Functional MRI of galvanic vestibular stimulation with alternating currents at different frequencies

Integrating vestibular and visual cues for verticality perception

Verticality is the perception of what's upright relative to gravity. The vestibular system provides information about the head's orientation relative to gravity, while visual cues influence the perception of external objects' alignment with the vertical. According to Bayesian integration, the perception of verticality depends on the relative reliability of visual and vestibular cues. Ambiguities in vestibular signals are resolved through visual information, with the brain integrating these cues alongside prior knowledge of the upright orientation. While it is established that both vestibular and visual cues contribute to verticality perception, the precise mechanisms underlying this integration remain unclear. Here we investigated how the human brain combines vestibular and visual cues to perceive verticality based on their reliability. We assessed verticality perception using a signal detection theory based visual verticality detection task. Participants were shown lines that were either vertical or tilted and asked to judge their orientation. To manipulate cue reliability, we used optokinetic stimulation for visual cues, galvanic vestibular stimulation for vestibular cues, and a combined visual-vestibular condition by simultaneously delivering optokinetic and galvanic vestibular stimulation. Sham stimulations were administered to control for non-specific effects. Our findings demonstrate that reductions in the reliability of visual and vestibular cues impair sensitivity to verticality, with visual cues exerting a more pronounced influence. Importantly, no changes in response bias were observed. The observed pattern aligns with a model in which the relative contributions of visual and vestibular inputs are determined by linear weightings and their combined summation.

Altered amplitude of low-frequency fluctuation and functional connectivity in patients with acute unilateral vestibulopathy: a resting-state fMRI study

Objective

To investigate changes of brain functional activity in patients with acute unilateral vestibulopathy (AUVP) using functional magnetic resonance imaging (fMRI).

Methods

We studied 32 AUVP patients and 30 healthy controls (HC) who received resting-state fMRI scanning. Methods of voxel-based amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC) were adopted to compare the difference in brain function between the two groups. In addition, we evaluated the associations between abnormal neuroimaging results and clinical data in AUVP patients.

Results

Compared with HC, patients with AUVP showed lower ALFF in brain regions of bilateral insular, right precentral gyrus, left inferior frontal gyrus and right middle frontal gyrus, as well as higher ALFF in left cerebellar anterior lobe. Using these abnormal brain areas as seeds, we observed decreased FC between left insular and left precuneus in AUVP patients. Furthermore, AUVP patients showed increased FC between left insular and left supplementary motor area. Results of correlation analysis indicated that ALFF value (z-value) in left insular was negatively correlated with the canal paresis value (p = 0.005, r = -0.483), and the FC (z-value) between left insular and left precuneus was negatively correlated with dizziness handicap inventory score (p = 0.012, r = -0.438) in patients with AUVP.

Conclusion

Patients with AUVP during acute period showed altered functional activity and connectivity in brain regions mainly involved in motor control and vestibular information processing. These changes in brain functional activity and connectivity were potentially attributed to decreased vestibular input resulting from unilateral peripheral vestibular impairment.

Increased parietal operculum functional connectivity following vestibular rehabilitation in benign paroxysmal positional vertigo patients with residual dizziness: a randomized controlled resting-state fMRI study

INTRODUCTION

Residual dizziness (RD) is common in patients with benign paroxysmal positional vertigo (BPPV) after successful canalith repositioning procedures. This study aimed to investigate the therapeutic effects of vestibular rehabilitation (VR) on BPPV patients experiencing RD, and to explore the impact of VR on functional connectivity (FC), specifically focusing on the bilateral parietal operculum (OP) cortex.

METHODS

Seventy patients with RD were randomly assigned to either a four-week VR group or a control group that received no treatment. Assessments included the dizziness Visual Analog Scale (VAS), Dizziness Handicap Inventory (DHI), Hamilton Anxiety/Depression Scale (HAMA/HAMD), and resting-state functional magnetic resonance imaging.

RESULTS

The VR group exhibited a significant decline in scores on VAS, DHI, HAMA and HAMD following training (all p < 0.05). Furthermore, the VR group demonstrated increased FC between the left OP and both the left precuneus and left middle frontal gyrus (MFG), and between the right OP and the right MFG (voxel-level p < 0.001; cluster-level p < 0.05, FDR corrected). Additionally, these changes in FC were found to correlate with clinical features, including scores on HAMA (p = 0.012, r =  - 0.513) and DHI (p = 0.022, r =  - 0.475) after the intervention.

CONCLUSION

This study demonstrated the therapeutic effects of VR in alleviating RD and emotional disorders, as well as in improving overall quality of life. Notably, these positive outcomes might be associated with increased FC between brain regions involved in mood regulation and vestibular processing. Our findings offer novel neuroimaging evidence that supports the hypothesis that VR facilitates dynamic vestibular compensation.

Restoring vestibular function during natural self-motion: Progress and challenges

The vestibular system is integral to behavior; the loss of peripheral vestibular function leads to disabling consequences, such as blurred vision, dizziness, and unstable posture, severely limiting activities of daily living. Fortunately, the vestibular system's well-defined peripheral structure and well-understood encoding strategies offer unique opportunities for developing sensory prostheses to restore vestibular function. While these devices show promising results in both animal models and implanted patients, substantial room for improvement remains. Research from an engineering perspective has largely focused on optimizing stimulation protocol to improve outcomes. However, this approach has often been pursued in isolation from research in neuroscience that has enriched our understanding of neural responses at the synaptic, cellular, and circuit levels. Accordingly, this review bridges the domains of neuroscience and engineering to consider recent progress and challenges in vestibular prosthesis development. We advocate for interdisciplinary approaches that leverage studies of neural circuits at the population level, especially in light of recent advancement in large-scale recording technology, to identify impediments still to overcome and to develop more naturalistic stimulation strategies. Fully integrating neuroscience and engineering in the context of prosthesis development will help advance the field forward and ultimately improve patient outcomes.

No enhancement of vestibular stimulation on visual working memory for actions

Holding and processing actions in visual working memory (VWM) is crucial for daily functioning, but it is capacity-limited. The vestibular system, which is activated by both vestibular signals and visual gravitational motion, may be involved in this cognitive process. Past research indicates that galvanic vestibular stimulation (GVS) is a non-invasive technique that can enhance motor functions and various cognitive functions. However, the impact of GVS on VWM for actions has not been explored. This study addresses this gap by investigating whether GVS can improve VWM capacity for both upright and inverted actions. Using a virtual reality platform, we assessed VWM capacity in a change detection task, applying either STIM-current (0.8 mA) or SHAM-current (0 mA) GVS. The results showed no significant effect of GVS on VWM for either upright or inverted actions, at least for non-noisy GVS with stimulation intensity below cutaneous threshold. Despite the absence of significant effects, this study provides valuable insights into the interactions between the vestibular system and cognitive processes, laying the groundwork for future research on GVS applications in cognitive enhancement.

Induced electric fields in MRI settings and electric vestibular stimulations: same vestibular effects?

In Magnetic Resonance Imaging scanner environments, the continuous Lorentz Force is a potent vestibular stimulation. It is nowadays so well known that it is now identified as Magnetic vestibular stimulation (MVS). Alongside MVS, some authors argue that through induced electric fields, electromagnetic induction could also trigger the vestibular system. Indeed, for decades, vestibular-specific electric stimulations (EVS) have been known to precisely impact all vestibular pathways. Here, we go through the literature, looking at potential time varying magnetic field induced vestibular outcomes in MRI settings and comparing them with EVS-known outcomes. To date, although theoretically induction could trigger vestibular responses the behavioral evidence remains poor. Finally, more vestibular-specific work is needed.

The altered functional status in vestibular migraine: A meta-analysis

PURPOSE

Vestibular migraine (VM) is a disorder with prominent vestibular symptoms that are causally correlated with migraine and is the most prevalent neurological cause of episodic vertigo. Nevertheless, the functional underpinnings of VM remain largely unclear. This study aimed to reveal concordant alteration patterns of functional connectivity (FC) in VM patients.

METHODS

We searched literature measuring resting-state FC abnormalities of VM patients in PubMed, Embase, Cochrane, and Scopus databases before May 2023. Furthermore, we applied the anisotropic effect size-signed differential mapping (AES-SDM) to conduct a whole-brain voxel-wise meta-analysis to identify the convergence of FC alterations in VM patients.

RESULTS

Nine studies containing 251 VM patients and 257 healthy controls (HCs) were included. Relative to HCs, VM patients showed reduced activity in the left superior temporal gyrus and left midcingulate/paracingulate gyri, and increased activity in the precuneus, right superior parietal gyrus, and right middle frontal gyrus. Jackknife's analysis and subgroup analysis further supported the generalization and robustness of the main results. Furthermore, meta-regression analyses indicated that the Dizziness Handicap Inventory (DHI) ratings were positively correlated with the activity in the precuneus, while higher Headache Impact Test-6 and DHI scores were associated with lower activity within the left midcingulate/paracingulate gyri.

CONCLUSIONS

The study indicates that VM is associated with specific functional deficits of VM patients in crucial regions involved in the vestibular and pain networks and provides further information on the pathophysiological mechanisms of VM.

Aberrant cerebral blood flow and functional connectivity in patients with vestibular migraine: a resting-state ASL and fMRI study

BACKGROUND

Prior neuroimaging studies on vestibular migraine (VM) have extensively certified the functional and structural alterations in multiple brain regions and networks. However, few studies have assessed the cerebral blood flow (CBF) in VM patients using arterial spin labeling (ASL). The present study aimed to investigate CBF and functional connectivity (FC) alterations in VM patients during interictal periods.

METHODS

We evaluated 52 VM patients and 46 healthy controls (HC) who received resting-state pseudo-continuous ASL and functional magnetic resonance imaging (fMRI) scanning. Comparisons of voxel-based CBF and seed-based FC were performed between the two groups. Brain regions showed significant group differences in CBF analyses were chosen as seeds in FC analyses. Additionally, the associations between abnormal imaging results and clinical features were explored.

RESULTS

Compared with HC, VM patients showed higher normalized CBF in the right precentral gyrus (PreCG), left postcentral gyrus (PostCG), left superior frontal gyrus and bilateral insular (p < 0.05, FDR corrected). Furthermore, VM patients exhibited increased FC between the right PreCG and areas of the left PostCG, left cuneus and right lingual gyrus (p < 0.05, FDR corrected). In addition, we observed decreased FC between the left insular and regions of the left thalamus and right anterior cingulate cortex, as well as increased FC between the left insular and right fusiform gyrus in VM patients (p < 0.05, FDR corrected). Moreover, these variations in brain perfusion and FC were significantly correlated with multiple clinical features including frequency of migraine symptoms, frequency of vestibular symptoms and disease duration of VM (all p < 0.05).

CONCLUSIONS

Patients with VM during interictal period showed hyperperfusion and abnormal resting-state FC in brain regions potentially contributed to disrupted multi-sensory and autonomic processing, as well as impaired ocular motor control, pain modulation and emotional regulation. Our study provided novel insights into the complex neuropathology of VM from a CBF perspective.

Is activation of the vestibular system by electromagnetic induction a possibility in an MRI context?

In recent years, an increasing number of studies have discussed the mechanisms of vestibular activation in strong magnetic field settings such as occur in a magnetic resonance imaging scanner environment. Amid the different hypotheses, the Lorentz force explanation currently stands out as the most plausible mechanism, as evidenced by activation of the vestibulo-ocular reflex. Other hypotheses have largely been discarded. Nonetheless, both human data and computational modeling suggest that electromagnetic induction could be a valid mechanism which may coexist alongside the Lorentz force. To further investigate the induction hypothesis, we provide, herein, a first of its kind dosimetric analysis to estimate the induced electric fields at the vestibular system and compare them with what galvanic vestibular stimulation would generate. We found that electric fields strengths from induction match galvanic vestibular stimulation strengths generating vestibular responses. This review examines the evidence in support of electromagnetic induction of vestibular responses, and whether movement-induced time-varying magnetic fields should be further considered and investigated.

Altered parietal operculum cortex 2 functional connectivity in benign paroxysmal positional vertigo patients with residual dizziness: A resting-state fMRI study

AIMS

To investigate changes in functional connectivity (FC) focusing on parietal operculum cortex 2 (OP2) in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning procedure (CRP).

METHODS

High-resolution three-dimensional T1 and resting-state functional magnetic resonance imaging (fMRI) were performed on 55 healthy controls (HCs), 55 BPPV patients with RD, and 55 patients without RD after successful CRP. Seed-based (bilateral OP2) FC was calculated to investigate the changes in FC among the three groups. Additionally, we further explored the associations between abnormal FC and clinical symptoms.

RESULTS

One-way analysis of covariance showed significant FC differences among the three groups. Post-hoc analysis showed that patients with RD exhibited decreased FC between left OP2 and regions of left angular gyrus (AG), thalamus, precuneus, middle frontal gyrus (MFG), and right cerebellum posterior lobe (CPL) in comparison with HCs. In addition, compared with patients without RD, patients with RD showed decreased FC between left OP2 and regions of left MFG, AG, middle temporal gyrus, and right CPL. Moreover, in patients with RD, the FC between left thalamus and OP2 was negatively correlated with duration of RD, and the FC between left AG and OP2 was negatively correlated with duration of BPPV.

CONCLUSION

BPPV patients with RD showed reduced FC between brain regions involved in vestibular processing and spatial cognition; These results suggested that BPPV patients with RD might have diminished central processing of vestibular information and impaired spatial cognition.

Electrical stimulation of the peripheral and central vestibular system

PURPOSE OF REVIEW

Electrical stimulation of the peripheral and central vestibular system using noninvasive (galvanic vestibular stimulation, GVS) or invasive (intracranial electrical brain stimulation, iEBS) approaches have a long history of use in studying self-motion perception and balance control. The aim of this review is to summarize recent electrophysiological studies of the effects of GVS, and functional mapping of the central vestibular system using iEBS in awake patients.

RECENT FINDINGS

The use of GVS has become increasingly common in the assessment and treatment of a wide range of clinical disorders including vestibulopathy and Parkinson's disease. The results of recent single unit recording studies have provided new insight into the neural mechanisms underlying GVS-evoked improvements in perceptual and motor responses. Furthermore, the application of iEBS in patients with epilepsy or during awake brain surgery has provided causal evidence of vestibular information processing in mostly the middle cingulate cortex, posterior insula, inferior parietal lobule, amygdala, precuneus, and superior temporal gyrus.

SUMMARY

Recent studies have established that GVS evokes robust and parallel activation of both canal and otolith afferents that is significantly different from that evoked by natural head motion stimulation. Furthermore, there is evidence that GVS can induce beneficial neural plasticity in the central pathways of patients with vestibular loss. In addition, iEBS studies highlighted an underestimated contribution of areas in the medial part of the cerebral hemispheres to the cortical vestibular network.

Identification of the human cerebral cortical hemodynamic response to passive whole-body movements using near-infrared spectroscopy

The human vestibular system is crucial for motion perception, balance control, and various higher cognitive functions. Exploring how the cerebral cortex responds to vestibular signals is not only valuable for a better understanding of how the vestibular system participates in cognitive and motor functions but also clinically significant in diagnosing central vestibular disorders. Near-infrared spectroscopy (NIRS) provides a portable and non-invasive brain imaging technology to monitor cortical hemodynamics under physical motion.

Objective

This study aimed to investigate the cerebral cortical response to naturalistic vestibular stimulation induced by real physical motion and to validate the vestibular cerebral cortex previously identified using alternative vestibular stimulation.

Approach

Functional NIRS data were collected from 12 right-handed subjects when they were sitting in a motion platform that generated three types of whole-body passive translational motion (circular, lateral, and fore-and-aft).

Main results

The study found that different cortical regions were activated by the three types of motion. The cortical response was more widespread under circular motion in two dimensions compared to lateral and fore-and-aft motions in one dimensions. Overall, the identified regions were consistent with the cortical areas found to be activated in previous brain imaging studies.

Significance

The results provide new evidence of brain selectivity to different types of motion and validate previous findings on the vestibular cerebral cortex.

Top-down control of vestibular inputs by the dorsolateral prefrontal cortex

The vestibular apparatus provides spatial information on the position of the head in space and with respect to gravity. Low-frequency sinusoidal galvanic vestibular stimulation (sGVS), a means of selectively changing the firing of vestibular afferents, induces a frequency-dependent perception of sway and, in some individuals, induces nausea. Given that vestibular afferents project to the insular cortex-which forms part of the vestibular cortex-and that the insula receives inputs from the dorsolateral prefrontal cortex (dlPFC), we tested the hypothesis that electrical stimulation of the dlPFC can modulate vestibular inputs. Sinusoidal electrical stimulation (± 2 mA, 0.08 Hz, 100 cycles) was delivered via surface electrodes over (1) the mastoid processes alone (sGVS), (2) electroencephalogram (EEG) site F4 (right dlPFC) and the nasion or (3) to each site concurrently (sGVS + dlPFC) in 23 participants. The same stimulation protocol was used in a separate study to investigate EEG site F3 (left dlPFC) instead of F4 in 13 participants. During sGVS, all participants reported perceptions of sway and 13 participants also reported nausea, neither sensation of which occurred as a result of dlPFC stimulation. Interestingly, when sGVS and dlPFC stimulations were delivered concurrently, vestibular perceptions and sensations of nausea were almost completely abolished. We conclude that the dlPFC provides top-down control of vestibular inputs and further suggests that dlPFC stimulation may provide a novel means of controlling nausea.

Vestibular contribution to spatial encoding

Determining the spatial relation between objects and our location in the surroundings is essential for survival. Vestibular inputs provide key information about the position and movement of our head in the three-dimensional space, contributing to spatial navigation. Yet, their role in encoding spatial localisation of environmental targets remains to be fully understood. We probed the accuracy and precision of healthy participants' representations of environmental space by measuring their ability to encode the spatial location of visual targets (Experiment 1). Participants were asked to detect a visual light and then walk towards it. Vestibular signalling was artificially disrupted using stochastic galvanic vestibular stimulation (sGVS) applied selectively during encoding targets' location. sGVS impaired the accuracy and precision of locating the environmental visual targets. Importantly, this effect was specific to the visual modality. The location of acoustic targets was not influenced by vestibular alterations (Experiment 2). Our findings indicate that the vestibular system plays a role in localising visual targets in the surrounding environment, suggesting a crucial functional interaction between vestibular and visual signals for the encoding of the spatial relationship between our body position and the surrounding objects.

Frequency-Dependent Reduction of Cybersickness in Virtual Reality by Transcranial Oscillatory Stimulation of the Vestibular Cortex

Virtual reality (VR) applications are pervasive of everyday life, as in working, medical, and entertainment scenarios. There is yet no solution to cybersickness (CS), a disabling vestibular syndrome with nausea, dizziness, and general discomfort that most of VR users undergo, which results from an integration mismatch among visual, proprioceptive, and vestibular information. In a double-blind, controlled trial, we propose an innovative treatment for CS, consisting of online oscillatory imperceptible neuromodulation with transcranial alternating current stimulation (tACS) at 10 Hz, biophysically modelled to reach the vestibular cortex bilaterally. tACS significantly reduced CS nausea in 37 healthy subjects during a VR rollercoaster experience. The effect was frequency-dependent and placebo-insensitive. Subjective benefits were paralleled by galvanic skin response modulation in 25 subjects, addressing neurovegetative activity. Besides confirming the role of transcranially delivered oscillations in physiologically tuning the vestibular system function (and dysfunction), results open a new way to facilitate the use of VR in different scenarios and possibly to help treating also other vestibular dysfunctions.

Frequency-dependent tuning of the human vestibular "sixth sense" by transcranial oscillatory currents

OBJECTIVE

The vestibular cortex is a multisensory associative region that, in neuroimaging investigations, is activated by slow-frequency (1-2 Hz) galvanic stimulation of peripheral receptors. We aimed to directly activate the vestibular cortex with biophysically modeled transcranial oscillatory current stimulation (tACS) in the same frequency range.

METHODS

Thirty healthy subjects and one rare patient with chronic bilateral vestibular deafferentation underwent, in a randomized, double-blind, controlled trial, to tACS at slow (1 or 2 Hz) or higher (10 Hz) frequency and sham stimulations, over the Parieto-Insular Vestibular Cortex (PIVC), while standing on a stabilometric platform. Subjective symptoms of motion sickness were scored by Simulator Sickness Questionnaire and subjects' postural sways were monitored on the platform.

RESULTS

tACS at 1 and 2 Hz induced symptoms of motion sickness, oscillopsia and postural instability, that were supported by posturographic sway recordings. Both 10 Hz-tACS and sham stimulation on the vestibular cortex did not affect vestibular function. As these effects persisted in a rare patient with bilateral peripheral vestibular areflexia documented by the absence of the Vestibular-Ocular Reflex, the possibility of a current spread toward peripheral afferents is unlikely. Conversely, the 10 Hz-tACS significantly reduced his chronic vestibular symptoms in this patient.

CONCLUSIONS

Weak electrical oscillations in a frequency range corresponding to the physiological cortical activity of the vestibular system may generate motion sickness and postural sways, both in healthy subjects and in the case of bilateral vestibular deafferentation.

SIGNIFICANCE

This should be taken into account as a new side effect of tACS in future studies addressing cognitive functions. Higher frequencies of stimulation applied to the vestibular cortex may represent a new interventional option to reduce motion sickness in different scenarios.

Common neural correlates of vestibular stimulation and fear learning: an fMRI meta-analysis

BACKGROUND

A bidirectional functional link between vestibular and fear-related disorders has been previously suggested.

OBJECTIVE

To test a potential overlap of vestibular and fear systems with regard to their brain imaging representation maps.

METHODS

By use of voxel-based mapping permutation of subject images, we conducted a meta-analysis of earlier functional magnetic resonance imaging (fMRI) studies applying vestibular stimulation and fear conditioning in healthy volunteers.

RESULTS

Common clusters of concordance of vestibular stimulation and fear conditioning were found in the bilateral anterior insula cortex, ventrolateral prefrontal cortex and the right temporal pole, bilaterally in the adjacent ventrolateral prefrontal cortex, cingulate gyrus, secondary somatosensory cortex, superior temporal and intraparietal lobe, supplementary motor area and premotor cortex, as well as subcortical areas, such as the bilateral thalamus, mesencephalic brainstem including the collicular complex, pons, cerebellar vermis and bilateral cerebellar hemispheres. Peak areas of high concordance for activations during vestibular stimulation but deactivations during fear conditioning were centered on the posterior insula and S2.

CONCLUSIONS

The structural overlap of both networks allows the following functional interpretations: first, the amygdala, superior colliculi, and antero-medial thalamus might represent a release of preprogramed sensorimotor patterns of approach or avoidance. Second, the activation (vestibular system) and deactivation (fear system) of the bilateral posterior insula is compatible with the view that downregulation of the fear network by acute vestibular disorders or unfamiliar vestibular stimulation makes unpleasant perceived body accelerations less distressing. This also fits the clinical observation that patients with bilateral vestibular loss suffer from less vertigo-related anxiety.

In Vivo Localization of the Human Velocity Storage Mechanism and Its Core Cerebellar Networks by Means of Galvanic-Vestibular Afternystagmus and fMRI

Humans are able to estimate head movements accurately despite the short half-life of information coming from our inner ear motion sensors. The observation that the central angular velocity estimate outlives the decaying signal of the semicircular canal afferents led to the concept of a velocity storage mechanism (VSM). The VSM can be activated via visual and vestibular modalities and becomes manifest in ocular motor responses after sustained stimulation like whole-body rotations, optokinetic or galvanic vestibular stimulation (GVS). The VSM has been the focus of many computational modelling approaches; little attention though has been paid to discover its actual structural correlates. Animal studies localized the VSM in the medial and superior vestibular nuclei. A significant modulation by cerebellar circuitries including the uvula and nodulus has been proposed. Nevertheless, the corresponding neuroanatomical structures in humans have not been identified so far. The aim of the present study was to delineate the neural substrates of the VSM using high-resolution infratentorial fMRI with a fast T2* sequence optimized for infratentorial neuroimaging and via video-oculography (VOG). The neuroimaging experiment (n=20) gave first in vivo evidence for an involvement of the vestibular nuclei in the VSM and substantiate a crucial role for cerebellar circuitries. Our results emphasize the importance of cerebellar feedback loops in VSM most likely represented by signal increases in vestibulo-cerebellar hubs like the uvula and nodulus and lobule VIIIA. The delineated activation maps give new insights regarding the function and embedment of Crus I, Crus II, and lobule VII and VIII in the human vestibular system.

Modeling functional difference between gyri and sulci within intrinsic connectivity networks

Recently, the functional roles of the human cortical folding patterns have attracted increasing interest in the neuroimaging community. However, most existing studies have focused on the gyro-sulcal functional relationship on a whole-brain scale but possibly overlooked the localized and subtle functional differences of brain networks. Actually, accumulating evidences suggest that functional brain networks are the basic unit to realize the brain function; thus, the functional relationships between gyri and sulci still need to be further explored within different functional brain networks. Inspired by these evidences, we proposed a novel intrinsic connectivity network (ICN)-guided pooling-trimmed convolutional neural network (I-ptFCN) to revisit the functional difference between gyri and sulci. By testing the proposed model on the task functional magnetic resonance imaging (fMRI) datasets of the Human Connectome Project, we found that the classification accuracy of gyral and sulcal fMRI signals varied significantly for different ICNs, indicating functional heterogeneity of cortical folding patterns in different brain networks. The heterogeneity may be contributed by sulci, as only sulcal signals show heterogeneous frequency features across different ICNs, whereas the frequency features of gyri are homogeneous. These results offer novel insights into the functional difference between gyri and sulci and enlighten the functional roles of cortical folding patterns.

Neurofunctional differences and similarities between persistent postural-perceptual dizziness and anxiety disorder

INTRODUCTION

Persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) share behavioural symptoms like anxiety, avoidance, social withdrawal, hyperarousal, or palpitation as well as neurological symptoms like vertigo, stance and gait disorders. Furthermore, previous studies have shown a bidirectional link between vestibulo-spatial and anxiety neural networks. So far, there have been no neuroimaging-studies comparing these groups.

OBJECTIVES

The aim of this explorative study was to investigate differences and similarities of neural correlates between these two patient groups and to compare their findings with a healthy control group.

METHODS

63 participants, divided in two patient groups (ANX = 20 and PPPD = 14) and two sex and age matched healthy control groups (HC-A = 16, HC-P = 13) were included. Anxiety and dizziness related pictures were shown during fMRI-measurements in a block-design in order to induce emotional responses. All subjects filled in questionnaires regarding vertigo (VSS, VHQ), anxiety (STAI), depression (BDI-II), alexithymia (TAS), and illness-perception (IPQ). After modelling the BOLD response with a standard canonical HRF, voxel-wise t-tests between conditions (emotional-negative vs neutral stimuli) were used to generate statistical contrast maps and identify relevant brain areas (pFDR < 0.05, cluster size >30 voxels). ROI-analyses were performed for amygdala, cingulate gyrus, hippocampus, inferior frontal gyrus, insula, supramarginal gyrus and thalamus (p ≤ 0.05).

RESULTS

Patient groups differed from both HC groups regarding anxiety, dizziness, depression and alexithymia scores; ratings of the PPPD group and the ANX group did differ significantly only in the VSS subscale 'vertigo and related symptoms' (VSS-VER). The PPPD group showed increased neural responses in the vestibulo-spatial network, especially in the supramarginal gyrus (SMG), and superior temporal gyrus (STG), compared to ANX and HC-P group. The PPPD group showed increased neural responses compared to the HC-P group in the anxiety network including amygdala, insula, lentiform gyrus, hippocampus, inferior frontal gyrus (IFG) and brainstem. Neuronal responses were enhanced in visual structures, e.g. fusiform gyrus, middle occipital gyrus, and in the medial orbitofrontal cortex (mOFC) in healthy controls compared to patients with ANX and PPPD, and in the ANX group compared to the PPPD group.

CONCLUSIONS

These findings indicate that neuronal responses to emotional information in the PPPD and the ANX group are comparable in anxiety networks but not in vestibulo-spatial networks. Patients with PPPD revealed a stronger neuronal response especially in SMG and STG compared to the ANX and the HC group. These results might suggest higher sensitivity and poorer adaptation processes in the PPPD group to anxiety and dizziness related pictures. Stronger activation in visual processing areas in HC subjects might be due to less emotional and more visual processing strategies.

Quantifying virtual self-motion sensations induced by galvanic vestibular stimulation

BACKGROUND

The vestibular system provides a comprehensive estimate of self-motion in 3D space. Widely used to artificially stimulate the vestibular system, binaural-bipolar square-wave Galvanic Vestibular Stimulation (GVS) elicits a virtual sensation of roll rotation. Postural responses to GVS have been clearly delineated, however quantifying the perceived virtual rotation vector has not been fully realised.

OBJECTIVE

We aimed to quantify the perceived virtual roll rotation vector elicited by GVS using a psychophysical approach on a 3D turntable.

METHODS

Participants were placed supine on the 3D turntable and rotated around the naso-occipital axis while supine and received square-wave binaural-bipolar GVS or sham stimulation. GVS amplitudes and intensities were systematically manipulated. The turntable motion profile consisted of a velocity step of 20°/s2 until the trial velocity between 0-20°/s was reached, followed by a 1°/s ramp until the end of the trial. In a psychophysical adaptive staircase procedure, we systematically varied the roll velocity to identify the exact velocity that cancelled the perceived roll sensation induced by GVS.

RESULTS

Participants perceived a virtual roll rotation towards the cathode of approximately 2°/s velocity for 1 mA GVS and 6°/s velocity for 2.5 mA GVS. The observed values were stable across repetitions.

CONCLUSIONS

Our results quantify for the first time the perceived virtual roll rotations induced by binaural-bipolar square-wave GVS. Importantly, estimates were based on perceptual judgements, in the absence of motor or postural responses and in a head orientation where the GVS-induced roll sensation did not interact with the perceived direction of gravity. This is an important step towards applications of GVS in different settings, including sensory substitution or Virtual Reality.

Phase-dependent modulation of the vestibular-cerebellar network via combined alternating current stimulation influences human locomotion and posture

Background

Human locomotion induces rhythmic movements of the trunk and head. Vestibular signaling is relayed to multiple regions in the brainstem and cerebellum, and plays an essential role in maintaining head stability. However, how the vestibular-cerebellar network contributes to the rhythmic locomotor pattern in humans is unclear. Transcranial alternating current stimulation (tACS) has been used to investigate the effects of the task-related network between stimulation regions in a phase-dependent manner. Here, we investigated the relationship between the vestibular system and the cerebellum during walking imagery using combined tACS over the left cerebellum and alternating current galvanic vestibular stimulation (AC-GVS).

Methods

In Experiment 1, we tested the effects of AC-GVS alone at around individual gait stride frequencies. In Experiment 2, we then determined the phase-specificity of combined stimulation at the gait frequency. Combined stimulation was applied at in-phase (0° phase lag) or anti-phase (180° phase lag) between the left vestibular and left cerebellar stimulation, and the sham stimulation. We evaluated the AC-GVS-induced periodic postural response during walking imagery or no-imagery using the peak oscillatory power on the angular velocity signals of the head in both experiments. In Experiment 2, we also examined the phase-locking value (PLV) between the periodic postural responses and the left AC-GVS signals to estimate entrainment of the postural response by AC-GVS.

Results

AC-GVS alone induced the periodic postural response in the yaw and roll axes, but no interactions with imagery walking were observed in Experiment 1 (p > 0.05). By contrast, combined in-phase stimulation increased yaw motion (0.345 ± 0.23) compared with sham (-0.044 ± 0.19) and anti-phase stimulation (-0.066 ± 0.18) during imaginary walking (in-phase vs. other conditions, imagery: p < 0.05; no-imagery: p ≥ 0.125). Furthermore, there was a positive correlation between the yaw peak power of actual locomotion and in-phase stimulation in the imagery session (imagery: p = 0.041; no-imagery: p = 0.177). Meanwhile, we found no imagery-dependent effects in roll peak power or PLV, although in-phase stimulation enhanced roll motion and PLV in Experiment 2.

Conclusion

These findings suggest that combined stimulation can influence vestibular-cerebellar network activity, and modulate postural control and locomotion systems in a temporally sensitive manner. This novel combined tACS/AC-GVS stimulation approach may advance development of therapeutic applications.

Postural control paradigm (BioVRSea): towards a neurophysiological signature

Objective.To define a new neurophysiological signature from electroencephalography (EEG) during a complex postural control task using the BioVRSea paradigm, consisting of virtual reality (VR) and a moving platform, mimicking the behavior of a boat on the sea.Approach.EEG (64 electrodes) data from 190 healthy subjects were acquired. The experiment is composed of 6 segments (Baseline, PRE, 25%, 50%, 75%, POST). The baseline lasts 60 s while standing on the motionless platform with a mountain view in the VR goggles. PRE and POST last 40 s while standing on the motionless platform with a sea simulation. The 3 other tasks last 40 s each, with the platform moving to adapt to the waves, and the subject holding a bar to maintain its balance. The power spectral density (PSD) difference for each task minus baseline has been computed for every electrode, for five frequency bands (delta, theta, alpha, beta, and low-gamma). Statistical significance has been computed.Main results.All the bands were significant for the whole cohort, for each task regarding baseline. Delta band shows a prefrontal PSD increase, theta a fronto-parietal decrease, alpha a global scalp power decrease, beta an increase in the occipital and temporal scalps and a decrease in other areas, and low-gamma a significant but slight increase in the parietal, occipital and temporal scalp areas.Significance.This study develops a neurophysiological reference during a complex postural control task. In particular, we found a strong localized activity associated with certain frequency bands during certain phases of the experiment. This is the first step towards a neurophysiological signature that can be used to identify pathological conditions lacking quantitative diagnostics assessment.

Vestibular Extremely Low-Frequency Magnetic and Electric Stimulation Effects on Human Subjective Visual Vertical Perception

Electric fields from both extremely low‐frequency magnetic fields (ELF‐MF) and alternating current (AC) stimulations impact human neurophysiology. As the retinal photoreceptors, vestibular hair cells are graded potential cells and are sensitive to electric fields. Electrophosphene and magnetophosphene literature suggests different impacts of AC and ELF‐MF on the vestibular hair cells. Furthermore, while AC modulates the vestibular system more globally, lateral ELF‐MF stimulations could be more utricular specific. Therefore, to further address the impact of ELF‐MF‐induced electric fields on the human vestibular system and the potential differences with AC stimulations, we investigated the effects of both stimulation modalities on the perception of verticality using a subjective visual vertical (SVV) paradigm. For similar levels of SVV precision, the ELF‐MF condition required more time to adjust SVV, and SVV variability was higher with ELF‐MF than with AC vestibular‐specific stimulations. Yet, the differences between AC and ELF‐MF stimulations were small. Overall, this study highlights small differences between AC and ELF‐MF vestibular stimulations, underlines a potential utricular contribution, and has implications for international exposure guidelines and standards. © 2022 Bioelectromagnetics Society.

Concurrent brain structural and functional alterations in patients with chronic unilateral vestibulopathy

BACKGROUND

Chronic unilateral vestibulopathy (CUVP) is a common chronic vestibular syndrome which may be caused by incomplete vestibular dynamic compensation. Neuroimaging technology provides important clues to explore the mechanism of complicated by vestibular dynamic compensation in patients with CUVP. However, previous studies mostly used positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) to investigate the changes of brain function in these patients during the task state, few studies have investigated the alterations during the resting state, Therefore, the study aimed to investigate the possible brain structural and functional alterations in patients with CUVP and explore the dynamic compensation state in patients with CUVP.

METHODS

We recruited 18 patients with right CUVP and 18 age-, gender-, and education level-matched healthy controls (HCs). Vestibular evaluations, such as videonystagmography and caloric tests, were performed. All participants underwent Dizziness Handicap Inventory (DHI) assessment. All participants underwent multimodal magnetic resonance imaging of the brain, including fMRI and three-dimensional T1-weighted MRI. We analyzed the amplitude of low frequency fluctuations (ALFF), regional homogeneity (ReHo), seed based functional connectivity, and voxel-based morphometry (VBM).

RESULTS

Compared with HCs, CUVP patients showed significantly increased ALFF values in the right supplementary motor area, significantly decreased ALFF values in the right middle occipital gyrus, significantly decreased ReHo values in the bilateral superior parietal lobule, and significantly enhanced ReHo values in the bilateral cerebellar hemisphere [both P<0.05, family-wise error (FWE) corrected]. Compared with HCs, patients with CUVP showed increased gray matter volumes in the left medial superior frontal gyrus and left middle cingulate gyrus [P<0.001, false discovery rate (FDR) corrected]. Compared with HCs, in patients with CUVP, functional connectivity was enhanced between the left medial superior frontal gyrus and the left orbital inferior frontal gyrus and left angular gyrus and was significantly decreased between the left medial superior frontal gyrus and the right dorsolateral superior frontal gyrus (both P<0.01, FWE corrected). Pearson correlation analysis showed that there was a positive correlation between DHI score and VBM value of the left medial superior frontal gyrus in patients with CUVP (r=-0.430, P=0.003).

CONCLUSIONS

This study identified abnormalities of neuronal activity intensity and overall activity synchronization in multiple brain regions in patients with CUVP, suggesting that patients with CUVP have extensive brain functional abnormalities, which in turn affects their spatial perception and motor perception. Increased gray matter volume and functional connectivity of the default mode network may be used as potential imaging biomarkers of chronic symptoms in patients with CUVP.

Extraction of the GVS electrical artifact from EEG recordings of the motor related cortical potential

BACKGROUND

Galvanic vestibular stimulation (GVS) involves the administration of low-amplitude trans-mastoidal current which induces a dense electrical field across the scalp that is difficult to remove from the EEG record. In two proof-of-concept experiments, we designed a paradigm to evaluate functional limb movement, and tested a method of blind source separation to remove the scalp artifact induced by low-amplitude, alternating current GVS to allow measurement of the motor-related cortical response (MRCP) during voluntary movement.

NEW METHOD

Off-line Extended Infomax Independent Component Analysis (ICA) was applied to the concatenated dataset to identify and remove core characteristics of the artifact induced by a trans-mastoidal current (Experiment 1: 0.01Hz, 0.2-3mA; Experiment 2: 0.01Hz, 0.3-0.4mA) during finger (Experiments 1 and 2) and foot tapping (Experiment 2).

RESULTS

In Experiment 1, a GVS-related independent component was identified and successfully removed without compromising measurement of the MRCP. This success was replicated in Experiment 2 which included both finger and foot tapping, and a higher GVS amplitude, which resulted in the identification of additional GVS-related artifacts.

COMPARISON WITH EXISTING METHODS

Existing methods of artifact rejection typically use an offline bandpass filter that overlaps with the frequency range of the MRCP. Even when similar ICA-based approaches have been employed, they have been applied during rest rather than active movement, have not been described in sufficient detail to enable replication, and require significant expertise and bespoke software to implement.

CONCLUSION

The ICA-based approach described here provides a relatively simple and accessible means by which MRCPs can be measured during alternating current GVS. This provides opportunity to identify new biomarkers associated with the therapeutic effects of GVS in people with Parkinson's disease and other disorders of voluntary movement.

Frequency-Specific Effects of Galvanic Vestibular Stimulation on Response-Time Performance in Parkinson's Disease

Background: Galvanic vestibular stimulation (GVS) is being increasingly explored as a non-invasive brain stimulation technique to treat symptoms in Parkinson's disease (PD). To date, behavioral GVS effects in PD have been explored with only two stimulus types, direct current and random noise (RN). The interaction between GVS effects and anti-parkinsonian medication is unknown. In the present study, we designed multisine (ms) stimuli and investigated the effects of ms and RN GVS on motor response time. In comparison to the RN stimulus, the ms stimuli contained sinusoidal components only at a set of desired frequencies and the phases were optimized to improve participants' comfort. We hypothesized GVS motor effects were a function of stimulation frequency, and specifically, that band-limited ms-GVS would result in better motor performance than conventionally used broadband RN-GVS.

Materials and Methods: Eighteen PD patients (PDMOFF/PDMON: off-/on-levodopa medication) and 20 healthy controls (HC) performed a simple reaction time task while receiving sub-threshold GVS. Each participant underwent nine stimulation conditions: off-stimulation, RN (4–200 Hz), ms-θ (4–8 Hz), ms-α (8–13 Hz), ms-β (13–30 Hz), ms-γ (30–50 Hz), ms-h1 (50–100 Hz), ms-h2 (100–150 Hz), and ms-h3 (150–200 Hz).

Results: The ms-γ resulted in shorter response time (RPT) in both PDMOFF and HC groups compared with the RN. In addition, the RPT of the PDMOFF group decreased during the ms-β while the RPT of the HC group decreased during the ms-α, ms-h1, ms-h2, and ms-h3. There was considerable inter-subject variability in the optimum stimulus type, although the frequency range tended to fall within 8–100 Hz. Levodopa medication significantly reduced the baseline RPT of the PD patients. In contrast to the off-medication state, GVS did not significantly change RPT of the PD patients in the on-medication state.

Conclusions: Using band-limited ms-GVS, we demonstrated that the GVS frequency for the best RPT varied considerably across participants and was >30 Hz for half of the PDMOFF patients. Moreover, dopaminergic medication was found to influence GVS effects in PD patients. Our results indicate the common “one-size-fits-all” RN approach is suboptimal for PD, and therefore personalized stimuli aiming to address this variability is warranted to improve GVS effects.

Functional Magnetic Resonance Imaging Reveals Early Connectivity Changes in the Auditory and Vestibular Cortices in Idiopathic Sudden Sensorineural Hearing Loss With Vertigo: A Pilot Study

The underlying pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo has yet to be identified. The aims of the current study were (1) to elucidate whether there are functional changes of the intrinsic brain activity in the auditory and vestibular cortices of the ISSNHL patients with vertigo using resting-state functional magnetic resonance imaging (rs-fMRI) and (2) whether the connectivity alterations are related to the clinical performance associated with ISSNHL with vertigo. Twelve ISSNHL patients with vertigo, eleven ISSNHL patients without vertigo and eleven healthy subjects were enrolled in this study. Rs-fMRI data of auditory and vestibular cortices was extracted and regional homogeneity (ReHo) and seed-based functional connectivity (FC) were evaluated; the chi-square test, the ANOVA and the Bonferroni multiple comparison tests were performed. Significantly decreased ReHo in the ipsilateral auditory cortex, as well as increased FC between the inferior parietal gyrus and the auditory cortex were found in the ISSNHL with vertigo groups. These findings contribute to a characterization of early plastic changes in ISSNHL patients with vertigo and cultivate new insights for the etiology research.

Delineating neural responses and functional connectivity changes during vestibular and nociceptive stimulation reveal the uniqueness of cortical vestibular processing

Vestibular information is ubiquitous and often processed jointly with visual, somatosensory and proprioceptive information. Among the cortical brain regions associated with human vestibular processing, area OP2 in the parietal operculum has been proposed as vestibular core region. However, delineating responses uniquely to vestibular stimulation in this region using neuroimaging is challenging for several reasons: First, the parietal operculum is a cytoarchitectonically heterogeneous region responding to multisensory stimulation. Second, artificial vestibular stimulation evokes confounding somatosensory and nociceptive responses blurring responses contributing to vestibular perception. Furthermore, immediate effects of vestibular stimulation on the organization of functional networks have not been investigated in detail yet. Using high resolution neuroimaging in a task-based and functional connectivity approach, we compared two equally salient stimuli—unilateral galvanic vestibular (GVS) and galvanic nociceptive stimulation (GNS)—to disentangle the processing of both modalities in the parietal operculum and characterize their effects on functional network architecture. GNS and GVS gave joint responses in area OP1, 3, 4, and the anterior and middle insula, but not in area OP2. GVS gave stronger responses in the parietal operculum just adjacent to OP3 and OP4, whereas GNS evoked stronger responses in area OP1, 3 and 4. Our results underline the importance of considering this common pathway when interpreting vestibular neuroimaging experiments and underpin the role of area OP2 in central vestibular processing. Global network changes were found during GNS, but not during GVS. This lack of network reconfiguration despite the saliency of GVS may reflect the continuous processing of vestibular information in the awake human.

Vestibular-Evoked Cerebral Potentials

The human vestibular cortex has mostly been approached using functional magnetic resonance imaging and positron emission tomography combined with artificial stimulation of the vestibular receptors or nerve. Few studies have used electroencephalography and benefited from its high temporal resolution to describe the spatiotemporal dynamics of vestibular information processing from the first milliseconds following vestibular stimulation. Evoked potentials (EPs) are largely used to describe neural processing of other sensory signals, but they remain poorly developed and standardized in vestibular neuroscience and neuro-otology. Yet, vestibular EPs of brainstem, cerebellar, and cortical origin have been reported as early as the 1960s. This review article summarizes and compares results from studies that have used a large range of vestibular stimulation, including natural vestibular stimulation on rotating chairs and motion platforms, as well as artificial vestibular stimulation (e.g., sounds, impulsive acceleration stimulation, galvanic stimulation). These studies identified vestibular EPs with short latency (<20 ms), middle latency (from 20 to 50 ms), and late latency (>50 ms). Analysis of the generators (source analysis) of these responses offers new insights into the neuroimaging of the vestibular system. Generators were consistently found in the parieto-insular and temporo-parietal junction-the core of the vestibular cortex-as well as in the prefrontal and frontal areas, superior parietal, and temporal areas. We discuss the relevance of vestibular EPs for basic research and clinical neuroscience and highlight their limitations.

Binary Semantic Classification Using Cortical Activation with Pavlovian-Conditioned Vestibular Responses in Healthy and Locked-In Individuals

To develop a more reliable brain–computer interface (BCI) for patients in the completely locked-in state (CLIS), here we propose a Pavlovian conditioning paradigm using galvanic vestibular stimulation (GVS), which can induce a strong sensation of equilibrium distortion in individuals. We hypothesized that associating two different sensations caused by two-directional GVS with the thoughts of “yes” and “no” by individuals would enable us to emphasize the differences in brain activity associated with the thoughts of yes and no and hence help us better distinguish the two from electroencephalography (EEG). We tested this hypothesis with 11 healthy and 1 CLIS participant. Our results showed that, first, conditioning of GVS with the thoughts of yes and no is possible. And second, the classification of whether an individual is thinking “yes” or “no” is significantly improved after the conditioning, even in the absence of subsequent GVS stimulations. We observed average classification accuracy of 73.0% over 11 healthy individuals and 85.3% with the CLIS patient. These results suggest the establishment of GVS-based Pavlovian conditioning and its usability as a noninvasive BCI.

Altered thalamo-cortical functional connectivity in patients with vestibular migraine: a resting-state fMRI study

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.

Altered Gray Matter Volume and Functional Connectivity in Patients With Vestibular Migraine

Subjects

Vestibular migraine (VM) is the most common neurological cause of vertigo in adults. Previous neuroimaging studies have reported structural alterations in areas associated with pain and vestibular processing. However, it is unclear whether altered resting-state functional connectivity (FC) exists in brain regions with structural abnormalities in patients with VM.

Methods

Resting-state functional magnetic resonance imaging (MRI) and three-dimensional T1-weighed MRI were performed in 30 patients with VM and 30 healthy controls (HCs). Patients underwent an evaluation of migraine and dizziness severity. FC and voxel-based morphometry (VBM) were performed using DPABI 4.3 and CAT12, respectively. The association between changes in gray matter (GM) volume or FC and clinical parameters was also analyzed.

Results

Compared with HCs, patients with VM demonstrated a reduced GM volume in the bilateral parietoinsular vestibular cortex (PIVC), right middle frontal gyrus, and precuneus. The GM volume of the left PIVC was negatively associated with Dizziness Handicap Inventory score in patients with VM. Taking this region as a seed region, we further observed increased FC between the left primary somatosensory cortex (S1)/inferior parietal lobule (IPL) and the left PIVC in patients with VM.

Conclusion

FC between regions with a decline in GM volume (the PIVC and S1/IPL) is altered in patients with VM, suggesting that abnormalities in vestibular cortical network could be useful for understanding the underlying mechanisms of VM.

Caloric and galvanic vestibular stimulation for the treatment of Parkinson's disease: rationale and prospects

Introduction: Deeply embedded within the inner ear, the sensory organs of the vestibular system are exquisitely sensitive to the orientation and movement of the head. This information constrains aspects of autonomic reflex control as well as higher-level processes involved in cognition and affect. The anatomical pathways that underline these functional interactions project to many cortical and sub-cortical brain areas, and the question arises as to whether they can be therapeutically harnessed.Areas covered: The body of work reviewed here indicates that the controlled application of galvanic or thermal current to the vestibular end-organs can modulate activity throughout the ascending vestibular network and, under appropriate conditions, reduce motor and non-motor symptoms associated with Parkinson's disease, a disease of growing prevalence and continued unmet clinical need.Expert opinion: The appeal of vestibular stimulation in Parkinson's disease is underpinned by its noninvasive nature, favorable safety profile, and capacity for home-based administration. Clinical adoption now rests on the demonstration of cost-effectiveness and on the commercial availability of suitable devices, many of which are only permitted for research use or lack functionality. Dose optimization and mechanisms-of-action studies are also needed, along with a broader awareness amongst physicians of its therapeutic potential.

Galvanic Vestibular Stimulation Improves Subnetwork Interactions in Parkinson's Disease

Background

Activating vestibular afferents via galvanic vestibular stimulation (GVS) has been recently shown to have a number of complex motor effects in Parkinson's disease (PD), but the basis of these improvements is unclear. The evaluation of network-level connectivity changes may provide us with greater insights into the mechanisms of GVS efficacy.

Objective

To test the effects of different GVS stimuli on brain subnetwork interactions in both health control (HC) and PD groups using fMRI.

Methods

FMRI data were collected for all participants at baseline (resting state) and under noisy, 1 Hz sinusoidal, and 70-200 Hz multisine GVS. All stimuli were given below sensory threshold, blinding subjects to stimulation. The subnetworks of 15 healthy controls and 27 PD subjects (on medication) were identified in their native space, and their subnetwork interactions were estimated by nonnegative canonical correlation analysis. We then determined if the inferred subnetwork interaction changes were affected by disease and stimulus type and if the stimulus-dependent GVS effects were influenced by demographic features.

Results

At baseline, interactions with the visual-cerebellar network were significantly decreased in the PD group. Sinusoidal and multisine GVS improved (i.e., made values approaching those seen in HC) subnetwork interactions more effectively than noisy GVS stimuli overall. Worsening disease severity, apathy, depression, impaired cognitive function, and increasing age all limited the beneficial effects of GVS.

Conclusions

Vestibular stimulation has widespread system-level brain influences and can improve subnetwork interactions in PD in a stimulus-dependent manner, with the magnitude of such effects associating with demographics and disease status.

Current perspectives on galvanic vestibular stimulation in the treatment of Parkinson's disease

Introduction: Galvanic vestibular stimulation (GVS) is a noninvasive technique that activates vestibular afferents, influencing activity and oscillations in a broad network of brain regions. Several studies have suggested beneficial effects of GVS on motor symptoms in Parkinson's Disease (PD).Areas covered: A comprehensive overview of the stimulation techniques, potential mechanisms of action, challenges, and future research directions.Expert opinion: This emerging technology is not currently a viable therapy. However, a complementary therapy that is inexpensive, easily disseminated, customizable, and portable is sufficiently enticing that continued research and development is warranted. Future work utilizing biomedical engineering approaches, including concomitant functional neuroimaging, have the potential to significantly increase efficacy. GVS could be explored for other PD symptoms including orthostatic hypotension, dyskinesia, and sleep disorders.

Cortical Effects of Noisy Galvanic Vestibular Stimulation Using Functional Near-Infrared Spectroscopy

Noisy galvanic vestibular stimulation (nGVS) can improve different motor, sensory, and cognitive behaviors. However, it is unclear how this stimulation affects brain activity to facilitate these improvements. Functional near-infrared spectroscopy (fNIRS) is inexpensive, portable, and less prone to motion artifacts than other neuroimaging technology. Thus, fNIRS has the potential to provide insight into how nGVS affects cortical activity during a variety of natural behaviors. Here we sought to: (1) determine if fNIRS can detect cortical changes in oxygenated (HbO) and deoxygenated (HbR) hemoglobin with application of subthreshold nGVS, and (2) determine how subthreshold nGVS affects this fNIRS-derived hemodynamic response. A total of twelve healthy participants received nGVS and sham stimulation during a seated, resting-state paradigm. To determine whether nGVS altered activity in select cortical regions of interest (BA40, BA39), we compared differences between nGVS and sham HbO and HbR concentrations. We found a greater HbR response during nGVS compared to sham stimulation in left BA40, a region previously associated with vestibular processing, and with all left hemisphere channels combined (p < 0.05). We did not detect differences in HbO responses for any region during nGVS (p > 0.05). Our results suggest that fNIRS may be suitable for understanding the cortical effects of nGVS.

The potential of noisy galvanic vestibular stimulation for optimizing and assisting human performance

Noisy galvanic vestibular stimulation (nGVS) is an emerging non-invasive brain stimulation technique. It involves applying alternating currents of different frequencies and amplitudes presented in a random, or noisy, manner through electrodes on the mastoid bones behind the ears. Because it directly activates vestibular hair cells and afferents and has an indirect effect on a variety of brain regions, it has the potential to impact many different functions. The objective of this review is twofold: (1) to review how nGVS affects motor, sensory, and cognitive performance in healthy adults; and (2) to discuss potential clinical applications of nGVS. First, we introduce the technique. We then describe the regions receiving and processing vestibular information. Next, we discuss the effects of nGVS on motor, sensory, and cognitive function in healthy adults. Subsequently, we outline its potential clinical applications. Finally, we highlight other electrical stimulation technologies and discuss why nGVS offers an alternative or complementary approach. Overall, nGVS appears promising for optimizing human performance and as an assistive technology, though further research is required.

Efficacy of transmastoidal galvanic stimulation on recovery outcomes in patients with unilateral peripheral vestibular disorders: a randomized controlled trial

Background

Peripheral vestibular disorders are common disorders among population with increased prevalence with age advancement, manifested by balance disorders and postural instability that negatively affect daily activities and social participation.

Objectives

To investigate the effect of transmastoidal galvanic stimulation added to a designed vestibular rehabilitation program on recovery outcomes in Egyptian patients with unilateral peripheral vestibular disorders.

Subjects and methods

Forty patients (from both sexes) diagnosed with unilateral peripheral vestibular weakness were evenly and randomly designated into two groups: study and control groups. The study group received transmastoidal galvanic stimulation, in addition to a vestibular rehabilitation program, whereas control group undergone vestibular rehabilitation program only. Treatment sessions were conducted three times weekly for four successive weeks. Assessment of vestibular canal weakness was carried out using videonystagmography, postural stability using computerized posturography, while participation in daily activities was carried out using Vestibular Disorders Activities of Daily Living Scale (VADL). All assessment measures were carried out pre- and post-treatment.

Results

Study group showed improvement of post-treatment scores of canal weakness, postural stability parameters, and VADL scale in reverse to control group that showed improvement of scores of preference and VADL only. A statistically significant difference was found between both groups in post-treatment scores of canal weakness, total equilibrium composite, and vestibular component with more improvement in the study group.

Conclusion

Adding transmastoidal galvanic stimulation to vestibular rehabilitation exercises for unilateral peripheral vestibular disorders improves the recovery outcomes of vestibular canal weakness, equilibrium, and vestibular components of postural stability.

Trial registration

Clinical trials identification number (NCT04010435). Registered 7 March 2019—retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4

Structural connectome and connectivity lateralization of the multimodal vestibular cortical network

Unlike other sensory systems, the structural connectivity patterns of the human vestibular cortex remain a matter of debate. Based on their functional properties and hypothesized centrality within the vestibular network, the ‘core’ cortical regions of this network are thought to be areas in the posterior peri-sylvian cortex, in particular the retro-insula (previously named the posterior insular cortex-PIC), and the subregion OP2 of the parietal operculum.

To study the vestibular network, structural connectivity matrices from n=974 healthy individuals drawn from the public Human Connectome Project (HCP) repository were estimated using multi-shell diffusion-weighted data followed by probabilistic tractography and spherical-deconvolution informed filtering of tractograms in combination with subject-specific grey-matter parcellations. Weighted graph-theoretical measures, modularity, and ‘hubness’ of the multimodal vestibular network were then estimated, and a structural lateralization index was defined in order to assess the difference in fiber density of homonym regions in the right and left hemisphere. Differences in connectivity patterns between OP2 and PIC were also estimated.

We found that the bilateral intraparietal sulcus, PIC, and to a lesser degree OP2, are key ‘hub’ regions within the multimodal vestibular network. PIC and OP2 structural connectivity patterns were lateralized to the left hemisphere, while structural connectivity patterns of the posterior peri-sylvian supramarginal and superior temporal gyri were lateralized to the right hemisphere. These lateralization patterns were independent of handedness.

We also found that the structural connectivity pattern of PIC is consistent with a key role of PIC in visuo-vestibular processing and that the structural connectivity pattern of OP2 is consistent with integration of mainly vestibular somato-sensory and motor information. These results suggest an analogy between PIC and the simian visual posterior sylvian (VPS) area and OP2 and the simian parieto-insular vestibular cortex (PIVC).

Overall, these findings may provide novel insights to the current models of vestibular function, as well as to the understanding of the complexity and lateralized signs of vestibular syndromes.

Multisensory Interactions in Virtual Reality: Optic Flow Reduces Vestibular Sensitivity, but Only for Congruent Planes of Motion

During exposure to Virtual Reality (VR) a sensory conflict may be present, whereby the visual system signals that the user is moving in a certain direction with a certain acceleration, while the vestibular system signals that the user is stationary. In order to reduce this conflict, the brain may down-weight vestibular signals, which may in turn affect vestibular contributions to self-motion perception. Here we investigated whether vestibular perceptual sensitivity is affected by VR exposure. Participants' ability to detect artificial vestibular inputs was measured during optic flow or random motion stimuli on a VR head-mounted display. Sensitivity to vestibular signals was significantly reduced when optic flow stimuli were presented, but importantly this was only the case when both visual and vestibular cues conveyed information on the same plane of self-motion. Our results suggest that the brain dynamically adjusts the weight given to incoming sensory cues for self-motion in VR; however this is dependent on the congruency of visual and vestibular cues.

Global multisensory reorganization after vestibular brain stem stroke

OBJECTIVE

Patients with acute central vestibular syndrome suffer from vertigo, spontaneous nystagmus, postural instability with lateral falls, and tilts of visual vertical. Usually, these symptoms compensate within months. The mechanisms of compensation in vestibular infarcts are yet unclear. This study focused on structural changes in gray and white matter volume that accompany clinical compensation.

METHODS

We studied patients with acute unilateral brain stem infarcts prospectively over 6 months. Structural changes were compared between the acute phase and follow-up with a group of healthy controls using voxel-based morphometry.

RESULTS

Restitution of vestibular function following brain stem infarcts was accompanied by downstream structural changes in multisensory cortical areas. The changes depended on the location of the infarct along the vestibular pathways in patients with pathological tilts of the SVV and on the quality of the vestibular percept (rotatory vs graviceptive) in patients with pontomedullary infarcts. Patients with pontomedullary infarcts with vertigo or spontaneous nystagmus showed volumetric increases in vestibular parietal opercular multisensory and (retro-) insular areas with right-sided preference. Compensation of graviceptive deficits was accompanied by adaptive changes in multiple multisensory vestibular areas in both hemispheres in lower brain stem infarcts and by additional changes in the motor system in upper brain stem infarcts.

INTERPRETATION

This study demonstrates multisensory neuroplasticity in both hemispheres along with the clinical compensation of vestibular deficits following unilateral brain stem infarcts. The data further solidify the concept of a right-hemispheric specialization for core vestibular processing. The identification of cortical structures involved in central compensation could serve as a platform to launch novel rehabilitative treatments such as transcranial stimulations.

Antero-Posterior vs. Lateral Vestibular Input Processing in Human Visual Cortex

Visuo-vestibular integration is crucial for locomotion, yet the cortical mechanisms involved remain poorly understood. We combined binaural monopolar galvanic vestibular stimulation (GVS) and functional magnetic resonance imaging (fMRI) to characterize the cortical networks activated during antero-posterior and lateral stimulations in humans. We focused on functional areas that selectively respond to egomotion-consistent optic flow patterns: the human middle temporal complex (hMT+), V6, the ventral intraparietal (VIP) area, the cingulate sulcus visual (CSv) area and the posterior insular cortex (PIC). Areas hMT+, CSv, and PIC were equivalently responsive during lateral and antero-posterior GVS while areas VIP and V6 were highly activated during antero-posterior GVS, but remained silent during lateral GVS. Using psychophysiological interaction (PPI) analyses, we confirmed that a cortical network including areas V6 and VIP is engaged during antero-posterior GVS. Our results suggest that V6 and VIP play a specific role in processing multisensory signals specific to locomotion during navigation.

Modeling Vestibular Compensation: Neural Plasticity Upon Thalamic Lesion

The present study in rats was conducted to identify brain regions affected by the interruption of vestibular transmission and to explore selected aspects of their functional connections. We analyzed, by positron emission tomography (PET), the regional cerebral glucose metabolism (rCGM) of cortical, and subcortical cerebral regions processing vestibular signals after an experimental lesion of the left laterodorsal thalamic nucleus, a relay station for vestibular input en route to the cortical circuitry. PET scans upon galvanic vestibular stimulation (GVS) were conducted in each animal prior to lesion and at post-lesion days (PLD) 1, 3, 7, and 20, and voxel-wise statistical analysis of rCGM at each PLD compared to pre-lesion status were performed. After lesion, augmented metabolic activation by GVS was detected in cerebellum, mainly contralateral, and in contralateral subcortical structures such as superior colliculus, while diminished activation was observed in ipsilateral visual, entorhinal, and somatosensory cortices, indicating compensatory processes in the non-affected sensory systems of the unlesioned side. The changes in rCGM observed after lesion resembled alterations observed in patients suffering from unilateral thalamic infarction and may be interpreted as brain plasticity mechanisms associated with vestibular compensation and substitution. The second set of experiments aimed at the connections between cortical and subcortical vestibular regions and their neurotransmitter systems. Neuronal tracers were injected in regions processing vestibular and somatosensory information. Injections into the anterior cingulate cortex (ACC) or the primary somatosensory cortex (S1) retrogradely labeled neuronal somata in ventral posteromedial (VPM), posterolateral (VPL), ventrolateral (VL), posterior (Po), and laterodorsal nucleus, dorsomedial part (LDDM), locus coeruleus, and contralateral S1 area. Injections into the parafascicular nucleus (PaF), VPM/VPL, or LDDM anterogradely labeled terminal fields in S1, ACC, insular cortex, hippocampal CA1 region, and amygdala. Immunohistochemistry showed tracer-labeled terminal fields contacting cortical neurons expressing the μ-opioid receptor. Antibodies to tyrosine hydroxylase, serotonin, substance P, or neuronal nitric oxide-synthase did not label any of the traced structures. These findings provide evidence for opioidergic transmission in thalamo-cortical transduction.

Direct comparison of activation maps during galvanic vestibular stimulation: A hybrid H2[15 O] PET-BOLD MRI activation study

Previous unimodal PET and fMRI studies in humans revealed a reproducible vestibular brain activation pattern, but with variations in its weighting and expansiveness. Hybrid studies minimizing methodological variations at baseline conditions are rare and still lacking for task-based designs. Thus, we applied for the first time hybrid 3T PET-MRI scanning (Siemens mMR) in healthy volunteers using galvanic vestibular stimulation (GVS) in healthy volunteers in order to directly compare H₂¹⁵O-PET and BOLD MRI responses. List mode PET acquisition started with the injection of 750 MBq H₂¹⁵O simultaneously to MRI EPI sequences. Group-level statistical parametric maps were generated for GVS vs. rest contrasts of PET, MR-onset (event-related), and MR-block. All contrasts showed a similar bilateral vestibular activation pattern with remarkable proximity of activation foci. Both BOLD contrasts gave more bilateral wide-spread activation clusters than PET; no area showed contradictory signal responses. PET still confirmed the right-hemispheric lateralization of the vestibular system, whereas BOLD-onset revealed only a tendency. The reciprocal inhibitory visual-vestibular interaction concept was confirmed by PET signal decreases in primary and secondary visual cortices, and BOLD-block decreases in secondary visual areas. In conclusion, MRI activation maps contained a mixture of CBF measured using H₂¹⁵O-PET and additional non-CBF effects, and the activation-deactivation pattern of the BOLD-block appears to be more similar to the H₂¹⁵O-PET than the BOLD-onset.

Electrical stimulation of cranial nerves in cognition and disease

The cranial nerves are the pathways through which environmental information (sensation) is directly communicated to the brain, leading to perception, and giving rise to higher cognition. Because cranial nerves determine and modulate brain function, invasive and non-invasive cranial nerve electrical stimulation methods have applications in the clinical, behavioral, and cognitive domains. Among other neuromodulation approaches such as peripheral, transcranial and deep brain stimulation, cranial nerve stimulation is unique in allowing axon pathway-specific engagement of brain circuits, including thalamo-cortical networks. In this review we amalgamate relevant knowledge of 1) cranial nerve anatomy and biophysics; 2) evidence of the modulatory effects of cranial nerves on cognition; 3) clinical and behavioral outcomes of cranial nerve stimulation; and 4) biomarkers of nerve target engagement including physiology, electroencephalography, neuroimaging, and behavioral metrics. Existing non-invasive stimulation methods cannot feasibly activate the axons of only individual cranial nerves. Even with invasive stimulation methods, selective targeting of one nerve fiber type requires nuance since each nerve is composed of functionally distinct axon-types that differentially branch and can anastomose onto other nerves. None-the-less, precisely controlling stimulation parameters can aid in affecting distinct sets of axons, thus supporting specific actions on cognition and behavior. To this end, a rubric for reproducible dose-response stimulation parameters is defined here. Given that afferent cranial nerve axons project directly to the brain, targeting structures (e.g. thalamus, cortex) that are critical nodes in higher order brain networks, potent effects on cognition are plausible. We propose an intervention design framework based on driving cranial nerve pathways in targeted brain circuits, which are in turn linked to specific higher cognitive processes. State-of-the-art current flow models that are used to explain and design cranial-nerve-activating stimulation technology require multi-scale detail that includes: gross anatomy; skull foramina and superficial tissue layers; and precise nerve morphology. Detailed simulations also predict that some non-invasive electrical or magnetic stimulation approaches that do not intend to modulate cranial nerves per se, such as transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), may also modulate activity of specific cranial nerves. Much prior cranial nerve stimulation work was conceptually limited to the production of sensory perception, with individual titration of intensity based on the level of perception and tolerability. However, disregarding sensory emulation allows consideration of temporal stimulation patterns (axon recruitment) that modulate the tone of cortical networks independent of sensory cortices, without necessarily titrating perception. For example, leveraging the role of the thalamus as a gatekeeper for information to the cerebral cortex, preventing or enhancing the passage of specific information depending on the behavioral state. We show that properly parameterized computational models at multiple scales are needed to rationally optimize neuromodulation that target sets of cranial nerves, determining which and how specific brain circuitries are modulated, which can in turn influence cognition in a designed manner.

Subthreshold stochastic vestibular stimulation affects balance-challenged standing and walking

Subthreshold stochastic vestibular stimulation (SVS) is thought to enhance vestibular sensitivity and improve balance. However, it is unclear how SVS affects standing and walking when balance is challenged, particularly when the eyes are open. It is also unclear how different methods to determine stimulation intensity influence the effects. We aimed to determine (1) whether SVS affects stability when balance is challenged during eyes-open standing and overground walking tasks, and (2) how the effects differ based on whether optimal stimulation amplitude is derived from sinusoidal or cutaneous threshold techniques. Thirteen healthy adults performed balance-unchallenged and balance-challenged standing and walking tasks with SVS (0–30 Hz zero-mean, white noise electrical stimulus) or sham stimulation. For the balance-challenged condition, participants had inflatable rubber hemispheres attached to the bottom of their shoes to reduce the control provided by moving the center of pressure under their base of support. In different blocks of trials, we set SVS intensity to either 50% of participants’ sinusoidal (motion) threshold or 80% of participants’ cutaneous threshold. SVS reduced medial-lateral trunk velocity root mean square in the balance-challenged (p < 0.05) but not in the balance-unchallenged condition during standing. Regardless of condition, SVS decreased step-width variability and marginally increased gait speed when walking with the eyes open (p < 0.05). SVS intensity had minimal effect on the standing and walking measures. Taken together, our results provide insight into the effectiveness of SVS at improving balance-challenged, eyes-open standing and walking performance in healthy adults.

Changes in Cortical Activation During Dual-Task Walking in Individuals With and Without Visual Vertigo

BACKGROUND AND PURPOSE

Persons with vestibular disorders are known to have slower gait speed with greater imbalance and veering during dual-task walking than healthy individuals, but the cerebral mechanisms are unknown. The purpose of this study was to determine whether individuals with visual vertigo (VV) have different cerebral activation during dual-task walking compared with control subjects.

METHODS

Fourteen individuals with VV and 14 healthy controls (CON) were included (mean 39 years old, 85% women). A cross-sectional experimental study consisting of 4 combinations of 2 surfaces (even and uneven) and 2 task conditions (single- and dual-task) was performed. Participants walked over an even (level flooring) or uneven (wood prisms underneath carpeting) surface, either quietly or while reciting every other letter of the alphabet. Changes in cerebral activation over the bilateral prefrontal cortices were recorded using functional near-infrared spectroscopy during 4 task conditions relative to quiet standing. Gait speed and cognitive performance were recorded.

RESULTS

There were no between-group differences in cognitive performance. Both groups slowed when walking on an uneven surface or performing a dual-task; participants in the VV group walked more slowly than those in the CON group in all conditions. Participants with VV had decreased cerebral activation in the bilateral prefrontal regions in comparison to CON participants in all conditions.

DISCUSSION AND CONCLUSIONS

Participants with VV had lower prefrontal cortex activation than CON participants during dual-task walking. Lower cortical activity in those with VV may be due to shifted attention away from the cognitive task to prioritize maintenance of dynamic balance.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A303).