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Arshad Q, Moreno-Ajona D, Goadsby PJ, Kheradmand A. What visuospatial perception has taught us about the pathophysiology of vestibular migraine. Curr Opin Neurol 2024; 37:32-39. [PMID: 38018799 PMCID: PMC11090135 DOI: 10.1097/wco.0000000000001232] [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] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW A decade has passed since vestibular migraine (VM) was formally established as a clinical entity. During this time, VM has emerged amongst the most common cause of episodic vertigo. Like all forms of migraine, VM symptoms are most prominent during individual attacks, however many patients may also develop persistent symptoms that are less prominent and can still interfere with daily activities. RECENT FINDINGS Vestibular inputs are strongly multimodal, and because of extensive convergence with other sensory information, they do not result in a distinct conscious sensation. Here we review experimental evidence that supports VM symptoms are linked to multisensory mechanisms that control body motion and position in space. SUMMARY Multisensory integration is a key concept for understanding migraine. In this context, VM pathophysiology may involve multisensory processes critical for motion perception, spatial orientation, visuospatial attention, and spatial awareness.
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Affiliation(s)
- Qadeer Arshad
- InAmind Laboratory, College of Life Sciences, University of Leicester, Leicester, UK
| | - David Moreno-Ajona
- Department of Neurology, Queen Elizabeth Hospital, London UK
- NIHR King’s Clinical Research Facility, King’s College London, UK
| | - Peter J. Goadsby
- NIHR King’s Clinical Research Facility, King’s College London, UK
- Department of Neurology, University of California, Los Angeles, CA USA
| | - Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bogle JM, King AZ, Deep N, Weisskopf P, Starling AJ. Static Subjective Visual Vertical (SVV) in Patients with Vestibular Migraine. J Am Acad Audiol 2022; 33:396-404. [PMID: 36070782 DOI: 10.1055/a-1938-1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Vestibular migraine (VM) is one of the common causes of episodic dizziness, but it is underdiagnosed and poorly understood. Previous research suggests that otolith reflex pathway performance is often impaired in this patient group, leading to altered perception of roll plane stimuli. Clinically, this perception can be measured with subjective visual vertical (SVV) testing. PURPOSE The aim of this study is to compare static SVV performance (absolute mean SVV tilt, variance) in a cohort of patients diagnosed with VM to results obtained from clinically derived normative data. STUDY DESIGN Retrospective case review. STUDY SAMPLE Ninety-four consecutive patients between 18 and 65 years of age diagnosed with VM were included in this comparison to clinically derived normative data. DATA COLLECTION AND ANALYSIS Retrospective chart review was completed. Demographic data, symptom report, and vestibular laboratory results were documented. SVV performance was documented in terms of absolute mean SVV tilt and response variance. RESULTS Abnormal mean SVV tilt was described in 54% (n = 51) of patients with VM. Including abnormal response variance increased those identified with abnormal presentation to 67% (n = 63). Laboratory findings were insignificant for semicircular canal function, but of those with abnormal ocular vestibular myogenic potential results (n = 30), 77% (n = 23) demonstrated both abnormal SVV and utriculo-ocular reflex performance. There were no associations noted for SVV performance and demographic or other self-report variables. CONCLUSION Absolute mean SVV tilt and response variance are often abnormal in patients diagnosed with VM. These findings support theories suggesting atypical intralabyrinthine integration within the vestibular nuclei and cerebellar nodular pathways.
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Affiliation(s)
- Jamie M Bogle
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Ashley Zaleski King
- Department of Speech-Language/Audiology, Towson University, Towson, Maryland
| | - Nicholas Deep
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Peter Weisskopf
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
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Risk of Vestibulocochlear Disorders in Patients with Migraine or Non-Migraine Headache. J Pers Med 2021; 11:jpm11121331. [PMID: 34945803 PMCID: PMC8707905 DOI: 10.3390/jpm11121331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Headaches, especially migraines, have been associated with various vestibular symptoms and syndromes. Tinnitus and hearing loss have also been reported to be more prevalent among migraineurs. However, whether headaches, including migraine or non-migraine headaches (nMH), are associated with vestibular and cochlear disorders remains unclear. Thus, we sought to investigate possible associations between headache and vestibulocochlear disorders. We analyzed 10 years of data from the Smart Clinical Data Warehouse. In patients with migraines and nMH, meniere’s disease (MD), BPPV, vestibular neuronitis (VN) and cochlear disorders, such as sensorineural hearing loss (SNHL) and tinnitus, were collected and compared to clinical data from controls who had health check-ups without headache. Participants included 15,128 with migraines, 76,773 patients with nMH and controls were identified based on propensity score matching (PSM). After PSM, the odds ratios (OR) in subjects with migraine versus controls were 2.59 for MD, 2.05 for BPPV, 2.98 for VN, 1.74 for SNHL, and 1.97 for tinnitus, respectively (p < 0.001). The OR for MD (1.77), BPPV (1.73), VN (2.05), SNHL (1.40), and tinnitus (1.70) in patients with nMH was also high after matching (p < 0.001). Our findings suggest that migraines and nMH are associated with an increased risk of cochlear disorders in addition to vestibular disorders.
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Li F, Xu J, Li GR, Gao R, Shang CY, Tian E, Kong WJ, Zhuang JH, Zhang SL. The Value of Subjective Visual Vertical in Diagnosis of Vestibular Migraine. Curr Med Sci 2021; 41:654-660. [PMID: 34403088 DOI: 10.1007/s11596-021-2418-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the value of the subjective visual vertical (SVV) in the diagnosis of vestibular migraine (VM). METHODS This study recruited 128 VM patients and 64 age-matched normal subjects. We detected the SVV during the interval between attacks in both groups, in sitting upright, and the head tilted at 45° to the left or right. We then examined the correlation between the SVV results with the vestibular evoked myogenic potential (VEMP) and canal paresis (CP). RESULTS It was found there was a significant difference in SVV at the upright position between VM patients and normal controls (P=0.006) and no significant difference was found at the tilts of 45° to the left or right between the two groups. The SVV results at the upright position were significantly correlated with cervical VEMP (P=0.042) whereas not significantly correlated with CP and VEMP. There existed no significant difference in the conformity to the Müller effect (M effect) between the two groups. ROC analysis exhibited that the sensitivity, specificity of SVVs at the upright were 67.200% and 62.500% respectively. The diagnostic value of SVV at the upright position was significantly higher than that at tilts of 45° to the left and right (P=0.006). Nonetheless the diagnostic accuracy was relatively low. CONCLUSION Abnormality in SVV possibly stems from the lasting functional disorder of cerebellar or high-level cortical centers in VM patients or is linked to the vestibular compensation. The SVV is of low diagnostic value for VM and the value of SVV in VM warrants further study.
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Affiliation(s)
- Fei Li
- Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Jin Xu
- Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Gen-Ru Li
- Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Rui Gao
- Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Chen-Yong Shang
- Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei-Jia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jian-Hua Zhuang
- Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
| | - Su-Lin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Rodríguez-Almagro D, Obrero-Gaitán E, Lomas-Vega R, Zagalaz-Anula N, Osuna-Pérez MC, Achalandabaso-Ochoa A. New Mobile Device to Measure Verticality Perception: Results in Young Subjects with Headaches. Diagnostics (Basel) 2020; 10:E796. [PMID: 33036468 PMCID: PMC7601549 DOI: 10.3390/diagnostics10100796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023] Open
Abstract
The subjective visual vertical (SVV) test has been frequently used to measure vestibular contribution to the perception of verticality. Recently, mobile devices have been used to efficiently perform this measurement. The aim of this study was to analyze the perception of verticality in subjects with migraines and headaches. A cross-sectional study was conducted that included 28 patients with migraine, 74 with tension-type headache (TTH), and 93 healthy subjects. The SVV test was used through a new virtual reality system. The mean absolute error (MAE) of degrees deviation was also measured to qualify subjects as positive when it was greater than 2.5°. No differences in the prevalence of misperception in verticality was found among healthy subjects (31.18%), migraineurs (21.43%), or those with TTH (33.78%) (p = 0.480). The MAE was not significantly different between the three groups (migraine = 1.36°, TTH = 1.61°, and healthy = 1.68°) (F = 1.097, p = 0.336, and η2 = 0.011). The perception of verticality could not be explained by any variable usually related to headaches. No significant differences exist in the vestibular contribution to the perception of verticality between patients with headaches and healthy subjects. New tests measuring visual and somatosensory contribution should be used to analyze the link between the perception of verticality and headaches.
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Affiliation(s)
| | | | - Rafael Lomas-Vega
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (D.R.-A.); (E.O.-G.); (N.Z.-A.); (M.C.O.-P.); (A.A.-O)
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6
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Obrero-Gaitán E, Manrique-Navarro M, Lérida-Ortega MÁ, Rodríguez-Almagro D, Osuna-Pérez MC, Lomas-Vega R. Misperception of Visual Verticality in Patients with Primary Headache Disorders: A Systematic Review with Meta-Analysis. Brain Sci 2020; 10:brainsci10100664. [PMID: 32987639 PMCID: PMC7598580 DOI: 10.3390/brainsci10100664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023] Open
Abstract
Migraine and tension-type headache (TTH) are the two most prevalent primary headache disorders (PHDs) that may involve visual and vestibular impairments, neck pain, and postural unsteadiness. The perception of visual verticality (VV) has been studied in patients diagnosed with PHD to assess balance disorders showing varying findings. Our study aimed to assess the VV perception in patients diagnosed with PHD in comparison to healthy controls. A systematic review with meta-analysis was carried out in PubMed MEDLINE, Scopus, WOS, CINAHL, and SciELO. The Cohen standardized mean difference (SMD) was used to estimate the differences between exposed and healthy controls. Seven studies with 816 participants were included. The quality of included studies, according to the Newcastle–Ottawa Scale (NOS), was moderate (mean score of 5.2). Patients diagnosed with PHD showed a moderate misperception of VV as assessed with the subjective visual vertical (SVV) test (SMD = 0.530; 95% CI = 0.225, 0.836; p < 0.001). Specifically, a misperception of the SVV was found in patients with migraine (SMD = 0.369; 95% CI = 0.1, 0.638; p = 0.007) and with TTH (SMD = 1.122; 95% CI = 0.540, 1.704; p < 0.001). This review shows a misperception of VV in patients with migraine and TTH when assessed with the SVV test, being higher in patients with TTH, although the THH sample size was low.
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Affiliation(s)
- Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
| | | | - Miguel Ángel Lérida-Ortega
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
- Hospital San Agustín de Linares, 23700 Linares, Spain
- Escuela de Osteopatía de Madrid S.L., 28807 Alcalá de Henares, Madrid, Spain
| | - Daniel Rodríguez-Almagro
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
- Correspondence: ; Tel.: +34-953-212-381
| | - María Catalina Osuna-Pérez
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaen, 23071 Jaen, Spain; (E.O.-G.); (M.Á.L.-O.); (M.C.O.-P.); (R.L.-V.)
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7
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Vestibular Lab Testing: Interpreting the Results in the Headache Patient with Dizziness. Curr Neurol Neurosci Rep 2020; 20:16. [PMID: 32430768 DOI: 10.1007/s11910-020-01036-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of vestibular lab testing and to familiarize the reader with common results observed in headache patients with dizziness. RECENT FINDINGS The latest research indicates variable levels of both peripheral and central vestibular dysfunction in headache populations with dizziness. Mechanisms may include vestibulocerebellar loss of inhibition, central vestibular network misfiring, and peripheral pathology aggravating central hypersensitization. Headache patients are commonly affected by dizziness stemming from various etiologies. Although history is still the gold standard in diagnosis, vestibular lab testing can identify the integrity of vestibular function. Research is emerging and future directions are encouraging.
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Chang TP, Winnick AA, Hsu YC, Sung PY, Schubert MC. The bucket test differentiates patients with MRI confirmed brainstem/cerebellar lesions from patients having migraine and dizziness alone. BMC Neurol 2019; 19:219. [PMID: 31481007 PMCID: PMC6720090 DOI: 10.1186/s12883-019-1442-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background Amongst the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e. vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). Method Twenty-seven symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including; 1) SVV bucket test, 2) ABCD2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. Results Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8 ± 4.1° and 0.7 ± 1.0°, respectively. The abnormal rate of SVV deviations (> 2.3°) in CVD was significantly higher than VM (p < 0.001). Using the bucket test alone to differentiate CVD from VM, sensitivity was 74.1%, specificity 91.7%, positive likelihood ratio (LR+) 8.9, and negative likelihood ratio (LR-) 0.3. However, when we combined the SVV results with the clinical exam assessing gaze stability (nystagmus) with an abnormal focal neurological exam, the sensitivity (92.6%) and specificity (88.9%) were optimized (LR+ (8.3), LR- (0.08)). Conclusion The SVV bucket test is a useful clinical test to distinguish CVD from VM, particularly when interpreted along with the results of a focal neurological exam and clinical exam for nystagmus. Electronic supplementary material The online version of this article (10.1186/s12883-019-1442-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tzu-Pu Chang
- Department of Neurology/Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan.,Department of Neurology, Tzu Chi University, Hualien, Taiwan
| | - Ariel A Winnick
- Soroka University Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yung-Chu Hsu
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Pi-Yu Sung
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, 21205, USA. .,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21205, USA.
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9
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Molina F, Lomas-Vega R, Obrero-Gaitán E, Rus A, Almagro DR, Del-Pino-Casado R. Misperception of the subjective visual vertical in neurological patients with or without stroke: A meta-analysis. NeuroRehabilitation 2019; 44:379-388. [PMID: 31227659 DOI: 10.3233/nre-182642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interpretation of the verticality of the environment is crucial for a proper body balance. The subjective visual vertical test (SVV) is a widely used method to determine the visual perception of the verticality, whose alteration has been related with poor functional status. OBJECTIVE To analyze the visual perception of the verticality in neurological patients in comparison with healthy controls. METHODS We searched PubMed, Scopus, and Scielo from the start of the databases until October 2017 and manually searched the reference lists of studies comparing SVV values between neurological patients and controls. Standardized mean difference (SMD) and subgroup analysis were used to analyze differences between neurological patients and healthy subjects and between stroke and non-stroke patients, respectively. RESULTS A total of 1,916 subjects from 31 studies were included. Neurological patients misestimate the true vertical in comparison with controls (SMD = 1.05; 95% CI: 0.81, 1.28). The misperception of the verticality was higher in stroke patients (SMD = 1.35; 95% CI: 1.02, 1.68) than in patients with other neurological conditions (SMD = 0.48; 95% CI: 0.29, 0.68). CONCLUSIONS Neurological patients showed a misperception of the verticality, estimated using the SVV. The neurological pathology that most alters the SVV is stroke.
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Affiliation(s)
- Francisco Molina
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Rafael Lomas-Vega
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Alma Rus
- Department of Cell Biology, University of Granada, Campus Fuentenueva, Granada, Spain
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10
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Huang TC, Wang SJ, Kheradmand A. Vestibular migraine: An update on current understanding and future directions. Cephalalgia 2019; 40:107-121. [PMID: 31394919 DOI: 10.1177/0333102419869317] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Vestibular migraine is among the most common causes of recurrent vertigo in the general population. Despite its prevalence and high impact on healthcare cost and utilization, it has remained an under-recognized condition with largely unknown pathophysiology. In the present article, we aim to provide an overview of the current understanding of vestibular migraine. METHODS We undertook a narrative literature review on the epidemiology, presentations, clinical and laboratory findings, pathophysiology, and treatments of vestibular migraine. RESULTS Currently, the diagnosis of vestibular migraine relies solely on clinical symptoms since clinical tests of vestibular function are typically normal, or difficult to interpret based on inconsistent results reported in earlier studies. The challenges related to diagnosis of vestibular migraine lie in its relatively broad spectrum of manifestations, the absence of typical migraine headaches with vestibular symptoms, and its very recent definition as a distinct entity. Here, we highlight these challenges, discuss common vestibular symptoms and clinical presentations in vestibular migraine, and review the current aspects of its clinical diagnosis and evaluation. The concepts related to the pathophysiology and treatment of vestibular migraine are also discussed. CONCLUSION Vestibular migraine is still underdiagnosed clinically. Future studies are needed to address the pathophysiological mechanisms and investigate effective treatment regimens.
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Affiliation(s)
- Tzu-Chou Huang
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Living Water Neurological Clinic, Tainan, Taiwan
| | - Shuu-Jiun Wang
- Neurological Institute, Taipei-Veterans General Hospital, Taipei, Taiwan.,Brain Research Center and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Winnick A, Sadeghpour S, Otero-Millan J, Chang TP, Kheradmand A. Errors of Upright Perception in Patients With Vestibular Migraine. Front Neurol 2018; 9:892. [PMID: 30425678 PMCID: PMC6218433 DOI: 10.3389/fneur.2018.00892] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
Patients with vestibular migraine (VM) often report dizziness with changes in the head or body position. Such symptoms raise the possibility of dysfunction in neural mechanisms underlying spatial orientation in these patients. Here we addressed this issue by investigating the effect of static head tilts on errors of upright perception in a group of 27 VM patients in comparison with a group of 27 healthy controls. Perception of upright was measured in a dark room using a subjective visual vertical (SVV) paradigm at three head tilt positions (upright, ±20°). VM patients were also surveyed about the quality of their dizziness and spatial symptoms during daily activities. In the upright head position, SVV errors were within the normal range for VM patients and healthy controls (within 2° from true vertical). During the static head tilts of 20° to the right, VM patients showed larger SVV errors consistent with overestimation of the tilt magnitude (i.e., as if they felt further tilted toward the right side) (VM: −3.21° ± 0.93 vs. Control: 0.52° ± 0.70; p = 0.002). During the head tilt to the left, SVV errors in VM patients did not differ significantly from controls (VM: 0.77° ± 1.05 vs. Control: −0.04° ± 0.68; p = 0.52). There was no significant difference in SVV precision between the VM patients and healthy controls at any head tilt position. Consistent with the direction of the SVV errors in VM patients, they largely reported spatial symptoms toward the right side. These findings suggest an abnormal sensory integration for spatial orientation in vestibular migraine, related to daily dizziness in these patients.
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Affiliation(s)
- Ariel Winnick
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shirin Sadeghpour
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jorge Otero-Millan
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tzu-Pu Chang
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Department of Medicine, Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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12
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Kheradmand A, Winnick A. Perception of Upright: Multisensory Convergence and the Role of Temporo-Parietal Cortex. Front Neurol 2017; 8:552. [PMID: 29118736 PMCID: PMC5660972 DOI: 10.3389/fneur.2017.00552] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/28/2017] [Indexed: 12/18/2022] Open
Abstract
We inherently maintain a stable perception of the world despite frequent changes in the head, eye, and body positions. Such "orientation constancy" is a prerequisite for coherent spatial perception and sensorimotor planning. As a multimodal sensory reference, perception of upright represents neural processes that subserve orientation constancy through integration of sensory information encoding the eye, head, and body positions. Although perception of upright is distinct from perception of body orientation, they share similar neural substrates within the cerebral cortical networks involved in perception of spatial orientation. These cortical networks, mainly within the temporo-parietal junction, are crucial for multisensory processing and integration that generate sensory reference frames for coherent perception of self-position and extrapersonal space transformations. In this review, we focus on these neural mechanisms and discuss (i) neurobehavioral aspects of orientation constancy, (ii) sensory models that address the neurophysiology underlying perception of upright, and (iii) the current evidence for the role of cerebral cortex in perception of upright and orientation constancy, including findings from the neurological disorders that affect cortical function.
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Affiliation(s)
- Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Otolaryngology – Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ariel Winnick
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Aoki M. The impaired subjective perception of verticality independent of peripheral vestibular function in dizzy elderly with orthostatic hypotension. Aging Clin Exp Res 2017; 29:647-653. [PMID: 27568016 DOI: 10.1007/s40520-016-0624-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/12/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The elderly often complain of faintness, lightheadedness, dizziness, and unsteadiness, which may be associated with the orthostatic hypotension (OH), but most of them are subclinical. The pathogenic mechanism of subjective symptoms in the elderly with OH is controversial. AIMS The aim of this study was to assess the involvement of the irregularity of the vertical perception in the dizzy elderly with OH. METHODS This study consisted of 403 patients seeking treatment for dizziness in our hospital. The neurotological examinations include the subjective visual vertical (SVV) test and the bithermal caloric test. The self-perceived handicapping effects imposed by dizziness were assessed by the dizziness handicap inventory (DHI). The variability (standard deviation) and the average deviation of eight trials (four trials in each direction) were calculated. In addition, they underwent the orthostatic Schellong test for the diagnosis of the OH. They were separated into three groups, including patients aged ≥65 years, patients aged 50-64 years, and patients aged <50 years. RESULTS The variability of the SVV in the patients aged ≥65 years with OH was significantly larger than that in the patients aged ≥65 years without OH. There was no significant difference in the average deviation of the SVV, the canal paresis % by the bithermal caloric test, and the DHI score among groups. CONCLUSIONS The result suggests that the elderly patients with OH have subclinical impairment in the perception of the verticality independent of the peripheral vestibular function.
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Li Z, Yang YW. Creation and bioapplications of porous organic polymer materials. J Mater Chem B 2017; 5:9278-9290. [DOI: 10.1039/c7tb02647a] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Emerging porous organic polymers can serve as promising platforms for bio-related applications.
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Affiliation(s)
- Zheng Li
- International Joint Research Laboratory of Nano-Micro Architecture Chemistry (NMAC)
- College of Chemistry
- Jilin University
- Changchun 130012
- China
| | - Ying-Wei Yang
- International Joint Research Laboratory of Nano-Micro Architecture Chemistry (NMAC)
- College of Chemistry
- Jilin University
- Changchun 130012
- China
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Miller MA, Crane BT. Static and dynamic visual vertical perception in subjects with migraine and vestibular migraine. World J Otorhinolaryngol Head Neck Surg 2016; 2:175-180. [PMID: 28782063 PMCID: PMC5544022 DOI: 10.1016/j.wjorl.2016.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To measure the static visual vertical and the effect of visual rotation on the perception of visual vertical in migraine and vestibular migraine subjects. By so doing, we may better understand the vestibular contribution to the pathophysiology of migraine, as well as the capacity for visual compensation. METHODS The perception of visual vertical in the presence of static and dynamic visual cues was prospectively studied in 10 subjects with migraine, 6 subjects with vestibular migraines, and 10 controls. Subjects used a dial to rotate a fluorescent green line to the vertical position. Static visual vertical (SVV) was measured with a black background, as well as with a static random-dot visual pattern. This pattern was then rotated at various velocities to measure dynamic visual vertical (DVV). RESULTS Migraine subjects had greater deviation from true vertical than controls in SVV (P < 0.05). The DVV in migraine subjects was greater than controls when rotated in the counterclockwise at -5°/s (P < 0.01), -20°/s (P < 0.01), and -80°/s (P < 0.01), but not when the line was rotated clockwise. Vestibular migraine subjects did not deviate significantly from controls in SVV (P < 0.37, P < 0.22), but did show greater deviation in the DVV tasks at -80 and -20°/s (P < 0.05, P < 0.03). Migraine and vestibular migraine subjects demonstrated a wider range of vertical deviance when compared to controls (P < 0.02). CONCLUSIONS This study demonstrates a significant deviation of the perceived static as well as dynamic visual vertical in migraine subjects. Moving stimuli may have a greater influence on migraine and vestibular migraine subjects, which suggests an underlying sensory integration disorder.
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Affiliation(s)
- Mark A. Miller
- School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Benjamin T. Crane
- Department of Otolaryngology, University of Rochester, Rochester, NY 14642, USA
- Department of Bioengineering, University of Rochester, Rochester, NY 14642, USA
- Department of Neurobiology and Anatomy, University of Rochester, Rochester, NY 14642, USA
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Kim CH, Jang MU, Choi HC, Sohn JH. Subclinical vestibular dysfunction in migraine patients: a preliminary study of ocular and rectified cervical vestibular evoked myogenic potentials. J Headache Pain 2015; 16:93. [PMID: 26527349 PMCID: PMC4630263 DOI: 10.1186/s10194-015-0578-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/29/2015] [Indexed: 11/18/2022] Open
Abstract
Background Many studies have identified various vestibular symptoms and laboratory abnormalities in migraineurs. Although the vestibular tests may be abnormal, the changes may exist without vestibular symptoms. To date, vestibular-evoked myogenic potential (VEMP) has been the easiest and simplest test for measuring vestibular function in clinical practice. Cervical VEMP (cVEMP) represents a vestibulo-collic reflex, whereas ocular VEMP (oVEMP) reflects a vestibulo-ocular pathway. Therefore, we determined whether ocular and rectified cervical VEMPs differed in patients with migraine or tension type headache (TTH) and compared the results to controls with no accompanying vestibular symptoms. Methods The present study included 38 females with migraine without aura, 30 with episodic TTH, and 50 healthy controls without vestibular symptoms. oVEMP and cVEMP using a blood pressure manometer were recorded during a headache-free period. From the VEMP graphs, latency and amplitude parameters were analyzed, especially following EMG rectification in cVEMP. Results With respect to oVEMP, the migraine group exhibited significantly longer mean latencies of bilateral n1 and left p1 than the other groups (p < 0.05). Amplitudes of n1-p1 were lower than in other groups, but the difference did not reach statistical significance. In regards to cVEMP, p13 and n23 latencies and amplitudes after rectification did not differ significantly among groups. Conclusions An abnormal interictal oVEMP profile was associated with subclinical vestibular dysfunction in migraineurs, suggesting pathology within the vestibulo-ocular reflex. oVEMP is a more reliable measure than cVEMP to evaluate vestibular function in migraineurs, although results from the two tests in patients with migraine are complementary.
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Affiliation(s)
- Chul-Ho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 153 Gyo-dong, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea.
| | - Min-Uk Jang
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 153 Gyo-dong, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea.
| | - Hui-Chul Choi
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 153 Gyo-dong, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea.
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 153 Gyo-dong, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea.
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Liphart J. Use of Sensory Reweighting for a Woman With Persistent Mal de Debarquement. J Geriatr Phys Ther 2015; 38:96-103. [DOI: 10.1519/jpt.0000000000000022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Langhagen T, Lehrer N, Borggraefe I, Heinen F, Jahn K. Vestibular migraine in children and adolescents: clinical findings and laboratory tests. Front Neurol 2015; 5:292. [PMID: 25674076 PMCID: PMC4306301 DOI: 10.3389/fneur.2014.00292] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/23/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Vestibular migraine (VM) is the most common cause of episodic vertigo in children. We summarize the clinical findings and laboratory test results in a cohort of children and adolescents with VM. We discuss the limitations of current classification criteria for dizzy children. METHODS A retrospective chart analysis was performed on 118 children with migraine related vertigo at a tertiary care center. Patients were grouped in the following categories: (1) definite vestibular migraine (dVM); (2) probable vestibular migraine (pVM); (3) suspected vestibular migraine (sVM); (4) benign paroxysmal vertigo (BPV); and (5) migraine with/without aura (oM) plus vertigo/dizziness according to the International Classification of Headache Disorders, 3rd edition (beta version). RESULTS The mean age of all patients was 12 ± 3 years (range 3-18 years, 70 females). 36 patients (30%) fulfilled criteria for dVM, 33 (28%) for pVM, 34 (29%) for sVM, 7 (6%) for BPV, and 8 (7%) for oM. Somatoform vertigo (SV) co-occurred in 27% of patients. Episodic syndromes were reported in 8%; the family history of migraine was positive in 65%. Mild central ocular motor signs were found in 24% (most frequently horizontal saccadic pursuit). Laboratory tests showed that about 20% had pathological function of the horizontal vestibulo-ocular reflex, and almost 50% had abnormal postural sway patterns. CONCLUSION Patients with definite, probable, and suspected VM do not differ in the frequency of ocular motor, vestibular, or postural abnormalities. VM is the best explanation for their symptoms. It is essential to establish diagnostic criteria in clinical studies. In clinical practice, however, the most reasonable diagnosis should be made in order to begin treatment. Such a procedure also minimizes the fear of the parents and children, reduces the need to interrupt leisure time and school activities, and prevents the development of SV.
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Affiliation(s)
- Thyra Langhagen
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany ; Department of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-University of Munich , Munich , Germany
| | - Nicole Lehrer
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany
| | - Ingo Borggraefe
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany ; Department of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-University of Munich , Munich , Germany
| | - Florian Heinen
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany ; Department of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-University of Munich , Munich , Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany ; Schön Klinik Bad Aibling , Bad Aibling , Germany
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Chetana N, Jayesh R. Subjective Visual Vertical in Various Vestibular Disorders by Using a Simple Bucket Test. Indian J Otolaryngol Head Neck Surg 2014; 67:180-4. [PMID: 26075175 DOI: 10.1007/s12070-014-0760-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/01/2014] [Indexed: 12/15/2022] Open
Abstract
Subjective Visual Vertical (S.V.V.) assesses the ability to perceive verticality which depends on visual, vestibular and somatosensory inputs. The judgment of verticality is altered when there is otolith dysfunction. Objective of our study was to present a simple method to assess S.V.V. and to analyze S.V.V. changes in various vestibular disorders. 100 subjects presenting with vestibular disorders in period of 1 year 2 months were subjected to Neurotological history and examination. Patients with non-vestibular causes were excluded. S.V.V was tested with a simple innovative device-a specially designed bucket. The angle of deviation from vertical was noted in degrees. Normal deviation is 0 ± 2°. Out of 23 patients with vestibular neuritis 83 % showed abnormal S.V.V. Amongst 11 patients of Meniere's disease, 55 % and 42 patients of BPPV, 71 % had abnormal S.V.V. Amongst 24 patients with other causes 15 % showed abnormal S.V.V. S.V.V is a reliable screening tool in assessment of vestibular dysfunction along with other clinical tests. It has a prognostic value during recovery following vestibular damage. The modified 'Bucket' is a simple, easy to use and cost-effective device to do the S.V.V. in daily practice.
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Affiliation(s)
- Naik Chetana
- Department of E.N.T, Smt Kashibai Navale Medical College, Pune, 411041 India ; Vertigo Clinic, Ghaisas ENT Hospital, Pune, 411004 Maharashtra India
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A characteristic pattern in the postural sway of unilateral vestibular impaired patients. Gait Posture 2014; 40:435-40. [PMID: 24931111 DOI: 10.1016/j.gaitpost.2014.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 04/02/2014] [Accepted: 05/25/2014] [Indexed: 02/02/2023]
Abstract
The statistical properties of the center of pressure (COP) change over time, and -invariant methods of the COP analysis is not sufficient to monitor the changes. Therefore, dynamic temporal information of the COP signals has been important in assessing the postural stability. The purpose of this study was to evaluate the characteristic pattern of time-frequency dynamics during the upright stance in patients with unilateral vestibular dysfunction (UVD). This study included 20 dizzy patients with UVD and age-matched 20 control subjects without any vestibular disorder. The COP signals were collected using a single standard force platform and a spectral analysis including the time-frequency dynamics was carried out on the basis of the maximum entropy method (MEM) by using a segment time series analysis. The power spectral density (PSD) analysis exhibited an exponential decreasing shape (1/f (-)(β)) when plotted on a double logarithmic scale. The average value of β in the low frequency range of less than 1 Hz in the UVD group was significantly lower than that in the control group (p < 0.05) in the medial-lateral (ML) direction under eyes closed condition. In the segment time series analysis, the peak frequency of the COP signals in the patients with UVD gradually converged to the frequency range of 0.1-0.2 Hz in the ML direction under EC condition. Our results suggest that the segment time series analysis of the COP signals can derive a characteristic pattern related to the UVD. It may indicate an increased reflexivity of the COP fluctuation by the UVD, resulting in inducing the instability.
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Crevits L, Vanacker L, Verraes A. Patients with migraine correctly estimate the visual verticality. Clin Neurol Neurosurg 2012; 114:313-5. [DOI: 10.1016/j.clineuro.2011.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 10/23/2011] [Indexed: 12/12/2022]
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Tanaka K, Abe C, Sakaida Y, Aoki M, Iwata C, Morita H. Subsensory galvanic vestibular stimulation augments arterial pressure control upon head-up tilt in human subjects. Auton Neurosci 2011; 166:66-71. [PMID: 22088942 DOI: 10.1016/j.autneu.2011.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 10/07/2011] [Accepted: 10/10/2011] [Indexed: 12/19/2022]
Abstract
The vestibular system plays an important role in control of arterial pressure (AP) upon head-up tilt (HUT). To examine this role in human subjects, we previously compared changes in AP with and without high-amplitude galvanic vestibular stimulation (GVS), which is considered to obscure vestibular input. In contrast, regarding sensory function in skin and muscle, it has been documented that low-amplitude electrical stimulation improves both sensitivity and response. In the present study, we examined whether GVS of smaller amplitude improves AP control upon HUT. GVS was applied at the amplitude of the somatosensory threshold (0.3-0.8 mA), 0.1 mA over the threshold, and 0.1 and 0.2 mA below the threshold during HUT. AP decreased at the onset of HUT compared with that in the supine position in 15 of 25 subjects without GVS (-12±2 mmHg), but applying GVS at 0.1 mA below the somatosensory threshold diminished the decrease (0.3±0.7 mmHg). The APs of another 10 subjects were maintained or decreased by less than 5 mmHg without GVS at the onset of HUT (4±2 mmHg), but applying GVS at the amplitude of 0.1 mA below the somatosensory threshold further increased the AP (12±2 mmHg). GVS at the other amplitudes did not result in AP changes in either group. Thus, subsensory weak GVS enhances AP control at the onset of HUT.
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Affiliation(s)
- Kunihiko Tanaka
- Department of Physiology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan.
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