ACTH(4-10) accelerates ocular motor recovery in the guinea pig following vestibular deafferentation

Spatial anxiety contributes to the dizziness-related handicap of adults with peripheral vestibular disease

In subjects with peripheral vestibular disease and controls, we assessed: 1. The relationship between spatial anxiety and perceived stress, and 2. The combined contribution of spatial anxiety, spatial perspective-taking, and individual cofactors to dizziness-related handicap. 309 adults participated in the study (153 with and 156 without peripheral vestibular disease), including patients with bilateral vestibular deficiency, unilateral deficiency (evolution <3 or ≥3 months), Meniere's disease, and Benign Paroxysmal Positional Vertigo. Assessments included: general health, personal habits, spatial anxiety (3-domains), perceived stress, spatial perspective-taking, dizziness-related handicap (3-domains), unsteadiness, sleep quality, motion sickness susceptibility, trait anxiety/depression, state anxiety, depersonalization/derealization. After bivariate analyses, analysis of covariance was performed (p ≤ 0.05). Spatial anxiety was related to unsteadiness and perceived stress, with an inverse relationship with trait anxiety (ANCoVA, adjusted R2 = 0.27-0.30, F = 17.945-20.086, p < 0.00001). Variability on perspective-taking was related to vestibular disease, trait and state anxiety, motion sickness susceptibility, and age (ANCoVA, adjusted R2 = 0.18, F = 5.834, p < 0.00001). All domains of spatial anxiety contributed to the Physical domain of dizziness-related handicap, while the Navigation domain contributed to the Functional domain of handicap. Handicap variability was also related to unsteadiness, spatial perspective-taking, quality of sleep, and trait anxiety/depression (ANCoVA, adjusted R2 = 0.66, F = 39.07, p < 0.00001). Spatial anxiety is related to perceived stress in adults both with and without vestibular disease, subjects with trait anxiety rated lower on spatial anxiety. State anxiety and acute stress could be helpful for recovery after peripheral vestibular lesion. Spatial anxiety and perspective-taking contribute to the Physical and Functional domains of dizziness-related handicap, possibly because it discourages behavior beneficial to adaptation.

Stress and the vestibular system

In this chapter we review the existing literature regarding the interactions between stress and the mechanisms that maintain balance. Evidence suggests that the interplay between neuro-endocrine and psychological factors may have a significant role in balance function. For example, in healthy individuals vestibular stimulation has been shown to trigger the stress response as indicated by increased blood cortisol levels, whereas in patients with vestibular pathology factors such as resilience and anxiety may be the key focus of interactions with stress. Critically, factors such as anxiety are known to influence clinical outcomes, despite our mechanistic understanding of these processes remaining in their infancy.

Interactions between Stress and Vestibular Compensation - A Review

Elevated levels of stress and anxiety often accompany vestibular dysfunction, while conversely complaints of dizziness and loss of balance are common in patients with panic and other anxiety disorders. The interactions between stress and vestibular function have been investigated both in animal models and in clinical studies. Evidence from animal studies indicates that vestibular symptoms are effective in activating the stress axis, and that the acute stress response is important in promoting compensatory synaptic and neuronal plasticity in the vestibular system and cerebellum. The role of stress in human vestibular disorders is complex, and definitive evidence is lacking. This article reviews the evidence from animal and clinical studies with a focus on the effects of stress on the central vestibular pathways and their role in the pathogenesis and management of human vestibular disorders.

Stress axis plasticity during vestibular compensation in the adult cat

The postural, ocular motor, perceptive and neurovegetative syndromes resulting from unilateral vestibular neurectomy (UVN) symptoms could generate a stress and thereby activate the hypothalamo-pituitary-adrenal (HPA) axis. This study was aimed at determining whether UVN causes changes in the activity of the HPA axis, and if so, evaluating the time course of changes associated with UVN syndrome. At the cellular level, corticotropin-releasing factor (CRF) and arginine vasopressin (AVP) immunoreactivity (Ir) were analyzed and quantified in the paraventricular nucleus (PVN) and the vestibular nuclei (VN) complex of cats killed early (1 and 7 days) or late (30 and 90 days) after UVN. Dopamine-beta-hydroxylase (DbetaH), the enzyme synthesizing noradrenaline was examined in the locus coeruleus (LC) in these same cats. At the behavioral level, the time course of recovery of the postural and locomotor functions was quantified at the same postoperative delays in another group of UVN cats. Results showed a significant bilateral increase in the number of both AVP-Ir and CRF-Ir neurons in the PVN and an increase of DbetaH-Ir neurons in the LC at 1, 7 and 30 days after UVN. This increased number of neurons was no longer observed at 90 days. Conversely, a significant bilateral decrease of CRF-Ir neurons was observed in the VN at these same postlesion times, with a similar return to control values at 90 days. Our behavioral observations showed strong posturo-locomotor functional deficits early after UVN (1 and 7 days), which had recovered partially at 30 days and completely by 90 days postlesion. We demonstrate a long-lasting activation of the HPA axis, which likely reflects a chronic stress, experienced by the animals, which corresponds to the time course of full vestibular compensation, and which is no longer present when the animals are completely free of posturo-locomotor symptoms at 90 days.

Avaliação do efeito da cafeína no teste vestibular

Há controvérsias sobre a interferência da cafeína no teste vestibular. O café é a fonte mais rica em cafeína. Enquanto em alguns serviços os pacientes são orientados a suspender a ingestão de café 24 a 48 horas antes da realização do teste, outros não consideram necessária a suspensão da ingestão dessa bebida. OBJETIVO: Avaliar o efeito da cafeína no resultado do teste vestibular. FORMA DE ESTUDO: clínico com coorte transversal. MATERIAL E MÉTODO: Estudo comparativo, transversal, pareado. O teste vestibular foi realizado em duplicidade, com intervalo máximo de cinco dias entre um e outro exame. No primeiro teste, os pacientes foram orientados a não ingerir café 24 horas antes do exame; no segundo teste, os pacientes foram orientados a beber café como de costume. Todos os participantes tinham indicação clínica de se submeter ao teste vestibular e tinham o hábito de tomar café. RESULTADOS: Participaram do estudo 19 mulheres com idade média de 49,5 anos. O consumo médio de café foi de três xícaras por dia. As queixas de ansiedade e cefaléia foram associadas ao teste realizado com suspensão do café. Não houve diferença estatisticamente significante nos resultados dos exames realizados com e sem ingestão de café. CONCLUSÃO: A ingestão moderada de café não interferiu no resultado do teste vestibular. Considerando ser recomendável que o paciente esteja tranqüilo ao se submeter ao teste vestibular e que a meia-vida da cafeína é de apenas seis horas, sugerimos que a orientação para a suspensão súbita e completa da ingestão moderada de café antes do teste vestibular para os indivíduos habituados à ingestão diária seja reavaliada.

Evaluation of the caffeine effect in the vestibular test

Exist controversy about the interference of the caffeine in the vestibular test. Coffee is the richest source of caffeine. While in some services, the patients were orient to suspend the ingestion of caffeine 24 to 48 hours before the vestibular test, other not consider the suspension of this drink necessary.

Aim

To evaluate the effect of caffeine in the vestibular test result.

Study design

clinical with transversal cohort.

Material and Method

Seccional and matched research. The vestibular test was performed twice in the same patient, with five days interval between the exams. In the first test, the patient did not drink coffee 24 hours before the exam; in the second, the patient drunk coffee as usual. All of the participants had clinical indication for vestibular test and were used to drinking coffee.

Results

Nineteen women, medium age of 49,5 years, participated. The average coffee consumption was three cups per day. The complaints of anxiety and headache were associated with the submission to the vestibular test without coffee. The exams were not statistically different comparing the results of the tests performed with and without the coffee ingestion.

Conclusion

The moderate ingestion of coffee was not shown to interfere in the results of the vestibular test. Considering that it is recommended that the patient be calm to be submitted to the vestibular test and that the half-life of the caffeine is only of six hours, we suggest that the orientation of complete and abrupt drinking coffee suspension of moderate dose before the vestibular test for the individuals used to daily drinking coffee be reevaluated.

Exercise and drug therapy alter recovery from labyrinth lesion in humans

Acute unilateral vestibular failure is characterized by rotatory vertigo, horizontal-rotatory nystagmus, and postural imbalance, all of which last from days to weeks. These signs and symptoms are caused by a vestibular tone imbalance between the two labyrinths. Recovery results from a combination of peripheral restoration of labyrinthine function (usually incomplete) and central vestibular compensation (CVC) of the vestibular tone imbalance. Acute unilateral failure is most often caused by vestibular neuritis, which is most likely due to the reactivation of a latent HSV-1 infection. Therefore, therapeutic strategies to improve the outcome of VN are theoretically based on two principles: (a) vestibular exercises and drugs to improve CVC and (b) drug treatment of the assumed viral inflammation. The following conclusions can be drawn from studies in animals and/or humans: (1) There is strong evidence that vestibular exercises may improve vestibulo-spinal compensation. These exercises should begin as early as possible after symptom onset. Moreover, slower exercises are likely to be more effective than faster exercises because slower ones seem to depend more on the vestibular system. (2) Despite extensive data from animal experiments indicating that drugs have a favorable effect on CVC, this has not been clinically proven and thus cannot be recommended yet. (3) Preliminary results of an interim analysis from an ongoing randomized, prospective study showed that methylprednisolone (plus an antiviral agent?) may be useful for improving peripheral vestibular function in vestibular neuritis.

The ACTH(4-9) analog ORG 2766 and recovery after brain damage in animal models--a review

Treatment with adrenocorticotrophic hormone (ACTH), as well as with ACTH fragments and analogues, can influence behaviour of animals and humans. Furthermore it facilitates recovery of damaged peripheral nervous tissue. The question whether ACTH/MSH peptides affect recovery processes after injury to the central nervous system as well is addressed in the present review. The effects of administration of the ACTH(4-9) analog ORG 2766 after brain lesions has been studied frequently. However, the interpretation of the available data is confused by the variability of the results. Several factors can be identified which influence the efficacy of the peptide: (i) not all behavioural tests are equally suitable to reveal a peptide effect on behavioural recovery; (ii) the affected brain area; (iii) whether cell bodies or terminals are affected; (iv) the post-operative housing conditions; and (v) the onset and duration of peptide administration. Two possible explanations of peptide efficacy on functional recovery are considered: first, the peptide may accelerate spontaneously occurring recovery processes and second, the peptide may induce compensatory mechanisms underlying functional recovery without recuperation of the damaged neurons. These compensatory mechanisms seem to rely mainly on enhanced non-selective attention by activation of limbic structures. It is as yet unknown to which receptor system ORG 2766 binds; the analog lacks affinity for the known melanocortin (MC) receptors in brain, yet ORG 2766 is able to modulate the activity of endogenous opioids and the NMDA-receptor. A modulating influence of the peptide on NMDA-receptor activity might indirectly account for both enhanced attention--with ensuing behavioural recovery--and the acceleration of spontaneous recovery.

An in vitro investigation of the effects of the ACTH/MSH(4-9) analogue, Org 2766, on guinea pig medial vestibular nucleus neurons

Vestibular compensation is a process of CNS plasticity that is correlated to a return of resting activity in medial vestibular nucleus (MVN) neurons ipsilateral to a peripheral vestibular deafferentation. Systemic administration of melanocortin peptides accelerates the compensation process; the ACTH/MSH(4-9) analogue, Org 2766, accelerates this process at smaller doses than ACTH/MSH(4-10). The present study investigated the effect of Org 2766 on MVN neurons in vitro using extracellular single-cell recording. Org 2766 was less potent at the neuronal level than ACTH/MSH(4-10). When Org 2766 and ACTH/MSH (4-10) were tested consecutively on the same neuron, the response was often different. Org 2766 and ACTH/MSH (4-10) may have a different mode and/or site of action.

alpha-Difluoromethylornithine delays behavioral recovery and induces decompensation after unilateral labyrinthectomy

Biochemical and pharmacologic studies suggest a role for the ornithine decarboxylase-polyamine system as a modulator of behavioral changes during vestibular compensation. alpha-Difluoromethylornithine specifically blocks the rate-limiting step of polyamine biosynthesis. To assess the effects of alpha-difluoromethylornithine on the acute phase of postural compensation, guinea pigs were divided into groups subjected to either unilateral labyrinthectomy only (n = 7), alpha-difluoromethylornithine (500 mg/kg/day) for 4 days before labyrinthectomy (n = 10), equivalent volumes of saline for 4 days before labyrinthectomy (n = 8), and sham operations (n = 5). Yaw head tilt and roll head tilt, trunk curvature, and air-righting reflex were measured at baseline and at regular intervals up to 4 weeks. alpha-Difluoromethylornithine significantly delayed recovery of normal air-righting but had no effect on yaw head tilt, roll head tilt, and trunk curvature. We also evaluated effects of alpha-difluoromethylornithine in compensated guinea pigs. Fully compensated animals from phase 1 were randomly assigned to receive alpha-difluoromethylornithine (500 mg/kg/day) or saline once daily for 4 days. Only 33% of alpha-difluoromethylornithine animals maintained air-righting, compared with 100% of saline-treated animals (p = 0.003). Maximum trunk curvature was greater in the alpha-difluoromethylornithine group (p = 0.02). Thus alpha-difluoromethylornithine not only delayed the time course for postural recovery after unilateral labyrinthectomy, it also transiently disrupted the maintenance of the compensated state.

A dose-response analysis of the beneficial effects of the ACTH-(4-9) analogue, Org 2766, on behavioural recovery following unilateral labyrinthectomy in guinea-pig

1. After removal of the peripheral vestibular receptors in one inner ear (unilateral labyrinthectomy, UL), oculo-motor and postural symptoms occur but disappear over time in a process of recovery known as vestibular compensation. 2. ACTH-(4-10), a fragment of the adrenocorticotrophic hormone (ACTH) molecule, which is devoid of corticotrophic activity, has been shown to enhance vestibular compensation. The present study investigated the effect of the ACTH-(4-9) analogue, Org 2766, on vestibular compensation in guinea-pig. Org 2766 is reported to be more potent behaviourally than ACTH-(4-10). 3. After UL, Org 2766 was delivered via an osmotic minipump implanted s.c. to 30 animals randomly assigned to one of five conditions: 1, 5, 10, 20 or 40 nmol kg-1 Org 2766, every 4 h for 52 h post-UL. Although infusion was continuous, in the present study the doses are expressed as nmol per 4 h in order to compare the results to a previous study in which animals received a discrete dose of ACTH-(4-10) at the end of each 4 h period. All animals were compared to saline controls (n = 6). 4. Three symptoms of UL, spontaneous ocular nystagmus, roll head tilt and yaw head tilt, were measured every 4 h for 52 h, beginning at 10 h post-UL. 5. Rates of infusion of 1, 5 and 10 nmol kg-1 accelerated spontaneous nystagmus compensation; 20 nmol kg-1 produced a significant decrease in the frequency of spontaneous nystagmus, as well as accelerating its compensation; 40 nmol kg-1 had no significant effect on spontaneous nystagmus compensation. 6. In comparison to the effects of Org 2766 on spontaneous nystagmus compensation, Org 2766 had little effect on the compensation of the postural symptoms, yaw head tilt and roll head tilt. Only 5 and 40 nmol kg-1 produced a significant change in postural compensation, and this was a reduction in the rate of roll head tilt compensation.7. At the optimal infusion rate of 20 nmol kg-1 every 4 h, Org 2766 produced a similar effect on spontaneous nystagmus compensation to that of ACTH-(4-10). However, Org 2766 was effective in accelerating spontaneous nystagmus compensation at much smaller doses per 4 h period than ACTH-(4-10). Org 2766 did not have the same effect on. postural compensation as it had on the compensation of spontaneous nystagmus.

The influences of fragments and analogs of ACTH/MSH upon recovery from nervous system injury

Post-injury treatment with some fragments and analogs of the adrenocorticotropic hormone (ACTH) can influence recovery after nervous system injury. This review considers both the successful and unsuccessful attempts to facilitate neural and behavioral recovery from nervous system damage via post-injury administration of these compounds. To date no single unifying explanation for the mixed results observed in animals prepared with forebrain injuries has been achieved. Several possible explanations for the variety of observations reported and several potentially productive avenues for future research are suggested.

Comparison of the effects of ACTH-(4-10) on medial vestibular nucleus neurons in brainstem slices from labyrinthine-intact and compensated guinea pigs

The effects of adrenocorticotrophic hormone fragment 4-10 (ACTH-(4-10)) on single medial vestibular nucleus (MVN) neurons, in brainstem slices from guinea pigs which had undergone vestibular compensation for a previous ipsilateral surgical unilateral labyrinthectomy, were compared with those on MVN neurons in slices from labyrinthine-intact guinea pigs observed in a previous study. Although the average resting discharge of MVN neurons in slices from compensated animals was significantly higher than that for MVN neurons from labyrinthine-intact animals, the responses of the two groups of MVN neurons to ACTH-(4-10) were very similar. These results suggest that ACTH-(4-10) treatment is unlikely to accelerate behavioral recovery following unilateral labyrinthectomy (vestibular compensation) by acting on a receptor within the MVN for which sensitivity to ACTH-(4-10) changes during the compensation process.

Molecular mechanisms of brainstem plasticity. The vestibular compensation model

Vestibular compensation is the process of behavioral recovery that occurs following unilateral deafferentation of the vestibular nerve fibers (unilateral labyrinthectomy, UL). Since UL results in a permanent loss of vestibular input from the ipsilateral vestibular (VIIIth) nerve, vestibular compensation is attributed to CNS plasticity and has been used as a general model of lesion-induced CNS plasticity. Behavioral recovery from the ocular motor and postural symptoms of UL is correlated with a partial return of resting activity to neurons in the vestibular nucleus (VN) on the deafferented side (the "deafferented VN"), and lesions to the deafferented VN prevent compensation; therefore, the regeneration of resting activity within the deafferented VN is believed to have a causal role in vestibular compensation. The biochemical mechanisms responsible for the adaptive neuronal changes within the deafferented VN are poorly understood. Neuropeptide hormone fragments, such as adrenocorticotrophic hormone (ACTH)-4-10, have been shown to accelerate vestibular compensation and can act directly on some VN neurons in vitro. Antagonists for the N-methyl-D-aspartate (NMDA) receptor have been shown to inhibit vestibular compensation if administered early in the compensation process. Biochemical studies in frog indicate marked alterations in the phosphorylation patterns of several proteins during compensation, and the in vitro phosphorylation of some of these proteins is modulated by ACTH-(1-24), calcium (Ca2+), and calmodulin or protein kinase C. It is therefore possible that ACTH fragments and NMDA antagonists (via their effects on NMDA receptor-mediated Ca2+ channels) modulate vestibular compensation through their action on Ca(2+)-dependent pathways within VN neurons. Recent studies have shown that some Ca2+ channel antagonists and the Ca(2+)-dependent enzyme inhibitor calmidazolium chloride facilitate vestibular compensation. How the regulation of Ca2+ may be related to the neuronal changes responsible for vestibular compensation is unclear at present.

Neurochemical mechanisms of recovery from peripheral vestibular lesions (vestibular compensation)

This paper reviews the literature relating to the neurochemical basis of vestibular compensation, a process of behavioral recovery which occurs following the removal of afferent input from one labyrinth (unilateral labyrinthectomy, UL). Although vestibular compensation is known to be correlated with a return of resting activity to the vestibular nucleus (VN) ipsilateral to the UL (the deafferented VN), the neurochemical mechanisms by which this neuronal recovery occurs, are unknown. At present, there is little evidence to support the hypothesis that denervation supersensitivity of excitatory amino acid, dopamine, norepinephrine or acetylcholine receptors in the deafferented VN, is responsible for vestibular compensation: binding studies for glutamate or acetylcholine do not support an upregulation of these receptor types. However, changes in the affinity or efficacy of these receptor complexes cannot be ruled out. There are still many neurotransmitter systems, such as serotonergic and histaminergic systems, which have not been investigated in relation to vestibular compensation. In several species it has been shown that treatment with adrenocorticotropic hormone, fragment 4-10 (ACTH-(4-10], can accelerate vestibular compensation. It is not clear how these drugs exert their effects. In vitro electrophysiological studies have shown that VN neurons are capable of generating resting activity in the absence of their normal afferent inputs and it is possible that these neurons have pacemaker-like membrane characteristics which contribute to the regeneration of activity following UL. Recent biochemical studies have revealed changes in the phosphorylation patterns of a number of proteins during compensation. The possible relationship between these phosphorproteins and the synaptic or membrane changes which are responsible for vestibular compensation remains to be determined.