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Hac NEF, Gold DR. Advances in diagnosis and treatment of vestibular migraine and the vestibular disorders it mimics. Neurotherapeutics 2024; 21:e00381. [PMID: 38845250 DOI: 10.1016/j.neurot.2024.e00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 07/15/2024] Open
Abstract
Dizziness is one of the most common chief complaints in both the ambulatory care setting and the emergency department. These symptoms may be representative of a broad range of entities. Therefore, any attempt at treatment must first start with determining the etiology. In this current perspective, we focus specifically on the diagnosis of and treatment of vestibular migraine, which is common and overlaps clinically with a variety of other diagnoses. We discuss the traditional treatments for vestibular migraine in addition to the recent explosion of novel migraine therapeutics. Because vestibular migraine can mimic, or co-exist with, a variety of other vestibular diseases, we discuss several of these disorders including persistent postural-perceptual dizziness, benign paroxysmal positional vertigo, post-concussive syndrome, Ménière's disease, and cerebrovascular etiologies. We discuss the diagnosis of each, as well as overlapping and distinguishing clinical features of which the reader should be aware. Finally, we conclude with evidence based as well as expert commentary on management, with a particular emphasis on vestibular migraine.
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Hannigan IP, Rosengren SM, Di Tanna GL, Watson SRD, Welgampola MS. Effects of nonprescription therapies on vestibular migraine: a questionnaire-based observational study. Intern Med J 2024; 54:916-924. [PMID: 38204302 DOI: 10.1111/imj.16314] [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: 09/23/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Vestibular migraine (VM) is a common cause of recurrent vertigo. Migraine headache preventative therapies are currently prescribed to control vertigo symptoms in VM. Clinical trials of nutraceuticals for migraine headache prevention have shown positive outcomes, but, to date, there have been no studies to assess their effectiveness in the management of VM. AIMS To report the effects of nonprescription therapy management on VM symptoms. METHODS We undertook a prospective, questionnaire-based assessment of patients diagnosed with VM between November 2019 and August 2021 at two Sydney tertiary referral clinics. Patients were advised on optimising sleep, hydration, exercise and nutrition and instructed to use an over-the-counter combination product containing riboflavin 200 mg, magnesium 150 mg, coenzyme Q10 75 mg and feverfew 200 mcg. Symptom severity and frequency were assessed using the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Score short-form (VSS-sf) and two visual analogue scales for severity (VAS-s) and frequency (VAS-f) before and 3 months after commencing treatment. RESULT In 82 participants (78% female; mean age, 44 ± 14 years) we recorded a decrease in DHI (mean, 16.8 [95% confidence interval (CI), 12.8-20.9], VSS-sf (9.3, 7.1-11.5), VAS-s (3.0, 2.2-3.8) and VAS-f (2.8, 2.1-3.4), equating to an improvement of 44.1%, 44.9%, 44.1% and 38.9% for each measure respectively. On the DHI and VSS-sf, 41 (50%) and 44 (53.7%) patients showed improvement in their symptoms; 39 (47.6%) and 36 (43.9%) patients noted no change and two patients reported worsening. The supplement was well-tolerated. CONCLUSIONS The results provide preliminary evidence that VM symptom frequency and severity can be reduced by using nonprescription therapies.
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Affiliation(s)
- Imelda P Hannigan
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Blacktown Neurology Clinic, Blacktown, New South Wales, Australia
| | - Sally M Rosengren
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Gian L Di Tanna
- Biostatistics and Data Science Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Shaun R D Watson
- Blacktown Neurology Clinic, Blacktown, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Miriam S Welgampola
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Tak Y, Tassone F, Hagerman RJ. Case Series: Vestibular Migraines in Fragile X Premutation Carriers. J Clin Med 2024; 13:504. [PMID: 38256638 PMCID: PMC10816080 DOI: 10.3390/jcm13020504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Vestibular migraine (VM) is one of the most common causes of recurrent vertigo and presents with a history of spontaneous or positional vertigo with a history of migraine headaches. While research has identified a high prevalence of migraine headaches and vestibular deficits among fragile X premutation carriers, there has been no discussion about VM within this population. OBJECTIVE This case series and review seeks to describe the clinical characteristics and pathophysiology of VM among individuals with the fragile X premutation. We also seek to discuss treatment and future steps in addressing VM in this population. METHODS A review of the literature regarding vestibular migraine and presentation of migraine headaches and vestibular deficits among premutation carriers was performed. A detailed clinical history of migraine headaches and vertigo was obtained from three patients with the fragile X premutation seen by the senior author (RJH). RESULTS All three cases first developed symptoms of migraine headaches earlier in life, with the development of VM near menopause. Two of the three cases developed progressive balance issues following the development of VM. All three cases found that their VM episodes were improved or resolved with pharmacological and/or lifestyle interventions. CONCLUSIONS It is important to recognize VM among premutation carriers because beneficial treatments are available. Future studies are needed regarding the prevalence of VM and the relationship to subsequent FXTAS. The pathophysiology of VM remains uncertain but possibilities include mitochondrial abnormalities, cranial nerve VIII toxicity secondary to neurotoxic protein accumulation, and calcitonin gene-related peptide (CGRP) signaling dysfunction due to altered levels of fragile X messenger ribonucleoprotein (FMRP).
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Affiliation(s)
- YeEun Tak
- University of California Davis School of Medicine, Sacramento Campus, Sacramento, CA 95817, USA; (Y.T.); (F.T.)
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95616, USA
| | - Flora Tassone
- University of California Davis School of Medicine, Sacramento Campus, Sacramento, CA 95817, USA; (Y.T.); (F.T.)
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Randi J. Hagerman
- University of California Davis School of Medicine, Sacramento Campus, Sacramento, CA 95817, USA; (Y.T.); (F.T.)
- Department of Pediatrics, University of California Davis Health, Sacramento, CA 95817, USA
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Zhe X, Zhang H, Tang M, Lei X, Zhang X, Jin C. Brain functional connectivity patterns associated with symptoms of vestibular migraine. Front Neurosci 2023; 17:1231273. [PMID: 38156263 PMCID: PMC10753008 DOI: 10.3389/fnins.2023.1231273] [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: 05/30/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Background Several functional magnetic resonance imaging (fMRI) investigations of patients with vestibular migraine (VM) have revealed abnormal functionality in different networks, indicating that VM is related to alterations in brain function. We sought to investigate the resting-state functional connectivity (FC) patterns during the interictal period in VM by combining data-driven voxel-wise degree centrality (DC) calculations and seed-based FC analyses, and thereby determine the associations between cerebral function and clinical symptoms. Methods Thirty-eight patients with VM and 33 matched normal controls were recruited. DC was calculated and compared between the groups, and the FC of locations showing DC alterations was further tested using a seed-based technique. The participants' clinical indicators were correlated with the DC and FC values of the brain areas. Results In contrast to the control group, the VM group showed considerably lower DC values in the bilateral medial prefrontal cortex (mPFC) and significantly higher DC values in the right occipital lobe. In the seed-based FC analyses, patients with VM demonstrated fewer connections of the bilateral mPFC with the bilateral posterior cingulate cortex, right parahippocampus, right cerebellar posterior lobe, bilateral cuneus, and left precuneus. In addition, clinical data from patients, such as pain intensity, episode frequency, and the Dizziness Handicap Inventory score, were negatively related to these FC and DC impairments. Conclusion Our findings showed changes in the default mode network and visual cortex in patients with VM, providing further insights into the complexity of the mechanisms underlying VM.
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Affiliation(s)
- Xia Zhe
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Hailian Zhang
- Department of Radiology, The Fifth People's Hospital of Qinghai Province, Xining, Qinghai, China
| | - Min Tang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Chenwang Jin
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Kim EK, Hum M, Sharon JD. Correlating Vestibular Migraine Patient Assessment Tool and Handicap Inventory to Daily Dizziness Symptoms. Otol Neurotol 2023; 44:1052-1056. [PMID: 37733970 DOI: 10.1097/mao.0000000000004014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Investigate the relationship between Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores and daily dizziness symptoms. STUDY DESIGN Prospective cohort analysis of 52 patients with vestibular migraine (VM). SETTING Tertiary referral center. PATIENTS Fifty-two patients diagnosed with VM or probable VM according to Barany Society criteria. INTERVENTIONS Subjects reported their dizzy symptoms (on a scale of 0 [no symptoms], 1 [mild], 2 [moderate], and 3 [severe]) every day for 1 month via automated text messaging linked to a cloud-based research database. Subjects completed VM-PATHI and Dizziness Handicap Inventory (DHI) scores at the end of the month. We examined the correlation between a composite of daily dizziness scores with VM-PATHI and DHI scores through linear regression and correlation analysis. MAIN OUTCOME MEASURES Pearson correlation coefficient, R2 value. RESULTS VM-PATHI showed a moderate correlation with daily dizziness symptoms (correlation coefficient, 0.51). DHI showed a lower correlation with daily dizziness (correlation coefficient, 0.38). VM-PATHI score was a strong predictor of daily dizziness with univariate linear regression ( R2 = 0.26, p = 0.001). In a multiple linear regression model with age, history of anxiety and/or depression, and VM-PATHI, the VM-PATHI score was the only statistically significant predictor of daily dizziness ( p < 0.001). CONCLUSIONS Daily dizziness symptoms are better correlated with VM-PATHI score than the DHI, providing further validation of VM-PATHI as a disease-specific outcome measure for patients with VM.
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Affiliation(s)
- Eric K Kim
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
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Rocha MF, Sacks B, Al-Lamki A, Koohi N, Kaski D. Acute vestibular migraine: a ghost diagnosis in patients with acute vertigo. J Neurol 2023; 270:6155-6158. [PMID: 37597072 DOI: 10.1007/s00415-023-11930-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Maria Francisca Rocha
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Benjamin Sacks
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Amira Al-Lamki
- The Ear Institute, University College London, London, UK
| | - Nehzat Koohi
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- The Ear Institute, University College London, London, UK
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, 33 Queen Square, London, WC1N 3BG, UK
| | - Diego Kaski
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- The Ear Institute, University College London, London, UK.
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, 33 Queen Square, London, WC1N 3BG, UK.
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Chuang F, Corbitt M, Tjahjono R, Whitfield B. Benign paroxysmal positional vertigo in a young child. BMJ Case Rep 2023; 16:e254098. [PMID: 37788917 PMCID: PMC10551929 DOI: 10.1136/bcr-2022-254098] [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: 10/05/2023] Open
Abstract
A girl in her early childhood presented to a regional otolaryngology outpatient clinic with classic signs of benign paroxysmal positional vertigo (BPPV). She reported episodic dizziness when rolling in a supine position. She did not convey any other associated audiovestibular symptoms. A bedside Dix-Hallpike test confirmed geotropic rotational nystagmus indicative of lateral canal BPPV. Due to her young age, limited communicative abilities and concerns for more sinister underlying pathology, a complete neurological examination, MRI and pure tone audiometry were performed. After two sessions of Epley's manoeuvre, she was symptom-free. At her 3-month follow-up, the patient denied any recurrent episodes of vertigo.
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Affiliation(s)
- Fred Chuang
- Otorhinolaryngology, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Matthew Corbitt
- Otorhinolaryngology, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Richard Tjahjono
- Otorhinolaryngology, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Bernard Whitfield
- Otorhinolaryngology, Cairns Base Hospital, Cairns, Queensland, Australia
- Otorhinolaryngology, Logan Hospital, Brisbane, Queensland, Australia
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Shen Y, Li D, Cao Q, Hu M, Hou Z, Xu L, Li Y, Hong D. Risk factors of vestibular migraine-related brain white matter lesions. Acta Neurol Belg 2023; 123:1833-1839. [PMID: 36071312 DOI: 10.1007/s13760-022-02076-y] [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: 04/04/2022] [Accepted: 08/22/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE AND PURPOSE Migraine is related to white matter lesions (WMLs), and attack frequency and duration in migraine patients are thought to increase WMLs. However, the relationship between vestibular migraine (VM) and WMLs remains unclear. This study explored the risk factors for WMLs in VM patients and provided a basis for the prevention of WMLs in VM patients. METHODS A large single-center cross-sectional study of patients with VM was conducted. None of the patients had comorbidities, such as hypertension and diabetes, or adverse lifestyle habits (smoking and drinking). All patients were divided into WML + and WML- groups after assessment of WMLs using magnetic resonance imaging (MRI). After collecting the patient's detailed medical history, statistical analysis was performed. RESULTS In univariate analysis, the frequency of vertigo was statistically significant between the WML + and WML- groups. However, there was no significant difference in other clinical features. Multivariate regression analysis found that the frequency of vertigo (OR 2.399; 95% CI 1.014-5.679; p = 0.046) was an independent risk factor for WMLs. High frequency of vertigo episodes showed more pronounced risk factors (OR 9.607; 95% CI 1.061-87.014; p = 0.044). CONCLUSION These results substantiate that vertigo frequency is an independent risk factor for WMLs in VM. A high frequency of vertigo episodes is more likely to be associated with WMLs than a low frequency. These results suggest a possible approach to the prevention of WMLs in VM patients.
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Affiliation(s)
- Yu Shen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17, Nanchang, Jiangxi, China
| | - Defu Li
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, Jiangxi, China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mengyao Hu
- The Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhou Hou
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yanping Li
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17, Nanchang, Jiangxi, China.
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Brooks KA, Tawk K, Djalilian HR, Hobson CE. Migraine management for the otolaryngologist. Laryngoscope Investig Otolaryngol 2023; 8:1080-1093. [PMID: 37621262 PMCID: PMC10446291 DOI: 10.1002/lio2.1109] [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: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 08/26/2023] Open
Abstract
Objective To characterize migraine pathophysiology, presentation, and current treatment strategies, specifically in regard to vestibulocochlear manifestations of migraine. Methods Narrative review of available literature. Results Migraine disorder can be described as a spectrum of otologic manifestations, with vestibular migraine now recognized with fully-fledged diagnostic criteria. Otologic manifestations are theorized to be due, in part, to trigeminal innervation of the inner ear structures and calcitonin gene-related peptide (CGRP) expression within the labyrinth. Patients can experience vertigo, aural fullness, enhanced tinnitus, and hearing loss without the characteristic migraine headache, leading to under recognition of these symptoms as migraine-related. Meniere's disease, mal de débarquement syndrome, persistent postural perceptual dizziness, and recurrent benign paroxysmal positional vertigo have close associations to migraine and may exist on the migraine spectrum. Migraine treatment consists of two goals: halting acute attacks (abortive therapy) and preventing attacks (prophylactic therapy). Abortive medications include triptans, corticosteroids, anti-histamines, and anti-emetics. Pharmacologic prophylaxis in conjunction with lifestyle modifications can decrease frequency and severity of symptoms and include tricyclic antidepressants, calcium channel blockers, anti-epileptic medications, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, beta-blockers, gepants, and monoclonal antibodies to CGRP. Promising evidence is emerging regarding the ability of migraine medications to positively treat the various otologic symptoms of migraine. Conclusion Migraine disorder manifesting with primarily cochleovestibular symptoms can be challenging to diagnose and manage for practicing clinicians. Patients with various vestibulopathies that are closely related to migraine may benefit from migraine treatment. Lifestyle choices and prophylactic medications are key to satisfactorily preventing acute migrainous attacks and improve function.
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Affiliation(s)
- Kaitlyn A. Brooks
- Department of Otolaryngology–Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Karen Tawk
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
- Department of Biomedical EngineeringUniversity of CaliforniaIrvineCaliforniaUSA
| | - Candace E. Hobson
- Department of Otolaryngology–Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
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Ritz H. Evaluating patients with vertigo. JAAPA 2023; 36:1-6. [PMID: 37229589 DOI: 10.1097/01.jaa.0000918772.20883.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
ABSTRACT Dizziness and vertigo are among the most common complaints in medicine. Patients often provide vague descriptions of symptoms, making clinicians' jobs challenging. However, a patient with vertigo also can be one of the most rewarding encounters of a clinician's day. In most cases, a focused history and bedside vestibular testing provide enough information to make a diagnosis and identify patients for appropriate referral. Canalith repositioning maneuvers often resolve symptoms, leaving patients and clinicians satisfied.
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Affiliation(s)
- Howard Ritz
- Howard Ritz practices in otolaryngology at Glens Falls (N.Y.) Hospital. The author has disclosed no potential conflicts of interest, financial or otherwise
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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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Wang A, Zhou G, Brodsky JR. Characteristics of Benign Paroxysmal Positional Vertigo in Young Children. Laryngoscope 2023; 133:694-699. [PMID: 35524589 DOI: 10.1002/lary.30172] [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: 01/11/2022] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aimed to determine the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in young children. STUDY DESIGN Retrospective case review. METHODS All children <10 years old that have been diagnosed with BPPV at our pediatric vestibular program between December 2012-July 2021 were selected. Clinical features were identified by medical record review, including demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. RESULTS A total of 34 children were diagnosed with BPPV with a mean age of 7.9 years old (SD ± 1/7; range 5-9) at the time of diagnosis and a male:female ratio of 1:1. Involved semicircular canals included posterior in 82% (n = 28), horizontal in 41% (n = 14), and superior in 24% (n = 8) of patients, respectively. Comorbid diagnoses included migraine (n = 14), concussion (n = 10), acute vestibular syndrome (n = 4), and persistent postural perceptual dizziness (n = 6). Recurrence with initially confirmed resolution occurred in 10 patients (29%) with a mean of 2.5 recurrences per patient (SD: 2.2; range 1-8). A family history of vertigo or migraine was identified in 11 and 17 patients, respectively. CONCLUSIONS BPPV is a cause of vertigo in children that may be overlooked. A relatively high proportion of patients demonstrated horizontal or superior canal involvement, recurrence, and additional comorbid causes of dizziness. Thus, providers evaluating young children with dizziness should perform diagnostic maneuvers to evaluate BPPV of all semicircular canals and continue to monitor children after successful treatment for recurrence. LEVEL OF EVIDENCE 4, Case Series Laryngoscope, 133:694-699, 2023.
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Affiliation(s)
- Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Chen Z, Liu H, Wei XE, Wang Q, Liu Y, Hao L, Lin C, Xiao L, Rong L. Aberrant dynamic functional network connectivity in vestibular migraine patients without peripheral vestibular lesion. Eur Arch Otorhinolaryngol 2023; 280:2993-3003. [PMID: 36707433 DOI: 10.1007/s00405-023-07847-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE This study aimed to investigate changes in dynamic functional network connectivity (FNC) in patients with vestibular migraine (VM) and explore their relationship with clinical manifestations. METHODS Resting-state functional magnetic resonance imaging (rs-fMRI) data were scanned from 35 VM patients without peripheral vestibular lesion and 40 age-, sex- and education-matched healthy controls (HC). Independent component analysis (ICA), sliding window (SW) and k-means clustering analysis were performed to explore the difference in FNC and temporal characteristics between two groups. Additionally, Pearson's partial correlation analysis was adopted to investigate the relationship between clinical manifestations and rs-fMRI results in patients with VM. RESULTS Compared with HC, patients with VM showed increased FNC in pairs of extrastriate visual network (eVN)-ventral attention network (VAN), eVN-default mode network (DMN) and eVN-left frontoparietal network (lFPN), and exhibited decreased FNC in pairs of VAN-auditory network (AuN). The altered FNC was correlated with clinical manifestations of patients with VM. Additionally, we found increased mean dwell time and fractional windows in state 2 in VM patients compared with HC. Mean dwell time was positively correlated with headache impact test-6 (HIT-6) scores, fractional windows was positively associated with dizziness handicap inventory (DHI) scores. CONCLUSION Our results indicated that patients with VM showed altered FNC primarily between sensory networks and networks related to cognitive, emotional and attention implementation, with more time spent in a state characterized by positive FNC between sensor cortex system and dorsal attention network (DAN). These findings could help reinforce the understanding on the neural mechanisms of 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
| | - 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
| | - 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
| | - Lei Hao
- 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
| | - Lijie Xiao
- 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.
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Decreased ALFF and Functional Connectivity of the Thalamus in Vestibular Migraine Patients. Brain Sci 2023; 13:brainsci13020183. [PMID: 36831726 PMCID: PMC9954115 DOI: 10.3390/brainsci13020183] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/14/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The thalamus has been reported to be associated with pain modulation and processing. However, the functional changes that occur in the thalamus of vestibular migraine (VM) patients remain unknown. METHODS In total, 28 VM patients and 28 healthy controls who were matched for age and sex underwent resting-state functional magnetic resonance imaging. They also responded to standardized questionnaires aimed at assessing the clinical features associated with migraine and vertigo. Differences in the amplitude of low-frequency fluctuation (ALFF) were analyzed and brain regions with altered ALFF in the two groups were used for further analysis of whole-brain functional connectivity (FC). The relationship between clusters and clinical features was investigated by correlation analyses. RESULTS The ALFF in the thalamus was significantly decreased in the VM group versus the control group. In the VM group, the ALFF in the left thalamus negatively correlated with VM episode frequency. Furthermore, the left thalamus showed significantly weaker FC than both regions of the medial prefrontal cortex, both regions of the anterior cingulum cortex, the left superior/middle temporal gyrus, and the left temporal pole in the VM group. CONCLUSIONS The thalamus plays an important role in VM patients and it is suggested that connectivity abnormalities of the thalamocortical region contribute to abnormal pain information processing and modulation, transmission, and multisensory integration in patients with VM.
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Atalar AÇ, Özge A, Türk BG, Ekizoğlu E, Kurt Gök D, Baykan B, Ayta S, Erdoğan FF, Yeni SN, Taşdelen B, Velioğlu SK, Midi İ, Serap S, Ulufer Ç, Sarıca Darol E, Ağan K, Ayç S, Gazioğlu S, Vildan Okudan Z, Görkem Şirin N, Bebek N, Dericioğlu N, Güçlü Altun İ, Destina Yalçın A, Sürmeli R, Osman Erdinç O, Erdal A, İlhan Algın D, Kutlu G, Bek S, Erdal Y, Övünç Özön A, Reyhani A, Güldiken B, Baklan B, Oğuz Genç B, Aykutlu Altindağ E, Karahan G, Koç G, Mısırlı H, Öztura İ, Aslan-Kara K, Merve MÇ, Türkmen N, Bulut O, Ömer K, Kesim Çahin Ö, Ferik S, Mehmet TP, Topaloğlu P, Üstün Özek S, Düzgün Ü, Yayla V, Gömceli Y, Ünlüsoy Acar Z. Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria. Front Neurol 2023; 13:1103541. [PMID: 36703639 PMCID: PMC9872152 DOI: 10.3389/fneur.2022.1103541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023] Open
Abstract
Background Migraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert. Methods In this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis. Results Longer headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone. Conclusion Longer headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs.
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Affiliation(s)
- Arife Çimen Atalar
- Department of Neurology, Istanbul Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye,*Correspondence: Arife Çimen Atalar ✉
| | - Aynur Özge
- Department of Neurology, Algology and Clinical Neurophysiology, Mersin University School of Medicine, Mersin, Türkiye
| | - Bengi Gül Türk
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Esme Ekizoğlu
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Duygu Kurt Gök
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Semih Ayta
- Child Neurology Unit, Department of Pediatrics, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Füsun Ferda Erdoğan
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Seher Naz Yeni
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Bahar Taşdelen
- Department of Biostatistics and Medical Informatics, Mersin University School of Medicine, Mersin University, Mersin, Türkiye
| | | | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Department of Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Türkiye
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Du Y, Liu X, Ren L, Wang Y, Ji F, Guo W, Wu Z. Saccades of video head impulse test in Meniere's disease and Vestibular Migraine: What can we learn from? J Otol 2023; 18:79-84. [PMID: 37153704 PMCID: PMC10159756 DOI: 10.1016/j.joto.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Background Saccades are often observed on video head impulse tests (vHIT) in patients with Meniere's Disease (MD) and Vestibular Migraine (VM). However, their saccadic features are not fully described. Objective This study aims to identify the saccades characteristics of MD and VM. Methods 75 VM patients and 103 definite unilateral MD patients were enrolled in this study. First raw saccades were exported and analyzed. The VM patients were divided into left and right based on their ears, while the MD patients were separated into affected and unaffected subgroups based on their audiograms and symptoms. Results The MD patients have more saccades on the affected side (85% vs. 69%), and saccade velocity is more consistent than the contralateral side (shown by the coefficient of variation). The saccades occurrence rates on both sides are similar in VM (77% vs. 76%), as are other saccadic parameters. The MD patients have more significant inter-aural differences than the VM patients, manifested in higher velocity (p-value 0.000), earlier arriving (p-value 0.010), and more time-domain gathered (p-value 0.003) on the affected side. Conclusions Bilateral saccades are commonly observed in MD and VM. In contrast to MD, saccades on VM are subtle, scattered, and late-arrived. Furthermore, the MD patients showed inconsistent saccadic distribution with more velocity-uniform saccades on the affected side.
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Affiliation(s)
- Yi Du
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Xingjian Liu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Lili Ren
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Yu Wang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Fei Ji
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Weiwei Guo
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Ziming Wu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
- Corresponding author. College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Gurberg J, Tomczak KK, Brodsky JR. Benign paroxysmal vertigo of childhood. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:229-240. [PMID: 38043965 DOI: 10.1016/b978-0-12-823356-6.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Benign paroxysmal vertigo of childhood (or recurrent vertigo of childhood) is the most common cause of vertigo in young children. It is considered a pediatric migraine variant or precursor disorder, and children with the condition have an increased likelihood of developing migraine later in life than the general population. Episodes are typically associated with room-spinning vertigo in conjunction with other migrainous symptoms (e.g. pallor, nausea, etc.), but it is rarely associated with headaches. Episodes typically only last for a few minutes and occur with a frequency of days to weeks without interictal symptoms or exam/test abnormalities. Treatment is rarely necessary, but migraine therapy may be beneficial in cases where episodes are particularly severe, frequent, and/or prolonged. An appreciation of the typical presentation and characteristics of this common condition is essential to any provider responsible for the care of children with migraine disorders and/or dizziness. This chapter will review the current literature on this condition, including its proposed pathophysiology, clinical presentation, and management. This chapter also includes a brief introduction to pediatric vestibular disorders, including relevant anatomy, physiology, embryology/development, history-taking, physical examination, testing, and a review of other common causes of pediatric dizziness/vertigo.
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Affiliation(s)
- Joshua Gurberg
- Department of Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Kinga K Tomczak
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Jacob R Brodsky
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, United States.
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Kulesh AA, Parfenov VA. Vestibular migraine: epidemiology, pathogenesis, clinical picture, diagnosis and treatment. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-4-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A. A. Kulesh
- Department of neurology and medical genetics, Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
| | - V. A. Parfenov
- Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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Sun X, Gao D, Shen J, Zhu Q, Wang L, Ma X, Wang W, Chen X, Zhang Q, Jin Y, Chen J, Yang J. Potential vestibular pathway impairment in children with recurrent vertigo: An investigation through air-conducted sound and galvanic vestibular stimulation-triggered vestibular evoked myogenic potentials. Front Neurol 2022; 13:997205. [PMID: 36299274 PMCID: PMC9588909 DOI: 10.3389/fneur.2022.997205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study aims to investigate the potential vestibular pathway impairment through vestibular evoked myogenic potentials (VEMPs) and to explore the pathophysiological significance of these instrument-based findings in children with recurrent vertigo. Materials and methods The clinical data of 21 children (mean age 4.67 ± 1.39 years) diagnosed as RVC who met the inclusion criteria of the Bárány Society and 29 healthy children (mean age 4.83 ± 1.34 years) enrolled as the control group from February 2021 to December 2021 were collected and analyzed retrospectively. All the subjects underwent both cervical VEMP (cVEMP) and ocular VEMP (oVEMP) triggered by air-conducted sound (ACS) and galvanic vestibular stimulation (GVS), respectively. The elicit rate, latency, and amplitude asymmetry ratio (AAR) of ACS-cVEMP, ACS-oVEMP, GVS-cVEMP, and GVS-oVEMP were analyzed. Results (1) The elicit rates of ACS-cVEMP and ACS-oVEMP were similar in the two groups (P > 0.05), as well as GVS-cVEMP and GVS-oVEMP (P > 0.05). (2) P1 and N1 latencies of ACS-cVEMP and GVS-cVEMP in the RVC group were longer than those in the control group (P < 0.05). (3) The N1 latency of ACS-oVEMP in the RVC group was shorter than that in the control group (P < 0.05), while there was no significant difference in the P1 latency of ACS-oVEMP (P > 0.05). The N1 and P1 latencies of GVS-oVEMP were not significantly different (P > 0.05). (4) There was no statistical difference in the AAR of ACS-cVEMP and GVS-cVEMP. Although there was an increased AAR of ACS-oVEMP in the RVC group (P < 0.05), the AAR was within the normal range. However, no statistical difference was found in the AAR of GVS-oVEMP in the two groups (P > 0.05). Conclusion The latencies of ACS-cVEMP and GVS-cVEMP in children with recurrent vertigo were significantly prolonged compared with those in healthy children, and there was no difference in elicit rates of ACS-cVEMP and GVS-cVEMP, suggesting that there might be potential impairment in the inferior vestibular nerve and the subsequent nerve conduction pathway in RVC.
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Affiliation(s)
- Xiayu Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Dekun Gao
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qi Zhu
- Department of Otorhinolaryngology-Head & Neck Surgery, Yuyao People's Hospital, Yuyao, China
| | - Lu Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Xiaobao Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Wei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Xiangping Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- *Correspondence: Yulian Jin
| | - Jianyong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Jianyong Chen
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Jun Yang
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Vestibular Migraine Confounds Management of Superior Canal Dehiscence Syndrome. Otol Neurotol 2022; 43:835-839. [PMID: 35878641 DOI: 10.1097/mao.0000000000003584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the prevalence of vestibular migraine (VM) in a cohort of patients with radiologic confirmation of superior canal dehiscence (SCD) and to compare management of superior canal dehiscence syndrome (SCDS) in patients with and without comorbid VM. STUDY DESIGN Retrospective review of a SCD database. SETTING University-based tertiary medical center. PATIENTS Ninety-one patients identified with SCD from 2009 to 2017. INTERVENTIONS None. MAIN OUTCOME MEASURES Coincidence of VM and SCD, and resolution of symptoms. RESULTS Ninety-one patients with SCD met the inclusion and exclusion criteria. VM was diagnosed in 36 (39.6%) patients. Of those receiving medical therapy for VM alone, five (45.5%) reported symptom resolution, five (45.5%) reported partial improvement, one (9.1%) had no change, and none worsened. Fifteen patients (41.7%) were treated with both surgery (for SCD) and medical therapy (for VM). Seven (46.7%) reported symptom resolution, seven (46.7%) reported partial improvement, and one (6.7%) worsened. There was no statistically significant difference in symptom resolution between SCD + VM patients who were treated medically compared with those treated with medical therapy and surgery (p = 0.951). There was no significant difference in symptom resolution after surgery between SCD + VM and SCD-only cohorts (p = 0.286). CONCLUSIONS This is the first study describing the incidence of VM in a cohort of patients with SCDS. The symptoms of VM confound those of SCDS and unrecognized or undertreated VM may contribute to surgical failure in SCDS. Therefore, we recommend a high index of suspicion for VM in patients with SCDS and a trial of medical therapy in the setting of suspected VM.
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Zhang S, Liu D, Tian E, Wang J, Guo Z, Kong W. Central vestibular dysfunction: don't forget vestibular rehabilitation. Expert Rev Neurother 2022; 22:669-680. [PMID: 35912850 DOI: 10.1080/14737175.2022.2106129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Vestibular rehabilitation (VR) is now a subject of active studies and has been shown to be effective for multiple vestibular disorders, peripheral or central. VR is a physical therapy that helps train the central nervous system to compensate for vestibular dysfunction. There is moderate to strong evidence that VR is safe and effective for the management of peripheral vestibular dysfunction. Nonetheless, the studies on how VR works on central vestibular dysfunction remains scanty. AREAS COVERED This article addressed the rehabilitation strategies and possible mechanisms, including how central vestibular function might improve upon rehabilitation. In addition, it provides some examples concerning the effect of VR on central vestibular dysfunction. EXPERT OPINION VR works on the vestibular system through repetition of specific physical exercises that activate central neuroplastic mechanisms to achieve adaptive compensation of the impaired functions. VR has become a mainstay in the management of patients with dizziness and balance dysfunction. Individualized VR programs are a safe and effective treatment option for a large percentage of patients with central vestibular disease reporting imbalance and dizziness. Exploration of various treatment strategies and possible mechanisms will help develop the best and personalized VR treatment for patients with central vestibular dysfunction.
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Affiliation(s)
- Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
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22
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Analysis of video head impulse test saccades data in patients with vestibular migraine or probable vestibular migraine. J Otol 2022; 17:197-202. [PMID: 36249928 PMCID: PMC9547111 DOI: 10.1016/j.joto.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Saccades accompanied by normal gain in video head impulse tests (vHIT) are often observed in patients with vestibular migraine (VM). However, they are not considered as an independent indicator, reducing their utility in diagnosing VM. To better understand clinical features of VM, it is necessary to understand raw saccades data. Methods Fourteen patients with confirmed VM, 45 patients with probable VM (p-VM) and 14 age-matched healthy volunteers were included in this study. Clinical findings related to spontaneous nystagmus (SN), positional nystagmus (PN), head-shaking nystagmus (HSN), caloric test and vHIT were recorded. Raw saccades data were exported and numbered by their sequences, and their features analyzed. Results VM patients showed no SN, PN or HSN, and less than half of them showed unilateral weakness (UW) on caloric test. The first saccades from lateral semicircular canal stimulation were the most predominant for both left and right sides. Neither velocity nor time parameters were significantly different when compared between the two sides. Most VM patients (86%) exhibited small saccades, around 35% of the head peak velocity, with a latency of 200–400 ms. Characteristics of saccades were similar in patients with p-VM. Only four normal subjects showed saccades, all unilateral and seemingly random. Conclusions Small saccades involving bilateral semicircular canals with a scattered distribution pattern are common in patients with VM and p-VM.
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Kovalchick J. Recognizing vestibular migraine. JAAPA 2022; 35:21-26. [PMID: 35543531 DOI: 10.1097/01.jaa.0000830172.67790.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Vestibular migraine is a recently defined disorder that is underrecognized by clinicians across specialties. Acute attacks cause symptoms of migraine headaches as well as vestibular symptoms such as dizziness or vertigo. Further research is needed to determine the pathophysiology of vestibular migraine. No consensus treatment guidelines exist for this condition, and treatment is based on other migraine guidelines. Clinicians who are aware of vestibular migraine can speed diagnosis and treatment for patients and improve their quality of life.
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Affiliation(s)
- Jessica Kovalchick
- Jessica Kovalchick practices at Ascension Lourdes in Binghamton, N.Y. The author has disclosed no potential conflicts of interest, financial or otherwise
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Koç A, Akkılıç EC. Evaluation of video head impulse test during vertiginous attack in vestibular migraine. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:281-286. [PMID: 35880368 PMCID: PMC9330756 DOI: 10.14639/0392-100x-n1951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/20/2022] [Indexed: 11/24/2022]
Abstract
Objective The aim of this study is to evaluate vestibular functions with video head impulse test (VHIT) and to understand the value of VHIT in differential diagnosis in patients with vestibular migraine (VM) during dizziness attack. Materials and methods Two groups were enrolled in this study. The first consisted of 84 vestibular migraine patients, and second group of 74 healthy subjects. VHIT was applied to patients with VM during vertigo attack and the results were compared with the VHIT values applied to subjects in the control group. Results The mean vestibulo-ocular reflex (VOR) in all semicircular canals in the VM group was lower than healthy individuals, but the results were not statistically significant. Refixation saccades were found in 52.3% of VM patients and in 10.2% of healthy individuals. Conclusions When patients with VM were evaluated with VHIT during vertiginous attack, VOR gain values were not different from healthy individuals, but the number of catch-up saccades were higher in VM patients, which indicates peripheral vestibular involvement. For differential diagnosis in patients with VM, vestibular tests should be performed during the vertigo attack. When evaluating VHIT results, the presence of refixation saccades should also be evaluated.
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25
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Is vestibular migraine really a separate form of migraine? Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Patel N, Talewar K, Bahra A, Kaski D. Vestibular migraine. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2022. [DOI: 10.47795/litm2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Vestibular migraine is an under-diagnosed but increasingly recognised neurological condition that causes episodic vertigo, associated with migrainous features. Making a diagnosis of VM relies on a clinical history, including the presence of recurrent episodes of vertigo or dizziness, on a background of migraine headaches, and associated migraine features that accompany the vestibular symptoms. It is the most common cause of spontaneous (non-positional) episodic vertigo, affecting up to 1% of the population, but remains under-diagnosed outside specialist centres, partly due to an absence of diagnostic biomarkers. Its pathophysiology remains poorly understood, and there is a paucity of high-quality treatment trials. Here we review the clinical features of vestibular migraine, highlight current theories that account for vestibular symptoms, and outline treatment guidelines.
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Woźniak M, Dżaman K, Kantor I, Kubiczek-Jagielska M, Zaborowska D. Dysfunctions of the vestibular organ in patients with migrainous vertigo in the results of objective tests of the equilibrium system. Otolaryngol Pol 2022; 76:1-6. [DOI: 10.5604/01.3001.0015.8339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Migrainous vertigo (MV) is one of the most common causes of episodic vertigo. Diagnostic criteria for MV are described in the appendix to the third edition of the International Classification of Headache Disorders (Beta Version). The dysfunction exerts its impact on certain peripheral and central structures within the vestibular system. </br></br> <b>Aim:</b> The aim of the study was to assess the function of the central and peripheral vestibular system in patients with MV based on the results of objective clinical tests including videonystagmography (VNG) and cervical vestibular evoked myogenic potentials (cVEMP) depending on the duration of the disease. </br></br> <b>Material and methods:</b> A query of the medical records of patients receiving vertigo treatment at the Department of Otolaryngo-logy of the Centre of Postgraduate Medical Education over the last four years returned a total of 84 cases of patients diagnosed with MV; the patients were assigned to either of the following two groups: study group I (SG1) – 42 patients with MV in whom the symp-tom onset had occurred within one year prior to hospital admission, and study group II (SG2) – 42 patients who had been suffering from vertigo for about 10 years. </br></br> <b>Results:</b> Patients in both groups (SG1 and SG2) were diagnosed with all three types of vestibular dysfunction (central, peri-pheral and mixed), with peripheral vestibular dysfunction being the predominant finding. A thorough analysis of the dura-tion of vestibular attacks revealed that the patients suffering from MV for a longer period of time (SG2) suffered from vertigo attacks which were longer than those in the patients with the shorter lasting-disorder (SG1). The duration of vertigo episodes was also estimated to be prolonged in peripheral and mixed types of vestibular disorders. The percentage of individuals with peripheral and mixed vestibular disorders increased significantly with increasing MV episode durations.
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Affiliation(s)
- Monika Woźniak
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Mazovian Hospital Brodnowski in Warsaw, Poland
| | - Karolina Dżaman
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Mazovian Hospital Brodnowski in Warsaw, Poland
| | - Ireneusz Kantor
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Mazovian Hospital Brodnowski in Warsaw, Poland
| | - Marzena Kubiczek-Jagielska
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Mazovian Hospital Brodnowski in Warsaw, Poland
| | - Dagmara Zaborowska
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Mazovian Hospital Brodnowski in Warsaw, Poland
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Hac NEF, Gold DR. Neuro-Visual and Vestibular Manifestations of Concussion and Mild TBI. Curr Neurol Neurosci Rep 2022; 22:219-228. [PMID: 35235169 DOI: 10.1007/s11910-022-01184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Mild traumatic brain injury, or concussion, is a major cause of disability. Vestibular and visual dysfunction following concussion is common and can negatively affect patients' well-being and prolong recovery. Etiologies of visual and vestibular symptoms are numerous, including ocular, neuro-ophthalmic, otologic, and neuro-vestibular conditions. Some etiologies are benign and may be treatable, while others are potentially vision or life-threatening, making a focused history and examination essential. This review offers an approach to the evaluation and treatment of the most common neuro-visual and vestibular impairments that may result from concussion. RECENT FINDINGS Treatment of concussion including exercise, computerized programs, transcranial magnetic stimulation, gene therapy, stem cell therapy, and nanoparticles has shown promise. Many novel therapies are in the pipework for visual and vestibular recovery after concussion; however, the treatment mainstay remains therapy and evaluation for co-existing diseases.
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Affiliation(s)
- Nicholas E F Hac
- Department of Neurology, The Johns Hopkins School of Medicine, 600 N Wolfe St, Path 2-210, Baltimore, MD, 21287, USA.
| | - Daniel R Gold
- Department of Neurology, The Johns Hopkins School of Medicine, 600 N Wolfe St, Path 2-210, Baltimore, MD, 21287, USA
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29
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Byeon JH. Vestibular migraine of childhood. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Vestibular migraine and benign paroxysmal vertigo are the most common causes of vertigo in children and adolescents. This is a review of vestibular migraine of childhood dizziness.Current Concepts: In children and adolescents, the symptoms of dizziness or vertigo are not well defined. Thus, few studies have investigated the characteristics of dizziness or vertigo in children and adolescents. Vestibular migraine is categorized as episodic syndromes associated with migraine in the International Classification of Headache Disorders, 3rd edition. Despite vertigo’s various clinical features and duration, vestibular migraine can be diagnosed only when a migraine accompanies vertigo from 5 minutes to 72 hours. Benign paroxysmal vertigo is more common in children and adolescents than vestibular migraine. Benign paroxysmal vertigo is considered one of the precursor syndrome of migraine, and the duration of vertigo is short from seconds to minutes.Discussion and Conclusion: Vestibular migraine is common in older children and adults who need a differential diagnosis. This review might be helpful to diagnose, evaluate, and treat children with vestibular migraine and to reassure their parents.
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Hoskin JL, Fife TD. New Anti-CGRP Medications in the Treatment of Vestibular Migraine. Front Neurol 2022; 12:799002. [PMID: 35153979 PMCID: PMC8828914 DOI: 10.3389/fneur.2021.799002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Vestibular migraine (VM) is a condition associated with migraine headache, vertigo, dizziness, and balance disturbances. Treatment options are limited. It is unknown if new calcitonin gene-related peptide (CGRP) migraine medications have efficacy in treating VM. Methods We retrospectively reviewed all patients with VM who were prescribed one of the new CGRP medications between January 2016 and July 2020. In total, 28 patients met the inclusion criteria. We specifically evaluated the “older” CGRP medications including erenumab, galcanezumab, fremanezumab, and ubrogepant. Medical records for subsequent visits were assessed to monitor improvement described by patients. Results Of the 28 patients identified, three were lost to follow up. For the remaining 25 patients, we divided the patients based on a scale of “significant improvement,” “moderate improvement,” “mild improvement,” or “no improvement.” In total 21 of 25 patients demonstrated some level of improvement in their VM symptoms with 15 having moderate to significant improvement. Conclusion Results demonstrated a trend toward improvement, suggesting that the CGRP medications appear to be a decent treatment option for VM. A prospective study evaluating CGRP medications in patients with VM would provide further information about this treatment option.
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Mallampalli MP, Rizk HG, Kheradmand A, Beh SC, Abouzari M, Bassett AM, Buskirk J, Ceriani CEJ, Crowson MG, Djalilian H, Goebel JA, Kuhn JJ, Luebke AE, Mandalà M, Nowaczewska M, Spare N, Teggi R, Versino M, Yuan H, Zaleski-King A, Teixido M, Godley F. Care Gaps and Recommendations in Vestibular Migraine: An Expert Panel Summit. Front Neurol 2022; 12:812678. [PMID: 35046886 PMCID: PMC8762211 DOI: 10.3389/fneur.2021.812678] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.
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Affiliation(s)
- Monica P Mallampalli
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Amir Kheradmand
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shin C Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, CA, United States
| | - Alaina M Bassett
- Department of Otolaryngology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - James Buskirk
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Claire E J Ceriani
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Matthew G Crowson
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye & Ear and Harvard Medical School, Boston, MA, United States
| | - Hamid Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, CA, United States
| | - Joel A Goebel
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jeffery J Kuhn
- Department of Research, Bayview Physicians Group, Chesapeake, VA, United States
| | - Anne E Luebke
- Biomedical Engineering and Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
| | - Marco Mandalà
- Otolaryngology Unit, University of Siena, Siena, Italy
| | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery, Laryngological Oncology, Nicolaus Copernicus University, Torun, Poland
| | - Nicole Spare
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Roberto Teggi
- Department of Otolaryngology, San Raffaele Scientific Hospital, Milan, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | - Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashley Zaleski-King
- Department of Speech-Language Pathology & Audiology, Towson University, Towson, MD, United States
| | - Michael Teixido
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| | - Frederick Godley
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
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Illarionova E, Gribova N. Vestibular migraine. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:78-83. [DOI: 10.17116/jnevro202212205178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Chen CC, Wang CY, Chen PY, Chen MC, Lee TY, Lee HH. Clinical Spectrum of Positional Vertigo in an Outpatient Setting. Ear Hear 2021; 43:1256-1261. [PMID: 34923556 DOI: 10.1097/aud.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore the clinical spectrum of positional vertigo (PV) and to study the causes of PV with atypical positional nystagmus (PN) and PV without PN. DESIGN We retrospectively analyzed the registry (2425 cases) in a university hospital. Patients who actively reported PV as their main dizziness pattern were included. Candidates were divided into three groups according to their PN: (1) benign paroxysmal PV (BPPV); (2) PV with atypical PN; and (3) PV without PN. The diagnoses and reported symptoms in each group were analyzed. RESULTS PV was the most commonly (n = 518, 28.3%) reported pattern in the registry. The two most common diagnoses of PV were BPPV (n = 146, 29.2%) and vestibular migraine (VM; n = 137, 27.4%). Fifty-seven (11.4%) patients had PV with atypical PN, the majority of which was caused by VM. Moreover, 297 (59.4%) patients had PV without PN. The two main diagnoses in this group were VM and functional dizziness, although the cause remained uncertain in 23.9% of the cases of PV without PN. The odds ratio of VM was 3.95 in patients with PV who reported headaches. CONCLUSIONS PV is the most common self-reported dizziness pattern and is predominantly caused by BPPV and VM. VM is the most common cause of PV with atypical PN and PV without PN. Clinicians often erroneously assume the presence of PN in those with PV. Managing PV without PN can be challenging because of the uncertainty surrounding this phenomenon. Structured patient-oriented questionnaires assist clinicians in making timely diagnoses and adjusting treatment goals accordingly.
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Affiliation(s)
- Chih-Chung Chen
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan Dizziness and Balance Disorder Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Janiak-Kiszka J, Nowaczewska M, Wierzbiński R, Kaźmierczak W, Kaźmierczak H. The visual-ocular and vestibulo-ocular reflexes
in vestibular migraine. Otolaryngol Pol 2021; 76:21-28. [DOI: 10.5604/01.3001.0015.5711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Vestibular migraine is a disease from the border of neurology and otoneurology. The diagnosis depends on patient history. There are no valuable laboratory or imaging tests, therefore the examination of visual-ocular and vestibulo-ocular reflexes is very useful in this group of patients. The material was collected from patients diagnosed due to dizziness at the Department of Otolaryngology and Oncology with the Subdepartment of Audiology and Phoniatrics, CM UMK in Bydgoszcz in 2019–2021. We considered patients with vestibular migraine and analyzed videonystagmographic tests in this study. The most common VNG abnormalities in patients suffering from vestibular migraine were an increased labyrinthine response, increased time constant of the rotational response and abnormal optokinetic response. There was not a single case of canal paresis in the group of patients with vestibular migraine.
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Affiliation(s)
- Joanna Janiak-Kiszka
- Department of Otolaryngology and Laryngological Oncology, Collegium Medicum of the Nicolaus Copernicus University in Bydgoszcz, Poland
| | - Magdalena Nowaczewska
- Department of Otolaryngology and Laryngological Oncology, Collegium Medicum of the Nicolaus Copernicus University in Bydgoszcz, Poland
| | - Rafał Wierzbiński
- Department of Otolaryngology and Laryngological Oncology with Subdepartment of Audiology and Phoniatrics, University Hospital No 1 in Bydgoszcz, Poland
| | - Wojciech Kaźmierczak
- Department of Otolaryngology and Laryngological Oncology with Subdepartment of Audiology and Phoniatrics, University Hospital No 1 in Bydgoszcz, Poland
| | - Henryk Kaźmierczak
- Department of Otolaryngology and Laryngological Oncology, Collegium Medicum of the Nicolaus Copernicus University in Bydgoszcz, Poland
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Donaldson LB, Yan F, Liu YF, Nguyen SA, Rizk HG. Does cognitive dysfunction correlate with dizziness severity in patients with vestibular migraine? Am J Otolaryngol 2021; 42:103124. [PMID: 34166962 DOI: 10.1016/j.amjoto.2021.103124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize the relationship between dizziness severity and cognitive dysfunction in vestibular migraine (VM) patients. METHODS Dizziness Handicap Inventory (DHI) and Cognitive Failures Questionnaire (CFQ) scores were compared pre- and post-treatment in a cohort of definite VM patients who underwent evaluation in a multidisciplinary clinic from 2016 to 2020. RESULTS 44 patients were included. DHI reduction of 11.96 (SD 11.49) (p < 0.001) from an initial mean of 58.36 (22.05) and CFQ reduction of 4.57 (12.20) (p = 0.017) from an initial mean of 47.66 (19.12) were demonstrated. Both pre- and post-treatment DHI scores correlated with pre- and post-treatment CFQ scores (r = 0.537, p < 0.001 and r = 0.667, p < 0.001, respectively). Change in DHI score correlated with change in CFQ score (r = 0.351, p = 0.019). CONCLUSIONS Cognitive dysfunction in VM patients is correlated with dizziness severity. The DHI may fail to thoroughly assess cognitive dysfunction in VM patients. Additionally, multidisciplinary treatment of VM reduces both dizziness severity and cognitive dysfunction.
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Evans RW, Turner DP. Clinical features of new daily persistent headache: A retrospective chart review of 328 cases. Headache 2021; 61:1529-1538. [PMID: 34710236 DOI: 10.1111/head.14207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the clinical features of new daily persistent headache (NDPH) at an outpatient neurology clinic with a subspecialty interest in headache in Houston, Texas. METHODS A retrospective chart review was performed by a neurologist subspecialty certified in headache medicine of all patients seen from September 1, 2011 through February 28, 2020 (8.5 years) with a provisional diagnosis of NDPH and abstracted charts meeting criteria for primary NDPH. RESULTS A total of 328 patients met the International Classification of Headache Disorders, 3rd edition criteria including 215 (65.5%) female patients. The mean age of onset was 40.3 years (range 12-87 years) with a mean age at first consultation in the study clinic of 42.6 years (range 12-87 years). The median [25th, 75th] duration of NDPH at initial consultation was 0.7 [0.3, 2.0] years, and at last visit, it was 1.9 [0.7, 4.8] years. The headaches were side-locked unilateral in 28/328 (8.5%). 12/328 cases (3.6%) with a thunderclap onset are reported. There was no obvious seasonal or other cyclical variation. The pain was usually moderate to severe and more often severe for the migraine phenotype (MP; 260/328 [79.3%] of cases) than for the tension-type phenotype (TTP). Precipitating factors were the following: stressful life events, 67/328 (20.4%); upper respiratory infection or flu-like illness, 33/328 (10.1%); and extracranial surgery, 5/328 (1.5%). Exacerbating or aggravating factors similar to migraine triggers were more often reported with the MP than with the TTP in this sample. For the MP, vertigo or dizziness was reported by 19/260 (7.3%) and a visual aura by 21/260 (8.1%) with descriptions provided. The prognostic types were the following for all patients: persisting (refractory), 305/328 (93.0%); relapsing-remitting, 9/328 (2.7%); and remitting (self-limited), 14/328 (4.3%). CONCLUSION NDPH is typically of moderate to severe intensity often with migraine features without obvious seasonal or other cyclical variation. Most cases are refractory. 3.6% have a thunderclap onset often with a good response to treatment.
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Affiliation(s)
- Randolph W Evans
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review. J Clin Med 2021; 10:jcm10194372. [PMID: 34640391 PMCID: PMC8509726 DOI: 10.3390/jcm10194372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.
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Zhao D, Zhu S, Xu Q, Deng J, Wang Z, Liu X. Neuronal intranuclear inclusion disease presented with recurrent vestibular migraine-like attack: a case presentation. BMC Neurol 2021; 21:334. [PMID: 34479498 PMCID: PMC8414699 DOI: 10.1186/s12883-021-02367-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Neuronal intranuclear inclusion disease (NIID) is a neurodegenerative disorder characterized by dementia, tremor, episodic encephalopathy and autonomic nervous dysfunction. To date, vestibular migraine (VM)-like attack has never been reported in cases with NIID. Here, we describe an 86-year-old patient with NIID who presented with recurrent vertigo associated with headache for more than 30 years. Case presentation An 86-year-old Chinese woman with vertigo, headache, weakness of limbs, fever, and disturbance of consciousness was admitted to our hospital. She had suffered from recurrent vertigo associated with headache since her 50 s,followed by essential tremor and dementia. On this admission, brain magnetic resonance imaging revealed high intensity signals along the corticomedullary junction on diffusion weighted imaging (DWI). Peripheral neuropathy of the extremities was detected through electrophysiological studies. We diagnosed NIID after detecting eosinophilic intranuclear inclusions in the ductal epithelial cells of sweat glands and identifying an abnormal expansion of 81 GGC repeats in the 5’UTR of NOTCH2NLC gene. Conclusions VM-like attack may be associated with NIID.
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Affiliation(s)
- Danhua Zhao
- Department of Neurology, Peking University International Hospital, 1 Shengmingyuan Road, Changping District, 102206, Beijing, P. R. China
| | - Sha Zhu
- Department of Neurology, Peking University International Hospital, 1 Shengmingyuan Road, Changping District, 102206, Beijing, P. R. China
| | - Qinlan Xu
- Department of Neurology, Peking University International Hospital, 1 Shengmingyuan Road, Changping District, 102206, Beijing, P. R. China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, 100034, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, 100034, Beijing, China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, 1 Shengmingyuan Road, Changping District, 102206, Beijing, P. R. China.
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The Role of the Functional Head Impulse Test with and without Optokinetic Stimuli in Vestibular Migraine and Acute Unilateral Vestibulopathy: Discovering a Dynamic Visual Dependence. J Clin Med 2021; 10:jcm10173787. [PMID: 34501235 PMCID: PMC8432176 DOI: 10.3390/jcm10173787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Visually induced vertigo (i.e., vertigo provoked by moving visual scenes) can be considered a noticeable feature of vestibular migraines (VM) and can be present in patients suffering from acute unilateral vestibulopathy (AUV). Hypersensitivity to moving or conflicting visual stimulation is named visual dependence. (2) Methods: Visuo-vestibular interactions were analyzed via the functional Head Impulse Test (fHIT) with and without optokinetic stimulation (o-fHIT) in 25 patients with VM, in 20 subjects affected by AUV, and in 20 healthy subjects. We calculated the percentage of correct answers (%CA) without and with the addition of the optokinetic background (OB). (3) In VM groups, the %CA on the fHIT was 92.07% without OB and 73.66% with OB. A significant difference was found between %CA on the deficit side and that on the normal side in AUV, both without OB and with OB. (4) Conclusions: The fHIT results in terms of %CA with and without OB could be useful to identify the presence of a dynamic visual dependence, especially in patients suffering from VM. The difference in %CA with and without OB could provide instrumental support to help correctly identify subjects suffering from VM. We propose the use of the fHIT in clinical practice whenever there is a need to highlight a condition of dynamic visual dependence.
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Chen Z, Xiao L, Liu H, Zhang Q, Wang Q, Lv Y, Zhai Y, Zhang J, Dong S, Wei X, Rong L. Altered thalamo-cortical functional connectivity in patients with vestibular migraine: a resting-state fMRI study. Neuroradiology 2021; 64:119-127. [PMID: 34374821 DOI: 10.1007/s00234-021-02777-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the functional connectivity (FC) between the bilateral thalamus and the other brain regions in patients with vestibular migraine (VM). METHODS Resting-state fMRI and 3D-T1 data were collected from 37 patients with VM during the interictal period and 44 age-, gender-, and years of education-matched healthy controls (HC). The FC of the bilateral thalamus was analyzed using a standard seed-based whole-brain correlation method. Furthermore, the correlations between thalamus FC and clinical characteristics of patients were investigated using Pearson's partial correlation. RESULTS Compared with HC, VM patients showed decreased FC between the left thalamus and the left anterior cingulate cortex (ACC), bilateral insular and right supplementary motor cortex. We also observed decreased FC between the right thalamus and the left insular and ACC in VM patients. Furthermore, patients with VM also exhibited increased FC between the left thalamus and the right precuneus and middle frontal gyrus, between the right thalamus and superior parietal lobule. FC between the right thalamus and the left insular was negatively correlated with disease duration (p = 0.019, r = - 0.399), FC between the left thalamus and the left ACC was negatively correlated with HIT-6 score (p = 0.004, r = - 0.484). CONCLUSION VM patients showed altered FC between thalamus and brain regions involved in pain, vestibular and visual processing, which are associated with specific clinical features. Specifically, VM patients showed reduced thalamo-pain and thallamo-vestibular pathways, while exhibited enhanced thalamo-visual pathway, which provided first insight into the underlying functional brain connectivity in VM patients.
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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, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Qingxiu Zhang
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Quan Wang
- Medical Imaging Department, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - You Lv
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Yujia Zhai
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Jun Zhang
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Shanshan Dong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Xiue Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, 221006, Jiangsu, China.
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Dlugaiczyk J, Lempert T, Lopez-Escamez JA, Teggi R, von Brevern M, Bisdorff A. Recurrent Vestibular Symptoms Not Otherwise Specified: Clinical Characteristics Compared With Vestibular Migraine and Menière's Disease. Front Neurol 2021; 12:674092. [PMID: 34220683 PMCID: PMC8248237 DOI: 10.3389/fneur.2021.674092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022] Open
Abstract
Despite the huge progress in the definition and classification of vestibular disorders within the last decade, there are still patients whose recurrent vestibular symptoms cannot be attributed to any of the recognized episodic vestibular syndromes, such as Menière's disease (MD), vestibular migraine (VM), benign paroxysmal positional vertigo (BPPV), vestibular paroxysmia, orthostatic vertigo or transient ischemic attack (TIA). The aim of the present international, multi-center, cross-sectional study was to systematically characterize the clinical picture of recurrent vestibular symptoms not otherwise specified (RVS-NOS) and to compare it to MD and VM. Thirty-five patients with RVS-NOS, 150 patients with VM or probable VM and 119 patients with MD were included in the study. The symptoms of RVS-NOS had been present for 5.4 years on average before inclusion, similar to VM and MD in this study, suggesting that RVS-NOS is not a transitory state before converting into another diagnosis. Overall, the profile of RVS-NOS vestibular symptoms was more similar to VM than MD. In particular, the spectrum of vestibular symptom types was larger in VM and RVS-NOS than in MD, both at group comparison and the individual level. However, in contrast to VM, no female preponderance was observed for RVS-NOS. Positional, head-motion and orthostatic vertigo were reported more frequently by patients with RVS-NOS than MD, while external vertigo was more prevalent in the MD group. At group level, the spectrum of attack durations from minutes to 3 days was evenly distributed for VM, while a small peak for short and long attacks in RVS-NOS and a big single peak of hours in MD were discernible. In general, vertigo attacks and associated vegetative symptoms (nausea and vomiting) were milder in RVS-NOS than in the other two disorders. Some patients with RVS-NOS described accompanying auditory symptoms (tinnitus: 2.9%, aural fullness and hearing loss: 5.7% each), migrainous symptoms (photophobia, phonophobia or visual aura in 5.7% each) or non-migrainous headaches (14%), but did not fulfill the diagnostic criteria for MD or VM. Absence of a life time diagnosis of migraine headache and attack duration of <5 min were further reasons not to qualify for VM. In some RVS-NOS patients with accompanying ear symptoms, attack durations of <20 min excluded them from being diagnosed with MD. These findings suggest that RVS-NOS is a stable diagnosis over time whose overall clinical presentation is more similar to VM than to MD. It is more likely to be composed of several disorders including a spectrum of mild or incomplete variants of known vestibular disorders, such as VM and MD, rather than a single disease entity with distinct pathognomonic features.
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Affiliation(s)
- Julia Dlugaiczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany
| | - Jose Antonio Lopez-Escamez
- Otology and Neurotology Group CTS 495, Department of Genomic Medicine, Centre for Genomic and Oncological Research (GENyO) Pfizer-Universidad de Granada-Junta de Andalucía, Granada, Spain
| | - Roberto Teggi
- ENT Department, San Raffaele Scientific Institute, "Vita e Salute" University, Milan, Italy
| | - Michael von Brevern
- Private Practice of Neurology and Department of Neurology, Charité, Berlin, Germany
| | - Alexandre Bisdorff
- Clinique du Vertige, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
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Kutlubaev M. Clinical and pathogenetic aspects of positional nystagmus. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:123-127. [DOI: 10.17116/jnevro2021121121123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mouelhi A, Ben Slama A, Marrakchi J, Trabelsi H, Sayadi M, Labidi S. Sparse classification of discriminant nystagmus features using combined video-oculography tests and pupil tracking for common vestibular disorder recognition. Comput Methods Biomech Biomed Engin 2020; 24:400-418. [PMID: 33043702 DOI: 10.1080/10255842.2020.1830972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Vertigo is a common sign related to a problem with the brain or vestibular system. Detection of ocular nystagmus can be a support indicator to distinguish different vestibular disorders. In order to get reliable and accurate real time measurements from nystagmus response, video-oculography (VOG) plays an important role in the daily clinical examination. However, vestibular diseases present a large diversity in their characteristics that leads to many complications for usual analysis. In this paper, we propose a novel automated approach to achieve both selection and classification of nystagmus parameters using four tests and a pupil tracking procedure in order to give reliable evaluation and standardized indicators of frequent vestibular dysfunction that will assist clinicians in their diagnoses. Indeed, traditional tests (head impulse, caloric, kinetic and saccadic tests) are applied to obtain clinical parameters that highlight the type of vertigo (peripheral or central vertigo). Then, a pupil tracking method is used to extract temporal and frequency nystagmus features in caloric and kinetic sequences. Finally, all extracted features from the tests are reduced according to their high characterization degree by linear discriminant analysis, and classified into three vestibular disorders and normal cases using sparse representation. The proposed methodology is tested on a database containing 90 vertiginous subjects affected by vestibular Neuritis, Meniere's disease and Migraines. The presented technique highly reduces labor-intensive workloads of clinicians by producing the discriminant features for each vestibular disease which will significantly speed up the vertigo diagnosis and provides possibility for fully computerized vestibular disorder evaluation.
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Affiliation(s)
- Aymen Mouelhi
- Laboratory of Signal Image and Energy Mastery, LR13ES03 (SIME), University of Tunis, ENSIT, 1008, Tunis, Tunisia
| | - Amine Ben Slama
- Laboratory of Biophysics and Medical Technologies, LR13ES07 (BTM), University of Tunis ELmanar, Higher Institute of Medical Technologies of Tunis (ISTMT), 1006, Tunis, Tunisia
| | - Jihene Marrakchi
- Department of Oto-Rhino-laryngology, La Rabta Hospital, Tunis, Tunisia
| | - Hedi Trabelsi
- Laboratory of Biophysics and Medical Technologies, LR13ES07 (BTM), University of Tunis ELmanar, Higher Institute of Medical Technologies of Tunis (ISTMT), 1006, Tunis, Tunisia
| | - Mounir Sayadi
- Laboratory of Signal Image and Energy Mastery, LR13ES03 (SIME), University of Tunis, ENSIT, 1008, Tunis, Tunisia
| | - Salam Labidi
- Laboratory of Biophysics and Medical Technologies, LR13ES07 (BTM), University of Tunis ELmanar, Higher Institute of Medical Technologies of Tunis (ISTMT), 1006, Tunis, Tunisia
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Imbalance, motion sensitivity, anxiety and handicap in vestibular migraine and migraine only patients. Auris Nasus Larynx 2020; 47:747-751. [DOI: 10.1016/j.anl.2020.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/12/2020] [Accepted: 02/26/2020] [Indexed: 11/19/2022]
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Abstract
Vertigo, dizziness and equilibrium disorders are symptoms with a variety of causes. First, four cardinal questions (type and duration of the vertigo, triggering factors, accompanying symptoms) must be answered. After that, the search for a spontaneous nystagmus (differentiation of peripheral and central disorder using the HINTS[head impulse, nystagmus, test of skew]-test ) and, as part of a positioning examination, the search for a benign paroxysmal positional vertigo (BPPV) are necessary. If the result is negative an instrument-based receptor-specific examination is carried out. The caloric examination (low-frequency stimulus) tests the horizontal semicircular canal and the superior vestibular nerve, whereas the 3‑D video head impulse test (vHIT, high-frequency stimulus) is used to analyze all three semicircular canals as well as the superior and inferior vestibular nerves. Analysis of the cervical vestibular evoked myogenic potential (cVEMP) checks the function of the sacculus and that of the ocular VEMP (oVEMP) checks the function of the utriculus. The final overall analysis usually gives a definitive diagnosis or at least provides a suspected diagnosis, which then determines the further diagnostic procedure (e.g. targeted radiological diagnostics if vestibular paroxysmia, superior canal dehiscence or a vestibular schwannoma are suspected).
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Affiliation(s)
- F Schmäl
- Schwindelambulanz am Zentrum für HNO Münster/Greven, Maria-Josef-Hospital GmbH, Lindenstr. 37, 48268, Greven, Deutschland.
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