White matter lesions in magnetic resonance imaging of the brain in 56 patients with visual vertigo

Home-based Vestibular Rehabilitation: A Feasible and Effective Therapy for Persistent Postural Perceptual Dizziness (A Pilot Study)

INTRODUCTION

Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder where there is persistent dizziness or unsteadiness occurring on most days for more than 3 months duration. Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications and/or cognitive behavioral therapy.

OBJECTIVES

This paper is a pilot study designed to compare the effects of Bal Ex as a home-based VRT on the quality of life (EQ-5D), dizziness handicap (DHI) and mental health (DASS-21) against hospital-based VRT.

DESIGN

This was an assessor-blinded, randomized controlled pilot study where PPPD patients were randomly selected to undergo Bal Ex, the home-based VRT (intervention group) or hospital-based (control group) VRT. The participants were reviewed at 4 weeks and 12 weeks after the start of therapy to assess the primary endpoints using the subjective improvement in symptoms as reported by patients, changes in DHI scores, DASS-21 scores and EQ5D VAS scores.

RESULTS

Thirty PPPD patients successfully completed the study with 15 in each study group. Within 4 weeks, there were significant improvements in the total DHI scores as well as anxiety levels. By the end of 12 weeks, there were significant improvements in the DHI, DASS-21 and EQ5D. The degree of improvement between Bal Ex and the control was comparable.

CONCLUSION

VRT is an effective modality in significantly improving quality of life, dizziness handicap, depression, and anxiety levels within 3 months in PPPD. Preliminary results show Bal Ex is as effective as hospital-based VRT and should be considered as a treatment option for PPPD.

Neuroimaging Systematic Review in Persistent Postural-Perceptual Dizziness: The Elaborate Alterations in the Delicate Network to Remain Balanced

OBJECTIVES

Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that may have normal physical examination, clinical laboratory testing and vestibular evaluation. However, advances in neuroimaging have provided new insights in brain functional connectivity and structure in patients with PPPD. This systematic review was aimed at identifying significant structural or alterations in functional connectivity in patients with PPPD.

DATABASES REVIEWED

Science Direct, Pubmed, Embase via Ovid databases, and Cochrane library.

METHODS

This review following the guidelines of PRISMA, systematically and independently examined papers published up to March 2021 which fulfilled the predetermined criteria. PROSPERO Registration (CRD42020222334).

RESULTS

A total of 15 studies were included (MRI = 4, SPECT = 1, resting state fMRI = 4, task-based fMRI = 5, task-based fMRI + MRI = 1). Significant changes in the gray matter volume, cortical folding, blood flow, and connectivity were seen at different brain regions involved in vestibular, visual, emotion, and motor processing.

CONCLUSION

There is a multisensory dimension to the impairment resulting in chronic compensatory changes in PPPD that is evident by the significant alterations in multiple networks involved in maintaining balance. These changes observed offer some explanation for the symptoms that a PPPD patient may experience.Systematic Review Registration: This study is registered with PROSPERO (CRD42020222334).

Neuroimaging studies in persistent postural-perceptual dizziness and related disease: a systematic review

BACKGROUND

Persistent Postural-Perceptual Dizziness (PPPD) is one of the most common types of chronic dizziness. The pathogenesis remains unclear.

OBJECTIVE

This study aimed to systematically review neuroimaging literature for investigating the central mechanism of PPPD and related disorders.

METHODS

PubMed, EMBASE, Medline, Cochrane, and Web of Science were searched by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles analyzing structural and functional neuroimaging features of PPPD and related disorders were selected according to eligibility criteria.

RESULTS

Fifteen articles, including 4 structural, 10 functional, and 1 multimodal imaging, were eligible for inclusion in this review. The whiter matter alterations in PPPD are not entirely consistent. The changes of grey matter mainly in multisensory vestibular cortices, visual cortex, cerebellum, as well as anxiety-related network. Consistent with structural imaging, functional imaging conducted during the specific tasks or in the resting state has both found abnormal functional activation and connectivity in the vestibular cortex, especially in the parieto-insular vestibular cortex (PIVC), visual cortex, cerebellum, and anxiety-related network in PPPD and related disorder.

CONCLUSIONS

The current review provides up-to-date knowledge and summarizes the possible central mechanism for PPPD and related disorders, and it is helpful to understanding the mechanism of PPPD.

Perceptual Postural Imbalance and Visual Vertigo

PURPOSE OF REVIEW

Disorders of posture and balance cause significant patient morbidity, with reduction of quality of life as patients refrain from critical activities of daily living such as walking outside the home and driving. This review describes recent efforts to characterize visual disorders that interact with the neural integrators of positional maintenance and emerging therapies for these disorders.

RECENT FINDINGS

Abnormalities of gait and body position sense may be unrecognized by patients but are correlated with focal neurological injury (stroke). Patients with traumatic brain injury can exhibit visual vertigo despite otherwise normal visual functioning. The effect of visual neglect on posture and balance, even in the absence of a demonstrable visual field defect, has been characterized quantitatively through gait analysis and validates the potential therapeutic value of prism treatment in some patients. In addition, the underlying neural dysfunction in visual vertigo has been explored further using functional imaging, and these observations may allow discrimination of patients with structural causes from those whose co-morbid psychosocial disorders may be primarily contributory.