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Chen Z, Liu Y, Lin C, Liu D, Xiao L, Liu H, Wei X, Rong L. Altered parietal operculum cortex 2 functional connectivity in benign paroxysmal positional vertigo patients with residual dizziness: A resting-state fMRI study. CNS Neurosci Ther 2024; 30:e14570. [PMID: 38421104 PMCID: PMC10850607 DOI: 10.1111/cns.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024] Open
Abstract
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.
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Affiliation(s)
- Zhengwei Chen
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Yueji Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Cunxin Lin
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Dan Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Lijie Xiao
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Haiyan Liu
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Xiu‐e Wei
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Liangqun Rong
- Department of NeurologySecond Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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Staab JP. Persistent Postural-Perceptual Dizziness: Review and Update on Key Mechanisms of the Most Common Functional Neuro-otologic Disorder. Neurol Clin 2023; 41:647-664. [PMID: 37775196 DOI: 10.1016/j.ncl.2023.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Persistent postural-perceptual dizziness (PPPD) is a functional neuro-otologic (vestibular) disorder manifesting dizziness, unsteadiness, or nonspinning vertigo lasting 3 months or more and exacerbated by upright posture, active or passive motion, and complex visual stimuli. PPPD is the most common cause of chronic vestibular symptoms. Early pathophysiologic models of PPPD emphasized the adverse effects of anxiety on postural control and spatial orientation. More recent concepts added predictive processing of sensory inputs and alterations in motion perception. Herein, a third-generation model incorporates prioritization of postural stability over fluid locomotion to explain symptoms, physiologic and neuroimaging data, and effects of current treatments.
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Affiliation(s)
- Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Maywald M, Pogarell O, Levai S, Paolini M, Tschentscher N, Rauchmann BS, Krause D, Stöcklein S, Goerigk S, Röll L, Ertl-Wagner B, Papazov B, Keeser D, Karch S, Chrobok A. Neurofunctional differences and similarities between persistent postural-perceptual dizziness and anxiety disorder. Neuroimage Clin 2023; 37:103330. [PMID: 36696807 PMCID: PMC9879992 DOI: 10.1016/j.nicl.2023.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Levai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nadja Tschentscher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Boris Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniela Krause
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sophia Stöcklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Röll
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Papazov
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Agnieszka Chrobok
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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Sui Lin CT, Prepageran N. The impact of disease duration in persistent postural-perceptual dizziness (PPPD) on the quality of life, dizziness handicap and mental health. J Vestib Res 2021; 32:373-380. [PMID: 34924408 DOI: 10.3233/ves-210087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional disorder which interferes with the way individuals experience their personal, social and work life. OBJECTIVE To study the impact of disease duration in PPPD on the quality of life (QOL), dizziness handicap and mental health on the patients. METHODS A prospective study comparing the EQ-5D for QOL, Dizziness Handicap Inventory (DHI) and DASS-21 between 27 patients with PPPD and 27 of those who have recovered from an acute vestibular event. Similar parameters between PPPD patients with symptoms less than one year and more than a year were compared. RESULTS The PPPD patients were predominantly females and middle-aged with significantly higher DHI scores (mean 48.3 + 25.7, p = 0.00002), higher total mean scores in the DASS-21 (mean 21.6 + 13.7, p = 0.009) and poorer QOL with mean EQ-5D VAS of 67.9 + 17.3 (p < 0.00001). PPPD patients with symptoms for more than a year had significant increase in physical handicap (p = 0.041) as well as anxiety levels (p = 0.008). CONCLUSIONS PPPD is predominantly seen in females and middle-aged which significantly reduces the QOL, increases dizziness handicap and increases depression, anxiety and stress levels. The increase in duration of illness further increases the anxiety levels and physical handicap.
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Affiliation(s)
- Carren Teh Sui Lin
- Department of Otorhinolaryngology, Hospital Sungai Buloh, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Narayanan Prepageran
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan University, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Indovina I, Passamonti L, Mucci V, Chiarella G, Lacquaniti F, Staab JP. Brain Correlates of Persistent Postural-Perceptual Dizziness: A Review of Neuroimaging Studies. J Clin Med 2021; 10:4274. [PMID: 34575385 PMCID: PMC8468644 DOI: 10.3390/jcm10184274] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
Persistent postural-perceptual dizziness (PPPD), defined in 2017, is a vestibular disorder characterized by chronic dizziness that is exacerbated by upright posture and exposure to complex visual stimuli. This review focused on recent neuroimaging studies that explored the pathophysiological mechanisms underlying PPPD and three conditions that predated it. The emerging picture is that local activity and functional connectivity in multimodal vestibular cortical areas are decreased in PPPD, which is potentially related to structural abnormalities (e.g., reductions in cortical folding and grey-matter volume). Additionally, connectivity between the prefrontal cortex, which regulates attentional and emotional responses, and primary visual and motor regions appears to be increased in PPPD. These results complement physiological and psychological data identifying hypervigilant postural control and visual dependence in patients with PPPD, supporting the hypothesis that PPPD arises from shifts in interactions among visuo-vestibular, sensorimotor, and emotional networks that overweigh visual over vestibular inputs and increase the effects of anxiety-related mechanisms on locomotor control and spatial orientation.
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Affiliation(s)
- Iole Indovina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (V.M.); (F.L.)
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK;
- Institute of Bioimaging & Molecular Physiology, National Research Council, 20054 Milano, Italy
| | - Viviana Mucci
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (V.M.); (F.L.)
- School of Science, Western Sydney University, Sydney, NSW 2000, Australia
| | - Giuseppe Chiarella
- Unit of Audiology, Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy;
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (V.M.); (F.L.)
- Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
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