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Goto F, Wasano K, Kaneda S, Okami K. Prognostic significance vestibular examination results in patients with vestibular migraine. Front Neurol 2024; 15:1370940. [PMID: 38660093 PMCID: PMC11039844 DOI: 10.3389/fneur.2024.1370940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Vestibular migraine (VM) is a newly defined clinical condition. Several vestibular abnormalities have been reported in patients with VM. However, to date, no specific vestibular examinations are used to define VM. Therefore, the utility of vestibular examinations is limited. Currently, the role of vestibular examination has not been clearly defined. We speculated that the results of vestibular examinations could predict the prognosis of VM. We investigated the relationship between the vestibular examination results and clinical outcomes in patients with VM. Methods This study included 25 patients with VM. Vestibular examinations, including the video head impulse test (V-HIT), cervical and ocular vestibular evoked myogenic potential (c-VEMP and o-VEMP), posturography, and several questionnaires, including the Dizziness Handicap Inventory (DHI), were conducted at the initial evaluation. Lifestyle modifications for VM and conventional pharmacological prophylactic treatments, including lomerizine, amitriptyline, and valproic acid, were performed. After 4 weeks of treatment, clinical improvements were evaluated using the Clinical Global Improvement Scale (CGI-s). The relationships among the CGI-S score, several clinical variables, and the results of several vestibular examinations were evaluated. Each patient was further classified into two subgroups according to treatment outcomes concerning vertigo and headache: CGI-S score from 0 to 2 (good response [GR]) and CGI-S score > 3 (poor response [PR]). Results Overall, after treatment, most of the patients had improved dizziness and headache, and the CGI-s was 2.7 ± 1.3. There were 12 GRs, and 13 had PRs. Thus, neither V-HIT nor posturography predicted the prognosis. For c-VEMP, patients with GRs had significantly small AR concerning PR (19.2 ± 12.8 and 62.5 ± 42.5, respectively, [p < 0.01]). There were five normal, six unilateral, and 14 bilateral no response in 500hz o-VEMP. CGI-s of normal, unilateral, and bilateral no response was 1.4 ± 0.5, 2.8 ± 1.3, and 3.1 ± 1.2, respectively. There was a statistically significant difference between the normal and bilateral non-response o-VEMP groups (p < 0.05). Conclusion Patients with VM had improvements in both headache and vertigo through a combination of lifestyle changes and prophylactic medications. Vestibular examinations, especially o- or c-VEMP, are beneficial for predicting the treatment outcomes of VM. The pathophysiology of VM is closely related to vestibular abnormalities, particularly the otolith-related pathways.
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Affiliation(s)
- Fumiyuki Goto
- Department of Otolaryngology, School of Medicine, Tokai University, Isehara, Kanagawa, Japan
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Waissbluth S, Sepúlveda V, Leung JS, Oyarzún J. Vestibular and Oculomotor Findings in Vestibular Migraine Patients. Audiol Res 2023; 13:615-626. [PMID: 37622929 PMCID: PMC10452030 DOI: 10.3390/audiolres13040053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Vestibular migraine (VM) is the most frequent etiology of recurrent spontaneous episodic vertigo. Vestibular and oculomotor abnormalities have been described in VM; however, the diagnosis is currently based on symptoms. The objective of this study was to determine the most frequent abnormalities in videonystagmography (VNG), caloric testing (Cal) and video head impulse test (vHIT) in patients with VM. METHODS A retrospective cohort study was conducted, including all VM and probable VM patients seen from January 2021 to July 2022. Demographics, auditory symptoms and results via VNG, Cal and vHIT were evaluated. VNG results were compared with a control group. RESULTS Sixty patients, 81.7% with VM and 18.3% with probable vestibular migraine, were included. VNG revealed the following abnormalities: 21.7% spontaneous nystagmus; 33.3% positional nystagmus, mostly central; 26.7% optokinetic nystagmus; 56.7% smooth pursuit abnormalities and 70% saccade test abnormalities, mostly velocity and latency. An abnormal unilateral caloric response was seen in 22.9%, while vHIT revealed a low gain in at least one canal in 21.7%, and saccades were seen in at least one canal with normal gains in 18.3%. Concordant results between Cal and lateral vHIT were seen in 77.1% of cases. CONCLUSIONS Although VM is a clinical diagnosis, vestibular and oculomotor abnormalities are commonly seen. The most frequent oculomotor findings were an abnormal saccade test, abnormal smooth pursuit and central positional nystagmus.
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Affiliation(s)
- Sofia Waissbluth
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago 8330033, Chile
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Outcome of vestibular rehabilitation in vestibular migraine. J Neurol 2022; 269:6246-6253. [PMID: 35802200 DOI: 10.1007/s00415-022-11250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/01/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the effects of an individualized vestibular rehabilitation (VR) program on balance and gait performance and on self-perceived handicap in a group of vestibular migraine (VM) patients with associated anxiety. METHODS An 8-week prospective clinical trial of a VR program was conducted on 74 VM patients. The effects were evaluated with the modified Clinical Test of Sensory Integration in Balance (mCTSIB), the Dynamic Gait Index (DGI), and the Dizziness Handicap Inventory (DHI) before and after VR. The Panic Agoraphobic Spectrum Self-Report version (PAS-SR) was used to assess the patients' level of anxiety. RESULTS DGI and DHI parameters significantly improved after VR (p < 0.05). The fall rates of mCTSIB were significantly decreased on foam with eyes closed (chi-square: 4.934, p = 0.026), and on foam with head back and eyes closed (chi-square: 7.451, p = 0.006). Forty-three (58.1%) of 74 VM patients had panic-anxiety complaints in terms of PAS scores (a score of > 46 points indicates the presence of anxiety). Balance and gait performance as measured by DGI (p = 0.000), DHI (p = 0.000), and mCTSIB (p < 0.05) improved significantly after VR in both groups of VM patients: those with and without anxiety complaints (PAS scores > 46 points and < 46 points, respectively). CONCLUSION Even VM patients with anxiety complaints benefited from vestibular exercises, and their imbalance complaints and perceived levels of handicap/disability improved. Individual specific vestibular exercises created with a clinical decision-making process provide functional improvement through vestibular compensation mechanisms. VR should be included in the treatment programs of VM patients with either high or low anxiety levels to improve vestibular function.
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Kısabay Ak A, Çelebisoy N, Özdemir HN, Gökçay F, Saruhan Durmaz G, Top Kartı D, Ertaşoğlu Toydemir H, Yayla V, Çolpak Işıkay Aİ, Erkent İ, Özçelik P, Akdal G, Ataç C, Bıçakcı Ş, Ozaydın-Göksu E, Güleç Uyaroğlu F. Factors determining the response to treatment in patients with vestibular migraine. Neurol Res 2022; 44:847-854. [PMID: 35348034 DOI: 10.1080/01616412.2022.2056341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To find out clinical features associated with poor response to treatment in vestibular migraine (VM). METHODS VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. ≥ 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. RESULTS The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 ± 12.2 years (range: 17-74 years), were analyzed. CONCLUSION Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives.
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Affiliation(s)
| | | | | | - Figen Gökçay
- Department of Neurology, Ege University, Izmir, Turkey
| | | | - Dilek Top Kartı
- Department of Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Hülya Ertaşoğlu Toydemir
- Department of Neurology, University of Health Sciences Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Vildan Yayla
- Department of Neurology, University of Health Sciences Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | | | - İrem Erkent
- Department of Neurology, Hacettepe University, Ankara, Turkey
| | - Pınar Özçelik
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Gülden Akdal
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Ceyla Ataç
- Department of Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Şebnem Bıçakcı
- Department Of Neurology, Çukurova University, Adana, Turkey
| | - Eylem Ozaydın-Göksu
- Department of Neurology, University of Health Sciences Antalya Education and Research Hospital, Antalya, Turkey
| | - Feray Güleç Uyaroğlu
- Department of Neurology, University of Health Sciences Izmir Tepecik Education and Research Hospital, Izmir, Turkey
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Fu W, Wang Y, He F, Wei D, Bai Y, Han J, Wang X. Vestibular and oculomotor function in patients with vestibular migraine. Am J Otolaryngol 2021; 42:103152. [PMID: 34218215 DOI: 10.1016/j.amjoto.2021.103152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 01/03/2023]
Abstract
AIM The purpose of this study was to assess the vestibular and oculomotor function in patients with vestibular migraine (VM). And we also investigate the relationship between testing results and effectiveness of preventive medications in VM. MATERIAL AND METHOD 41 patients with VM were recruited in this study and examined with cervical and ocular vestibular evoked myogenic potential(cVEMP, oVEMP), video head impulse test(vHIT), caloric test and videonystagmography. All patients were treated with preventive medications. We calculated symptomatic improvement and record episodes frequency in patients with VM. Six months later, the effectiveness of preventive medications were evaluated and the relationship between vestibular testing and effectiveness of preventive medications were analyzed further. RESULTS In vestibular function testing, 73% of patients with VM showed abnormal results. Abnormal cVEMP, oVEMP, vHIT, and caloric test were found in 20%, 44%, 32% and 56% respectively. The abnormal rate of oVEMP was significantly higher than that of cVEMP(p < 0.05). And the proportion of abnormal caloric test was obviously higher than that of vHIT (p < 0.05). In oculomotor function testing, 42% of the patients with VM showed pathological results which was significantly lower than that of vestibular function testing(p < 0.05). After 6 months follow-up, the proportion of prophylactic medication effectiveness was significantly higher in normal vestibular function testing group compared with the abnormal group (p < 0.05). CONCLUSION Abnormal vestibular and oculomotor functions are commonly observed in patients with VM. And these patients with abnormal vestibular function possess a weak effectiveness of preventive medications.
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Cho IH, Kwon JW, Yeo SS. Relations between gait characteristics and subjective visual vertical results in young adults. J Vestib Res 2021; 30:73-79. [PMID: 32145005 DOI: 10.3233/ves-200694] [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: 12/17/2022]
Abstract
OBJECTIVE Subjective visual vertical (SVV) deviation can indicate impairments of motion perception and spatial orientation in individuals with vestibular disorders. This study investigated the influence of SVV on tandem gait ability by assessing differences between temporal, spatial, and kinematic characteristics in young adults. METHODS We recruited sixteen young adults with increased SVV and 17 age-matched control subjects. All subjects recruited for this study were with no history of neurological or musculoskeletal diseases. Knee and hip-joint kinematic data, spatio-temporal parameters, and gait variability were measured during tandem gait. RESULTS Stride time variability and stride velocity variability were significantly greater in the experimental group than the control group (p < 0.05). In addition, a significant correlation was observed between stride time variability and SVV results (r = 0.345, p < 0.05). However, hip and knee joint angles were non-significantly different in the experimental and control groups (p > 0.05) and spatio-temporal parameters were similar between the two groups (p > 0.05). CONCLUSION Stride time variability and stride velocity variability during tandem gait were significantly different in the experimental and control groups. We presume that increased SVV deviation is related to greater gait variability during tandem gait.
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Affiliation(s)
- In Hee Cho
- Department of Clinical Science, Graduate School of Health and Welfare, Dankook University, Republic of Korea
| | - Jung Won Kwon
- Department of Physical Therapy, College of Health Sciences, Dankook University, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Republic of Korea
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Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière's Disease and Vestibular Migraine. Otol Neurotol 2021; 41:828-835. [PMID: 32271263 DOI: 10.1097/mao.0000000000002636] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the usefulness of vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Menière's disease (MD) and vestibular migraine (VM). STUDY DESIGN Retrospective cohort. SETTING Multidisciplinary neurotology clinic. PATIENTS Definite MD and definite VM patients between January, 2015 and May, 2017, as well as healthy volunteers. INTERVENTIONS Cervical and ocular VEMP (cVEMP and oVEMP) testing. MAIN OUTCOME MEASURES VEMP response, amplitude, and latency. RESULTS Twenty five definite MD, 34 definite VM, and 13 control subjects were analyzed. MD affected ears had significantly lower cVEMP (p = 0.007) and oVEMP (p < 0.001) amplitudes than control ears. VM ears had significantly lower oVEMP (p = 0.001), but not cVEMP (p = 0.198) amplitudes than control ears. MD affected ears, but not VM ears, had significantly more absent cVEMP (25.9% versus 0%, p = 0.005) and oVEMP responses (40.7% versus 0%, p < 0.001) than control ears. oVEMP latency was significantly shorter for both MD affected (p < 0.001) and VM ears (p < 0.001) than control ears. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated using a neurotology clinic MD prevalence of 7.9% in dizzy patients. A present cVEMP or oVEMP both have more than 93% chance of ruling MD out in the tested ear, while a cVEMP amplitude more than 54.9 μV or oVEMP amplitude more than 5.1 μV both have more than 94% of ruling out MD in the tested ear. CONCLUSIONS Despite some overlap in VEMP results between MD and VM, when the diagnosis is uncertain between the two disorders due to symptomatic overlap and nonspecific audiometric data, VEMPs can be helpful in guiding treatment toward one disease entity or the other until more evidence points to a definitive diagnosis.
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Jang SH, Oh S, Yeo SS. Lateral Medullary Syndrome Following Injury of Lateral Vestibulospinal Tract: Diffusion Tensor Imaging Study. J Stroke Cerebrovasc Dis 2020; 29:105252. [PMID: 33066903 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Unilateral lesions of vestibular nucleus can cause lateral medullary syndrome. Little is known about injury of medial and lateral vestibulospinal tract (VST) after dorsolateral medullary infarct. We investigated injury of the lateral VST in patients with typical central vestibular disorder using diffusion tensor tractography (DTT). METHODS Seven patients with lateral medullary syndrome and ten control subjects were recruited. For the medial VST, we determined seed region of interest (ROI) as medial vestibular nuclei of pons and target ROI on posteromedial medulla. For the lateral VST, the seed ROI was placed on lateral vestibular nuclei of pons, and the target ROI on posterolateral medulla. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. RESULT Reconstructed lateral VST on both sides had significantly lower FA values in patients than controls (p<0.05). Tract volume of lateral VST in affected side was significantly lower than unaffected side and control group (p<0.05). However, no DTI parameters of the medial VST differed between patients and controls (p>0.05). CONCLUSION Injury of the lateral VST was demonstrated in patients with lateral vestibular syndrome following dorsolateral medullary infarct. Analysis of the lateral VST using DTT would be helpful in evaluation of patients with lateral medullary syndrome.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, South Korea
| | - Seunghue Oh
- Department of Physical Therapy, Graduate School, Dankook University, South Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, South Korea.
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Imbalance, motion sensitivity, anxiety and handicap in vestibular migraine and migraine only patients. Auris Nasus Larynx 2020; 47:747-751. [DOI: 10.1016/j.anl.2020.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/12/2020] [Accepted: 02/26/2020] [Indexed: 11/19/2022]
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Jang SH, Park GY, Cho IH, Yeo SS. Injury of the lateral vestibulospinal tract in a patient with the lateral medullary syndrome: Case report. Medicine (Baltimore) 2020; 99:e22117. [PMID: 32925758 PMCID: PMC7489691 DOI: 10.1097/md.0000000000022117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Lateral medullary syndrome is a central vestibular disorder characterized by vertigo and ataxia. We report on a patient with injury of the lateral vestibulospinal tract (VST) following lateral medullary syndrome, detected on diffusion tensor tractography (DTT). PATIENT CONCERNS A 56-year-old male patient was diagnosed with lateral medullary syndrome due to an infarction in the posterior inferior cerebellar artery area. DIAGNOSES Two weeks following the infarction, he was transferred to the rehabilitation department of the same university hospital with severe vertigo, ataxia (Berg balance scale: 16 point), and dysphasia. In contrast, he maintained good motor power and cognitive function (Mini-mental state test: 26 points). INTERVENTIONS N/A OUTCOMES:: Both the patient's medial VSTs and left lateral VST were well-reconstructed. In contrast, the right lateral VST was not reconstructed. On DTT parameters of the VST, the patient's medial VSTs and left lateral VST did not differ significantly from the control subjects. LESSONS An injury of the right lateral VST was demonstrated in a patient with lateral medullary syndrome. We believe that the result will be helpful in clinical management and research for patients with lateral medullary syndrome.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Gyeongsangbuk-do, South Korea
| | | | - In Hee Cho
- Department of Physical Therapy, College of Health Sciences, Dankook University, Chungnam, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Chungnam, Republic of Korea
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Dornhoffer JR, Liu YF, Donaldson L, Rizk HG. Factors implicated in response to treatment/prognosis of vestibular migraine. Eur Arch Otorhinolaryngol 2020; 278:57-66. [DOI: 10.1007/s00405-020-06061-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
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Management of Ménière's Disease: How Does the Coexistence of Vestibular Migraine Affect Outcomes? Otol Neurotol 2020; 40:666-673. [PMID: 31083096 DOI: 10.1097/mao.0000000000002176] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report the incidence of vestibular migraine (VM) in patients with Ménière's disease (MD) and investigate whether management outcomes of MD differ by the association of VM. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic center. PATIENTS MD patients (n = 251) with/without VM who were managed for 5 years in a dizziness clinic. MAIN OUTCOME MEASURES Influence of VM on management outcomes and hearing at the latest follow-up in stepwise management options. RESULTS Incidence of VM was 35% in MD patients. VM was more common in women than men (40 vs. 22%) and in probable MD than definite MD (43 vs. 29%). Bilateral MD was more frequent with coexistence of VM than without VM in definite MD (14 vs. 0%) as well as probable MD (24 vs. 7%). At the latest follow-up, preventive medications were effective in controlling vertigo in most (80%) patients (74%/90% in definite/probable MD). Additional intratympanic steroids were required in 16% (20%/10% in definite/probable MD) and intratympanic gentamicin or surgeries in 9 (6%) patients with intractable MD. The percentage of intractable MD did not differ with coexistence of VM, though definite MD showed a significantly higher percentage of intractable MD than probable MD (6 vs. 0%, respectively, p = 0.002). Worsening hearing was more frequent in definite MD than probable MD (19 vs. 4%), and association of VM did not influence the incidence of worsening hearing. CONCLUSIONS Coexistence of VM was about 30 to 40% in definite and probable MD, especially frequent in bilateral MD (77%) and women with probable MD (50%), requiring identification of coexisting VM while managing MD patients. Management outcomes and worsening hearing in MD patients are not dependent on the coexistence of VM, when both are managed.
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Jang SH, Kwon JW, Yeo SS. Three Dimensional Identification of Medial and Lateral Vestibulospinal Tract in the Human Brain: A Diffusion Tensor Imaging Study. Front Hum Neurosci 2018; 12:229. [PMID: 29922138 PMCID: PMC5996120 DOI: 10.3389/fnhum.2018.00229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: The vestibulospinal tract (VST) is involved in balance control and gait function. No research has identified the VST in the human brain. In the current study, we attempted to identify the medial and lateral VST in the human brain, using diffusion tensor tractography (DTT). Materials and Methods: We recruited 40 healthy volunteers for this study. For reconstruction of the medial VST, a seed region of interest (ROI) was placed on the medial vestibular nuclei in the pons and target ROI on the posteromedial medulla. For reconstruction of the lateral VST, a seed ROI was placed on the lateral vestibular nuclei of pons and the target ROI on the posterolateral medulla. Values of fractional anisotropy (FA), mean diffusivity (MD), and tract volume of the medial and lateral VST were measured. Results: The medial VST, which originates from the medial vestibular nuclei, descends through the posteromedial medulla, and terminates at the anterior funiculus of the cervical spinal cord. The lateral VST originates from the lateral vestibular nuclei, and terminates in the anterior portion of lateral funiculus, through the posterolateral medulla. The FA value of medial VST was significantly higher than that of lateral VST. In contrast, the MD value and tract volume were significantly lower than those of lateral VST (p < 0.05). Conclusion: We identified the medial and lateral VST in the human brain using DTT and investigated the anatomical characteristics of the medial and lateral VST. The methodology and results of this study could be helpful to both clinicians and researchers in the neuroscience field.
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Affiliation(s)
- Sung H Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Jung W Kwon
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan, South Korea
| | - Sang S Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan, South Korea
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Balci B, Şenyuva N, Akdal G. Definition of Balance and Cognition Related to Disability Levels in Vestibular Migraine Patients. NORO PSIKIYATRI ARSIVI 2018; 55:9-14. [PMID: 30042635 DOI: 10.29399/npa.12617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
Abstract
Objective To compare the balance and cognition of vestibular migraine (VM) patients with migraineurs without vertigo history and healthy subjects, and to examine the effects of disability level on these functions. Material-method The study consisted of 32 VM patients, 32 migraineurs and 31 healthy subjects with similar sex and age. Balance functions were assessed with Balance Evaluation Systems Test (BEST), dizziness and headache severity with Visual Analogue Scale (VAS), disability related to dizziness with Dizziness Handicap Inventory (DHI), cognition with Stroop test. Results There was no statistical significant difference among the three groups in terms of age, gender, height, weight, marital status and education levels (p>0.05). Headache severity was higher in migraineurs than vestibular migraineurs and healthy subjects, also dizziness severity was higher in vestibular migraineurs than migraineurs and healthy subjects (p<0.0167). The outcomes of BEST 4, 5, 6 and BEST-total were significantly impaired in VM patients than migraineurs and healthy subjects, and worse in migraineurs rather than healthy subjects (p<0.0167). Stroop effect of cognitive examination was worse in VM and migraine patients rather than healthy subjects (p<0.0167). There was no significantly difference between VM and migraineurs (p>0.0167). There was a negative correlation between Stroop effect and BEST-total in VM patients significantly (r=-0.509, p=0.003), and no significant correlation in migraineurs (p>0.05). Disability levels of VM patients were low in 38.7%, mild in 51.6% and severe in 9.7% related to DHI. There was no significant difference between balance and cognition function in terms of disability levels (p>0.05). Conclusion The balance and cognition in VM patients and migraineurs were impaired rather than healthy subjects. The patient groups differed from each other in terms of vertiginous complaints rather than cognition. Solving the functional limitations with further longitudinal examinations can facilitate the treatment. The appropriate physiotherapy programs and patient education methods can be planned for these various issues.
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Affiliation(s)
- Birgül Balci
- Dokuz Eylül University, School of Physical Therapy and Rehabilitation, İzmir, Turkey
| | - Naziye Şenyuva
- Department of Physical Therapy, Gümüşsuyu Military Hospital, İstanbul, Turkey
| | - Gülden Akdal
- Department of Neurology, Dokuz Eylül University Medical Faculty, İzmir, Turkey
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Efficacy of steroid therapy based on symptomatic and functional improvement in patients with vestibular neuritis: a prospective randomized controlled trial. Eur Arch Otorhinolaryngol 2017; 274:2443-2451. [PMID: 28391531 DOI: 10.1007/s00405-017-4556-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to examine the efficacy of methylprednisolone in vestibular neuritis (VN) by objective and subjective measures. This prospective controlled randomized study was conducted at one tertiary hospital. Twenty-nine VN patients were randomized to either the steroid (n = 15) or the control (n = 14) group. The steroid group received methylprednisolone for 2 weeks, whereas control patients did not; both groups underwent regular vestibular exercises and were prescribed a Ginkgo biloba. Vestibular function tests including caloric test, video head impulse test (vHIT), and sensory organization test (SOT) were performed, and dizziness handicap index (DHI) was determined at enrollment; all tests were repeated at 1 and 6 months after enrollment. Both groups showed statistically significant improvements in caloric weakness and vHIT gain at 1- and 6-month follow-up evaluations compared to the initial examination; however, differences were not significant. The rates of normalization of canal paresis at 1 and 6 months were 50 and 64% in the control group and 33 and 60% in the steroid group, respectively, with no differences between the two groups. The rates of vHIT normalization at 1 and 6 months after treatment were 57 and 78% in the control group and 53 and 87% in the steroid group, respectively, with no differences between the two groups. Finally, there were no significant differences in the improvement of composite scores of SOT and the DHI scores between the two groups. In this prospective RCT, methylprednisolone had no additional benefit in patients with VN who underwent vestibular exercises and received a Ginkgo biloba. TRIAL REGISTRATION Clinicaltrials.gov Identifier, NCT02098330; Trial title, The Efficacy of Steroid Therapy in Vestibular Neuritis.
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Eliciting Cervical Vestibular-Evoked Myogenic Potentials by Bone-Conducted Vibration via Various Tapping Sites. Ear Hear 2016; 37:235-42. [PMID: 26465344 DOI: 10.1097/aud.0000000000000231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study compared bone-conducted vibration (BCV) cervical vestibular-evoked myogenic potentials (cVEMPs) via tapping at various skull sites in healthy subjects and patients with vestibular migraine (VM) to optimize stimulation conditions. DESIGN Twenty healthy subjects underwent a series of cVEMP tests by BCV tapping via a minishaker at the Fz (forehead), Cz (vertex), and inion (occiput) sites in a randomized order of tapping sites. Another 20 VM patients were also enrolled in this study for comparison. RESULTS All 20 healthy subjects had clear BCV cVEMPs when tapping at the inion (100%) or Cz (100%), but not at the Fz (75%). Mean p13 and n23 latencies from the Cz tapping were significantly longer than those from the Fz tapping, but not longer than those from the inion tapping. Unlike healthy subjects, tapping at the Cz (95%) elicited a significantly higher response rate of present cVEMPs than tapping at the inion (78%) in 20 VM patients (40 ears), because seven of nine VM ears with absent cVEMPs by inion tapping turned out to be present cVEMPs by Cz tapping. CONCLUSIONS While both inion and Cz tapping elicited 100% response rate of cVEMPs for healthy individuals, Cz tapping had a higher response rate of cVEMPs than inion tapping for the VM group. In cases of total loss of saccular function, cVEMPs could not be activated by either inion or Cz tapping. However, if residual saccular function remains, Cz tapping may activate saccular afferents more efficiently than inion tapping.
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Kang WS, Lee SH, Yang CJ, Ahn JH, Chung JW, Park HJ. Vestibular Function Tests for Vestibular Migraine: Clinical Implication of Video Head Impulse and Caloric Tests. Front Neurol 2016; 7:166. [PMID: 27746761 PMCID: PMC5044462 DOI: 10.3389/fneur.2016.00166] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/16/2016] [Indexed: 01/22/2023] Open
Abstract
Vestibular migraine (VM) is one of the most common causes of episodic vertigo. We reviewed the results of multiple vestibular function tests in a cohort of VM patients who were diagnosed with VM according to the diagnostic criteria of the Barany Society and the International Headache Society and assessed the efficacy of each for predicting the prognosis in VM patients. A retrospective chart analysis was performed on 81 VM patients at a tertiary care center from June 2014 to July 2015. Patients were assessed by the video head impulse test (vHIT), caloric test, vestibular-evoked myogenic potentials (VEMPs), and sensory organization test (SOT) at the initial visit and then evaluated for symptomatic improvement after 6 months. Complete response (CR) was defined as no need for continued medication, partial response (PR) as improved symptoms but need for continued medication, and no response (NR) as no symptomatic improvement and requiring increased dosage or change in medications. At the initial evaluation, 9 of 81 patients (11%) exhibited abnormal vHIT results, 14 of 73 (19%) exhibited abnormal caloric test results, 25 of 65 (38%) exhibited abnormal SOT results, 8 of 75 (11%) exhibited abnormal cervical VEMP results, and 20 of 75 (27%) exhibited abnormal ocular VEMP results. Six months later, 63 of 81 patients (78%) no longer required medication (CR), while 18 (22%) still required medication, including 7 PR and 11 NR patients. Abnormal vHIT gain and abnormal caloric results were significantly related to the necessity for continued medication at 6-month follow-up (OR = 5.67 and 4.36, respectively). Abnormal vHIT and caloric test results revealed semicircular canal dysfunction in VM patients and predicted prolonged preventive medication requirement. These results suggest that peripheral vestibular abnormalities are closely related to the development of vertigo in VM patients.
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Affiliation(s)
- Woo Seok Kang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Sang Hun Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Chan Joo Yang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Joong Ho Ahn
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Jong Woo Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Hong Ju Park
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
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