hemisphere. VLSM indicated that strokes in the medial cerebellar layers 7b, 8, 9 were associated with vertigo, strokes in the lateral cerebellar layer 8, crus 1, 2 with dizziness, and pontomesencephalic strokes with double vision. Symptom intensity and duration varied largely between patients. Higher symptom intensity and longer duration were associated with medial cerebellar lesions. Hemispheric lesions of the cortex were rare and presented with milder symptoms of shorter duration. Conclusions: Prospective evaluation of patients with acute vestibular or ocular motor stroke revealed that symptom quality, intensity and duration were not suited to differentiating peripheral from central etiologies. Lesions in the lateral cerebellum, thalamus, or cortex presented with unspecific, mild and transient symptoms prone to being misdiagnosed.
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Affiliation(s)
- Andreas Zwergal
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany
| | - Ken Möhwald
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany
| | - Elvira Salazar López
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany.,Department of Human Movement Science, Technical University of Munich, Munich, Germany
| | - Hristo Hadzhikolev
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany.,Clinical Neurosciences, LMU Munich, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany.,Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany.,Munich Cluster of Systems Neurology, SyNergy, Munich, Germany
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47
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Jang SH, Kwon HG. Injury of the ipsilateral vestibulothalamic tract in a patient with pontine hemorrhage. Acta Neurol Belg 2020; 120:951-954. [PMID: 30604338 DOI: 10.1007/s13760-018-01073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
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48
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Bottini G, Salvato G. In medio stat virtus: Integrating two functional models of vestibular cognition. Cogn Neuropsychol 2020; 37:427-429. [PMID: 32573342 DOI: 10.1080/02643294.2020.1784863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gabriella Bottini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, Milano, Italy.,NeuroMi, Milan Center for Neuroscience, Milan, Italy
| | - Gerardo Salvato
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, Milano, Italy.,NeuroMi, Milan Center for Neuroscience, Milan, Italy
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49
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Nepveu JF, Mikhail Y, Pion CH, Gossard JP, Barthélemy D. Assessment of vestibulocortical interactions during standing in healthy subjects. PLoS One 2020; 15:e0233843. [PMID: 32497147 PMCID: PMC7272097 DOI: 10.1371/journal.pone.0233843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 05/13/2020] [Indexed: 01/03/2023] Open
Abstract
The vestibular system is essential to produce adequate postural responses enabling voluntary movement. However, how the vestibular system influences corticospinal output during postural tasks is still unknown. Here, we examined the modulation exerted by the vestibular system on corticospinal output during standing. Healthy subjects (n = 25) maintained quiet standing, head facing forward with eyes closed. Galvanic vestibular stimulation (GVS) was applied bipolarly and binaurally at different delays prior to transcranial magnetic stimulation (TMS) which triggered motor evoked potentials (MEPs). With the cathode right/anode left configuration, MEPs in right Soleus (SOL) muscle were significantly suppressed when GVS was applied at ISI = 40 and 130ms before TMS. With the anode right/cathode left configuration, no significant changes were observed. Changes in the MEP amplitude were then compared to changes in the ongoing EMG when GVS was applied alone. Only the decrease in MEP amplitude at ISI = 40ms occurred without change in the ongoing EMG, suggesting that modulation occurred at a premotoneuronal level. We further investigated whether vestibular modulation could occur at the motor cortex level by assessing changes in the direct corticospinal pathways using the short-latency facilitation of the SOL Hoffmann reflex (H-reflex) by TMS. None of the observed modulation occurred at the level of motor cortex. Finally, using the long-latency facilitation of the SOL H-reflex, we were able to confirm that the suppression of MEP at ISI = 40ms occurred at a premotoneuronal level. The data indicate that vestibular signals modulate corticospinal output to SOL at both premotoneuronal and motoneuronal levels during standing.
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Affiliation(s)
- Jean-François Nepveu
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRIR, Montreal, Canada
- Department of Neuroscience, Université de Montréal, Montreal, Canada
| | - Youstina Mikhail
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRIR, Montreal, Canada
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | - Charlotte H. Pion
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRIR, Montreal, Canada
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | | | - Dorothy Barthélemy
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRIR, Montreal, Canada
- School of Rehabilitation, Université de Montréal, Montreal, Canada
- * E-mail:
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50
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Ertl M, Klaus M, Mast FW, Brandt T, Dieterich M. Spectral fingerprints of correct vestibular discrimination of the intensity of body accelerations. Neuroimage 2020; 219:117015. [PMID: 32505699 DOI: 10.1016/j.neuroimage.2020.117015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
Perceptual decision-making is a complex task that requires multiple processing steps performed by spatially distinct brain regions interacting in order to optimize perception and motor response. Most of our knowledge on these processes and interactions were derived from unimodal stimulations of the visual system which identified the lateral intraparietal area and the posterior parietal cortex as critical regions. Unlike the visual system, the vestibular system has no primary cortical areas and it is associated with separate multisensory areas within the temporo-parietal cortex with the parieto-insular vestibular cortex, PIVC, being the core region. The aim of the presented experiment was to investigate the transition from sensation to perception and to reveal the main structures of the cortical vestibular system involved in perceptual decision-making. Therefore, an EEG analysis was performed in 35 healthy subjects during linear whole-body accelerations of different intensities on a motor-driven motion platform (hexapod). We used a discrimination task in order to judge the intensity of the accelerations. Furthermore, we manipulated the expectation of the upcoming stimulus by indicating the probability (25%, 50%, 75%, 100%) of the motion direction. The analysis of the vestibular evoked potentials (VestEPs) showed that the decision-making process leads to a second positive peak (P2b) which was not observed in previous task-free experiments. The comparison of the estimated neural generators of the P2a and P2b components showed significant activity differences in the anterior cingulus, the parahippocampal and the middle temporal gyri. Taking into account the time courses of the P2 components, the physical properties of the stimuli, and the responses given by the subjects we conclude that the P2b likely reflects the transition from the processing of sensory information to perceptual evaluation. Analyzing the decision-uncertainty reported by the subjects, a persistent divergence of the time courses starting at 188 ms after the acceleration was found at electrode Pz. This finding demonstrated that meta-cognition by means of confidence estimation starts in parallel with the decision-making process itself. Further analyses in the time-frequency domain revealed that a correct classification of acceleration intensities correlated with an inter-trial phase clustering at electrode Cz and an inter-site phase clustering of theta oscillations over frontal, central, and parietal cortical areas. The sites where the phase clustering was observed corresponded to core decision-making brain areas known from neuroimaging studies in the visual domain.
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Affiliation(s)
- M Ertl
- Department of Psychology, University Bern, Switzerland; Department of Neurology, Ludwig-Maximilians-Universität München, Germany.
| | - M Klaus
- Department of Psychology, University Bern, Switzerland
| | - F W Mast
- Department of Psychology, University Bern, Switzerland
| | - T Brandt
- German Center for Vertigo and Balance Disorders-IFBLMU (DSGZ), Ludwig-Maximilians-Universität München, Germany; Hertie Senior Research Professor for Clinical Neuroscience, Ludwig-Maximilians-Universität München, Germany
| | - M Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany; German Center for Vertigo and Balance Disorders-IFBLMU (DSGZ), Ludwig-Maximilians-Universität München, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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