Autonomic indexes during the vestibular-visual conflict exposure: a squirrel monkey study

Autonomic related vertigo

OBJECTIVES

To demonstrate clinical evidence that vestibular symptomatology can occur in relation to autonomic dysfunction. Characterization of clinical findings and treatment response would then allow autonomic related vertigo to be differentiated from other vertiginous conditions that present in a like manner.

STUDY DESIGN

This was a retrospective review of 113 patients that described symptoms consistent with spontaneous, rotational vertigo and autonomic dysfunction.

METHODS

Vestibular, otologic, and autonomic symptoms are presented along with the results of audiologic, orthostatic, and autonomic testing. Medical management included fluid loading, dietary changes, exercise, and patient education. Treatment results were analyzed according to the effectiveness in control of vestibular and otologic symptoms. Results were compared with a control group that demonstrated a similar vestibular and otologic presentation without autonomic symptomatology.

RESULTS

All patients described spontaneous, rotational vertigo, with complete or substantial vertigo control obtained in 93 (85%) of 110 patients. Postural vertigo and distinct lightheadedness were also documented in 53% and 97% of cases, respectively. Vertigo failed to improve or worsened with prior treatment of low sodium diet or diuretic in 53 (91%) of 58 cases. Vertigo improvement was subsequently achieved in 48 (86%) of 56 cases with an autonomic treatment regimen. Long-term vertigo control was obtained in 56 (88%) of 64 patients followed for at least 18 months. Tinnitus was reported in 97 (86%) patients, aural fullness in 93 (82%) patients, and subjective hearing loss (HL) in 46 (41%) of 111 cases. Bilateral tinnitus and aural fullness occurred in 65% and 63%, respectively. Tinnitus improved with treatment in 56 (67%) of 84 patients, whereas aural fullness improved in 59 (74%) of 80 patients. Autonomic symptoms included palpitations in 103 (91%) patients, chronic fatigue in 102 (90%) patients, cold extremities in 91 (81%) patients, and previous fainting in 72 (64%) patients. A history of mitral valve prolapse was documented in 51 (45%) of cases and demonstrated with echocardiogram in 68 (93%) of the 73 patients tested. Audiologic testing was normal in 104 (95%) of 109 patients, and electrocochleography was abnormal in 42 (40%) of 105 patients. Orthostatic blood pressure and heart rate testing met the criteria for orthostatic hypotension in 16 (15%) of 104 patients. Autonomic testing was obtained in 34 cases, with orthostatic intolerance demonstrated in 33 (97%) patients and orthostatic hypotension demonstrated in 13 (38%) patients. Overall, orthostatic hypotension was documented through combined testing results in 23 (21%) of 107 patients. Vertigo was reproduced during autonomic testing in 17 (77%) of 22 patients, and otologic symptoms were reproduce in 9 (47%) of 19 patients. Comparison of the study population with a control group without autonomic symptoms revealed statistically significant differences in orthostatic testing and treatment results. There was no statistical difference noted in findings between patients of this study that demonstrated or failed to demonstrate orthostatic hypotension.

CONCLUSIONS

There is a subgroup of patients with spontaneous vertigo who also demonstrate symptoms and findings consistent with poor autonomic regulation. These patients report vertigo improvement with a treatment strategy that aims to improve autonomic dysfunction through expansion of effective circulating volume. Clinical findings and treatment results of this study suggest an underlying autonomic influence in the production of vertigo and otologic symptoms.

Effects of acute hypotension on expression of cFos-like protein in the vestibular nuclei of rats

The expression and regional distribution of cFos protein, which is an oncogene product and metabolic marker of neural excitation, were investigated in the vestibular nuclear complex following acute hypotension in adult Sprague-Dawley rats. Intravenous administration of nitroprusside elicited a 10-50% reduction in mean blood pressure for 10 min. Unilateral or bilateral chemical labyrinthectomies were performed 14 days before the start of the experiment to eliminate afferent signals from the peripheral vestibular receptors in the inner ear. All of the animals were sacrificed and the tissues were fixed 2 h after the onset of acute hypotension using the cardiac perfusion method for c-Fos immunohistochemical staining. The cFos-like immunoreactive (cFLI) neurons were expressed selectively in the central area of the medial vestibular nucleus following a 10% reduction in blood pressure. Once the blood pressure had fallen by 30%, bilateral expression of cFLI neurons was observed in the superior, medial, and spinal vestibular nuclei, but not in the lateral vestibular nucleus, of control rats with intact labyrinths. The expression of cFLI neurons increased proportionately with reductions in blood pressure. In unilaterally labyrinthectomized rats, acute hypotension induced the expression of cFLI neurons in vestibular nuclei contra lateral to the injured labyrinth, but not in the ipsilateral vestibular nuclei. However, cFLI neurons were not expressed in bilateral vestibular nuclei following acute hypotension in bilateral labyrinthectomized rats. These results suggest that afferent signals from the peripheral vestibular receptors are essential for cFos protein expression in the vestibular nuclei following acute hypotension.

Assessment of the otolith-autonomic response using spectral analysis of the R-R interval and blood pressure

The effects of otolith stimulation on systolic blood pressure (SBP) and R-R interval fluctuations were investigated in 12 healthy subjects and 5 patients with loss of labyrinthine function. The vestibular otolith organs were stimulated by centrifugal forces, the constant rotation of a chair fixed outside of the rotation axis on the horizontal plane. The chair was fixed along the direction of centrifugal force (eccentric rotation [ECR]) or along the tangent line (eccentric lateral rotation [ECLR]). The ECR stimulates both the utricular and saccular maculae, whereas the ECLR stimulates only the utricular maculae. Spectral analysis showed that in the healthy subjects, low-frequency SBP increased significantly during ECR but not during ECLR. There was no significant increase in low-frequency SBP in patients with labyrinthine loss. In the R-R interval analysis, however, the low- and high-frequency components did not change significantly in the healthy subjects during ECR. Our findings indicate that stimulation of the otolith maculae, especially the saccular organs, predominantly produces augmentation of the alpha-sympathetic activities rather than cardiac sympathovagal outflow to the heart.

Effects of galvanic stimulation of the mastoid process on the gastric motility induced by caloric stimulation

The effects of galvanic stimulation to the mastoid portion on the vestibuloautonomic symptoms induced by caloric stimulation, such as nausea, vomiting, and vertigo, were evaluated in this study. Gastric motility was measured by electrogastrography (EGG) in 20 healthy volunteers (11 male and nine female) aged 20-30 (average: 25.4) years. Electrical stimulation of the mastoid process with 1.0-3.0 mA, 1.0 ms, 100 Hz was applied using a bipolar-biaural method during caloric stimulation of the external auditory canal. The dominant frequency and power of EGG were determined using running spectral frequency analysis and the time-course of EGG was evaluated in a pseudo three dimensional graphic. Frequency of EGG was classified into normogastria with 3 cpm, bradygastria with lower than 3 cpm, and tachygastria with higher than 3 cpm. At quiescent period, normogastria was 78.7 +/- 3.7%, bradygastria 5.0 +/- 1.1%, and tachygastria 16.4 +/- 3.7%. Caloric stimulation with warm water in the unilateral ear and cold water in the contralateral ear elicited vestibuloautonomic symptoms, with accompanied decreases in normogastria (57.7 +/-4.6%, P < 0.01) and increases in tachygastria (34.8 +/- 4.8%, P < 0.01). Cathodal stimulation to the mastoid process ipsilateral to cold water irrigation during caloric stimulation restored normal pattern of gastric motility: normogastria in 77.1 + 5.3% and tachygastria in 19.3 +/- 4.7%, and relieved vestibuloautonomic symptoms. Cathodal stimulation to the inhibited vestibular system ameliorates the vestibular symptoms induced by caloric stimulation.

[Squirrel monkey--an ideal primate (correction of prmate) model of space physiology]

Investigation of the vestibulo-ocular system of the squirrel monkey was reviewed in consideration of space motion sickness (SMS), or which is recently more often termed as space adaptation syndrome (SAS). Since the first launching of the space satellite, Sputnik [correction of Sputonik] in October 1957, many experiments were carried out in biological and medical fields. A various kind of creatures were used as experimental models from protozoa to human beings. Rats and monkeys are most favorite animals, particularly the non-human primate seems to be the one, because of its phylogenetic relatives akin to the human beings. Chimpanzees, rhesus monkeys, pig tailed-monkeys, red-faced monkeys and squirrel monkeys have been used mostly in American space experiments. Russian used rhesus monkeys. Among these, however, the squirrel monkey has an advantage of the small size of the body, ranging from 600- l000g in adult. This small size as a primate is very advantageous in experiments conducted in a narrow room of the space satellite or shuttle because of its space-saving. The squirrel monkey has another advantage to rear easily as is demonstrated to keep it as a pet. Accordingly, this petit animal provides us a good animal model in biological and medical experiments in space craft. The size of the brain of the squirrel monkey is extraordinary large relative to the body size, which is even superior to that of the human beings. This is partly owed to enlargement of the occipito-temporal cortices, which are forced to well develop for processing a huge amount of audio-visual information indispensable to the arboreal habitant to survive in tropical forest. The vestibular system of the squirrel monkey seems to be the most superior as well, when judged from it relative size of the vestibular nuclear complex. Balancing on swinging twigs or jumping from tree to tree developed the capability of this equilibrium system. Fernandez, Goldberg and his collaborators used the squirrel monkey to elucidate functions of the peripheral vestibular system. A transfer function was proposed to explain the behaviors of regular and irregular unit activity of vestibular nerve fibers. The physiologic characteristics of the second order vestibular neuron was investigated in combination of electrophysiological and micro-morphological way, with using WGA-HRP methods, in relation to somato-motor and eye movements. Interconnections between vestibular neurons and cerebellum, interstitial nucleus of Cajal, oculomotor nuclear complex, superior colliculus and cervical spinal cord were elucidated. In physiological field of the vestibular system, the vestibulo-ocular reflex is well studied and results obtained from the squirrel monkey experiments were reviewed. The squirrel monkey, particularly the Bolivian, is a unique animal in that it is vulnerable to motion sickness induced by visual-motion stimulation with phase mismatch of the two stimuli. Experimental results of labyrinthectomy or bilateral ablation of the maculae staticae led to the conclusion that both semicircular and otolith organs are involved in the genesis of space motion sickness. On the other hand, destruction of the area postrema, acknowledged as the vomiting center to chemical stimulants, produced controversial results. However, it must be pointed out that the a human subject underwent to resection of the area postrema, became insensitive to administration of apomorphine, a well known chemical stimulant of vomiting. Finally the experiments in space revealed the presence of at least two origins of caloric nystagmus, that is, attributable to convection and non-convection current of the endolymphatic fluid.

Artificial G-load and chemical changes of saliva

Effectiveness of artificial G load is expected when it is used as a countermeasure against various bio-medical mishaps which are taking place in the micro-gravity environment, and probably more importantly, to prepare re-entry to the earth 1-G environment. Regarding the salivary chemical analysis, it has been known that, in case of (experimental) motion sickness, symptomatic outputs are delivered through the autonomic nervous system, and changes in salivary chemical components occur. In this study, accordingly, quantitative analyses of salivary potassium, sodium, chloride and total protein were performed before and after various levels of G loads which were produced by our short-radius human centrifuge. When the results were compared, the subjects who failed 60 minutes ride exhibited significantly higher post-load levels of potassium and sodium than those of successful 60 minutes riders. However, the differences between two groups were less clear in chloride and total protein. The result of present study indicates that salivary potassium and sodium are good indicators to represent autonomic nervous system function under the stressful condition produced by an artificial G load.

Salivary total protein and experimental Coriolis sickness

Symptomatic reporting has been used in quantifying the severity of motion sickness including Coriolis sickness. This study was designed to objectively examine if the dynamic changes of salivary protein concentration relate to the severity of Coriolis sickness. Healthy adults with normal vestibular function underwent a modified Coriolis Sickness Susceptibility Index (CSSI) test, utilizing a staircase profile. Salivary samples were obtained prior to stimulation, 15, 30, and 45 min following stimulus onset, and/or upon reaching "nausea-II" endpoint. Total protein concentration tended to rise over the initial 30 min of stimulation, and then level off or decline. A statistically significant difference was found between the pre-stimulation and 30 min samples. Although some variability existed among the subjects, the general pattern of changes along the time course was similar. An inverse correlation approaching statistical significance was found between control (non-stimulus) total protein levels, and minutes of Coriolis stimulation required to reach the "nausea-II" endpoint. Thus, baseline salivary total protein levels can be of use in predicting susceptibility of Coriolis sickness and other forms of motion sickness.