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Gandolfi M, Geroin C, Imbalzano G, Camozzi S, Menaspà Z, Tinazzi M, Alberto Artusi C. Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions. Clin Park Relat Disord 2024; 10:100240. [PMID: 38596537 PMCID: PMC11002662 DOI: 10.1016/j.prdoa.2024.100240] [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: 07/03/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson's disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients' disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, Italy
| | - Christian Geroin
- Department of Surgery, Dentistry, Paediatric and Gynaecology, University of Verona, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Serena Camozzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
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The effect of galvanic vestibular stimulation on postural balance in Parkinson's disease: A systematic review and meta-analysis. J Neurol Sci 2022; 442:120414. [PMID: 36116217 DOI: 10.1016/j.jns.2022.120414] [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] [Received: 03/24/2022] [Revised: 08/08/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
Abstract
People with Parkinson's disease (PD) develop postural imbalance and falls. Galvanic Vestibular Stimulation (GVS) may potentially improve postural balance in humans and hence reduce falls in PD. This systematic review and meta-analysis investigate the effects of GVS on postural balance in PD. Six separate databases and research registers were searched for cross-over design trials that evaluated the effects of GVS on postural balance in PD. We used standardized mean difference (Hedges' g) as a measure of effect size in all studies. We screened 223 studies, evaluated 14, of which five qualified for the meta-analysis. Among n = 40 patients in five studies (range n = 5 to 13), using a fixed effects model we found an effect size estimate of g = 0.43 (p < 0.001, 95% CI [0.29,0.57]). However, the test for residual heterogeneity was significant (p < 0.001), thus we used a random effects model and found a pooled effect size estimate of 0.62 (p > 0.05, 95% CI [- 0.17, 1.41], I2 = 96.21%). Egger's test was not significant and thus trim and funnel plot indicated no bias. To reduce heterogeneity, we performed sensitivity analysis and by removing one outlier study (n = 7 patients), we found an effect size estimate of 0.16 (p < 0.05, 95% CI [0.01, 0.31], I2 = 0%). Our meta-analysis found GVS has a favourable effect on postural balance in PD patients, but due to limited literature and inconsistent methodologies, this favourable effect must be interpreted with caution.
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Pires APBDÁ, Silva TR, Torres MS, Diniz ML, Tavares MC, Gonçalves DU. Galvanic vestibular stimulation and its applications: a systematic review. Braz J Otorhinolaryngol 2022; 88 Suppl 3:S202-S211. [DOI: 10.1016/j.bjorl.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 11/02/2022] Open
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Kataoka H, Okada Y, Kiriyama T, Kita Y, Nakamura J, Shomoto K, Sugie K. Effect of galvanic vestibular stimulation on axial symptoms in Parkinson’s disease. J Cent Nerv Syst Dis 2022; 14:11795735221081599. [PMID: 35237093 PMCID: PMC8883401 DOI: 10.1177/11795735221081599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/28/2022] [Indexed: 11/15/2022] Open
Abstract
Postural imbalance, abnormal axial posture, and axial rigidity are the characteristic features of Parkinson’s disease (PD), and they are referred to as axial symptoms. The symptoms are difficult to manage since they are often resistant to both L-DOPA and deep brain stimulation. Hence, other treatments that can improve Parkinsonian axial symptoms without adverse effects are required. Vestibular dysfunction occurs in PD since neuropathological changes and reflex abnormalities are involved in the vestibular nucleus complex. Galvanic vestibular stimulation (GVS), which activates the vestibular system, is a noninvasive method. This review aimed to assess the clinical effect of GVS on axial symptoms in PD. To date, studies on the effects of GVS on postural instability, anterior bending posture, lateral bending posture, and trunk rigidity and akinesia in PD had yielded interesting data, and none of the patients presented with severe adverse events, and the others had mild reactions. GVS indicated a possible novel therapy. However, most included a small number of patients, and the sample sizes were not similar in some studies that included controls. In addition, there was only one randomized controlled clinical trial, and it did not perform an objective evaluation of axial symptoms. In this type of research, vestibular contributions to balance should be distinguished from others such as proprioceptive inputs or nonmotor symptoms of PD.
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Affiliation(s)
- Hiroshi Kataoka
- The Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yohei Okada
- Graduate School of Health Science, Kio University, Kashiba, Nara, Japan
| | - Takao Kiriyama
- The Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yorihiro Kita
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Junji Nakamura
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Koji Shomoto
- Graduate School of Health Science, Kio University, Kashiba, Nara, Japan
| | - Kazuma Sugie
- The Department of Neurology, Nara Medical University, Kashihara, Japan
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Duncan SJ, Kamyla M, Ferguson HJ, Wilkinson DT. Extraction of the GVS electrical artifact from EEG recordings of the motor related cortical potential. J Neurosci Methods 2021; 368:109459. [PMID: 34954254 DOI: 10.1016/j.jneumeth.2021.109459] [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: 07/27/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Galvanic vestibular stimulation (GVS) involves the administration of low-amplitude trans-mastoidal current which induces a dense electrical field across the scalp that is difficult to remove from the EEG record. In two proof-of-concept experiments, we designed a paradigm to evaluate functional limb movement, and tested a method of blind source separation to remove the scalp artifact induced by low-amplitude, alternating current GVS to allow measurement of the motor-related cortical response (MRCP) during voluntary movement. NEW METHOD Off-line Extended Infomax Independent Component Analysis (ICA) was applied to the concatenated dataset to identify and remove core characteristics of the artifact induced by a trans-mastoidal current (Experiment 1: 0.01Hz, 0.2-3mA; Experiment 2: 0.01Hz, 0.3-0.4mA) during finger (Experiments 1 and 2) and foot tapping (Experiment 2). RESULTS In Experiment 1, a GVS-related independent component was identified and successfully removed without compromising measurement of the MRCP. This success was replicated in Experiment 2 which included both finger and foot tapping, and a higher GVS amplitude, which resulted in the identification of additional GVS-related artifacts. COMPARISON WITH EXISTING METHODS Existing methods of artifact rejection typically use an offline bandpass filter that overlaps with the frequency range of the MRCP. Even when similar ICA-based approaches have been employed, they have been applied during rest rather than active movement, have not been described in sufficient detail to enable replication, and require significant expertise and bespoke software to implement. CONCLUSION The ICA-based approach described here provides a relatively simple and accessible means by which MRCPs can be measured during alternating current GVS. This provides opportunity to identify new biomarkers associated with the therapeutic effects of GVS in people with Parkinson's disease and other disorders of voluntary movement.
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Affiliation(s)
- Shelley J Duncan
- Faculty of Sport, Health and Social Sciences, Solent University, Southampton, SO14 OYN, UK.
| | - Marques Kamyla
- School of Psychology, University of Kent, Canterbury, UK
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Nakamura J, Okada Y, Shiozaki T, Tanaka H, Ueta K, Ikuno K, Morioka S, Shomoto K. Reliability and laterality of the soleus H-reflex following galvanic vestibular stimulation in healthy individuals. Neurosci Lett 2021; 755:135910. [PMID: 33910060 DOI: 10.1016/j.neulet.2021.135910] [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: 07/20/2020] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
The vestibulospinal tract (VST) plays an important role in the control of the ipsilateral antigravity muscles, and the balance of left and right VST excitability is important in human postural control. A method for measuring VST excitability is the application of galvanic vestibular stimulation (GVS) before tibial nerve stimulation that evokes the soleus H-reflex; the change rate of the H-reflex amplitude is then evaluated. Assessments of VST excitability and the left and right balance could be useful when determining the pathology for interventions in postural control impairments. However, the reliability and laterality of this assessment have not been clarified, nor has its relationship to postural control. We investigated the reliability, laterality and standing postural control in relation to the degree of facilitation of the H-reflex following GVS in 15 healthy adults. The assessments were performed in two sessions, one each for the left- and right-sides, in random order. The inter-session reliability of the short-interval assessments of an increase in the H-reflex following GVS on both sides were sufficient. The degree of H-reflex facilitation by GVS showed no significant difference between the left- and right-sides in any session. There was a moderate positive correlation between the mediolateral position of the center of pressure in the eyes-closed standing on foam condition and the left/right ratio of the degree of increased H-reflex in the first-session. We concluded that this method for evaluating the increase in the soleus H-reflex following GVS has high inter-session reliability in the short-interval that did not differ between sides.
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Affiliation(s)
- Junji Nakamura
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan; Graduate School of Health Sciences, Kio University, Nara, Japan.
| | - Yohei Okada
- Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Tomoyuki Shiozaki
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Nara, Japan
| | - Hiroaki Tanaka
- Department of Rehabilitation Medicine, Baba Memorial Hospital, Osaka, Japan
| | - Kozo Ueta
- Neurorehabilitation Research Center of Kio University, Nara, Japan; Department of Rehabilitation Medicine, Hoshigaoka Medical Center, Osaka, Japan
| | - Koki Ikuno
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan; Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Shu Morioka
- Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Koji Shomoto
- Graduate School of Health Sciences, Kio University, Nara, Japan
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Lee S, Liu A, McKeown MJ. Current perspectives on galvanic vestibular stimulation in the treatment of Parkinson's disease. Expert Rev Neurother 2021; 21:405-418. [PMID: 33621149 DOI: 10.1080/14737175.2021.1894928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Galvanic vestibular stimulation (GVS) is a noninvasive technique that activates vestibular afferents, influencing activity and oscillations in a broad network of brain regions. Several studies have suggested beneficial effects of GVS on motor symptoms in Parkinson's Disease (PD).Areas covered: A comprehensive overview of the stimulation techniques, potential mechanisms of action, challenges, and future research directions.Expert opinion: This emerging technology is not currently a viable therapy. However, a complementary therapy that is inexpensive, easily disseminated, customizable, and portable is sufficiently enticing that continued research and development is warranted. Future work utilizing biomedical engineering approaches, including concomitant functional neuroimaging, have the potential to significantly increase efficacy. GVS could be explored for other PD symptoms including orthostatic hypotension, dyskinesia, and sleep disorders.
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Affiliation(s)
- Soojin Lee
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada.,Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford UK
| | - Aiping Liu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Martin J McKeown
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
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Jagadeesan T, Rajagopal A, Sivanesan S. Vestibular stimulation: a noninvasive brain stimulation in Parkinson's disease & its implications. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 18:657-665. [PMID: 33544521 DOI: 10.1515/jcim-2020-0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/13/2020] [Indexed: 11/15/2022]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease, and it is characterized by both motor and neuropsychiatric problems. Effective treatment of PD requires a combination of pharmacotherapy and physiotherapy; however, existing treatment generally involves one medical discipline most probably interpretation by neurologist. This pharmacotherapy relay on dopaminergic medications which is not capable of bringing sufficient alleviation of all motor symptoms in PD. Implementing positive lifestyle activities can support patients to improve the quality of life, symptoms, and possibly slow down the disease progression. In far effective management of PD, clinics are trying to execute and promote the use of additional integrative approaches of care among PD patients. Notably, vestibular stimulation like noisy galvanic vestibular stimulation (nGVS) is being studied as a potential treatment for PD, and a number of studies have presented scientific evidence in support of this concept. In this review paper, we highlight the importance of vestibular stimulation in both human and animal studies as one of the promising interventional approaches for PD. All the existing studies are heterogeneous in study design, so further studies have to be conducted which meets the standards of randomized control trial with proper sample size to validate the findings of vestibular stimulation.
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Affiliation(s)
- Thanalakshmi Jagadeesan
- Department of Physiology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
| | - Archana Rajagopal
- Department of Physiology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
| | - Senthilkumar Sivanesan
- Department of Research and Development, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
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Therapeutic interventions for Pisa syndrome in idiopathic Parkinson's disease. A Scoping Systematic Review. Clin Neurol Neurosurg 2020; 198:106242. [DOI: 10.1016/j.clineuro.2020.106242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022]
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Abstract
We describe a model of neurological disease based on dysfunctional brain oscillators. This is not a new model, but it is not one that is widely appreciated by clinicians. The value of this model lies in the predictions it makes and the utility it provides in translational applications, in particular for neuromodulation devices. Specifically, we provide a perspective on devices that provide input to sensory receptors and thus stimulate endogenous sensory networks. Current forms of clinically applied neuromodulation, including devices such as (implanted) deep brain stimulators (DBS) and various, noninvasive methods such as transcranial magnetic stimulation (TMS) and transcranial current methods (tACS, tDCS), have been studied extensively. The potential strength of neuromodulation of a sensory organ is access to the same pathways that natural environmental stimuli use and, importantly, the modulatory signal will be transformed as it travels through the brain, allowing the modulation input to be consistent with regional neuronal dynamics. We present specific examples of devices that rely on sensory neuromodulation and evaluate the translational potential of these approaches. We argue that sensory neuromodulation is well suited to, ideally, repair dysfunctional brain oscillators, thus providing a broad therapeutic approach for neurological diseases.
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Caloric vestibular stimulation for the management of motor and non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2019; 65:261-266. [DOI: 10.1016/j.parkreldis.2019.05.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/19/2022]
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Kataoka H, Sugie K. Recent advancements in lateral trunk flexion in Parkinson disease. Neurol Clin Pract 2019; 9:74-82. [PMID: 30859010 DOI: 10.1212/cpj.0000000000000574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/13/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Understanding the pathophysiologic underpinnings of lateral trunk flexion (LTF) in Parkinson disease (PD) has been growing. Adjusting antiparkinsonian medications, botulinum toxin, or surgical intervention has been found efficacious in some patients. Nevertheless, these treatments remain limited, often resulting in inadequate outcomes. We review patients with LTF with PD, including recent advancements in treatment and neuroimaging examination. Recent findings The basal ganglia system is a major contributing factor to LTF, and the therapeutic intervention also targets the basal ganglia system, including dystonic contraction. The perceptions of the postural verticality or spatial cognition of the correct body orientation promote the severity of LTF or result in a chronic condition with irreversible structural deformities. Conclusion The combination of pharmacologic interventions with nonpharmacologic interventions, such as rehabilitation, might be needed to manage LTF, and the initiation of these treatments should be started as early as possible.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
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Abstract
For decades it has been speculated that Parkinson's Disease (PD) is associated with dysfunction of the vestibular system, especially given that postural instability is one of the major symptoms of the disorder. Nonetheless, clear evidence of such a connection has been slow to emerge. There are still relatively few studies of the vestibulo-ocular reflexes (VORs) in PD. However, substantial evidence of vestibulo-spinal reflex deficits, in the form of abnormal vestibular-evoked myogenic potentials (VEMPs), now exists. The evidence for abnormalities in the subjective visual vertical is less consistent. However, some studies suggest that the integration of visual and vestibular information may be abnormal in PD. In the last few years, a number of studies have been published which demonstrate that the neuropathology associated with PD, such as Lewy bodies, is present in the central vestibular system. Increasingly, stochastic or noisy galvanic vestibular stimulation (nGVS) is being investigated as a potential treatment for PD, and a number of studies have presented evidence in support of this idea. The aim of this review is to summarize and critically evaluate the human and animal evidence relating to the connection between the vestibular system and PD.
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Affiliation(s)
- Paul F Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences and The Brain Health Research Centre, University of Otago, Dunedin, New Zealand.,Brain Research New Zealand Centre of Research Excellence, Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
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Cronin T, Arshad Q, Seemungal BM. Vestibular Deficits in Neurodegenerative Disorders: Balance, Dizziness, and Spatial Disorientation. Front Neurol 2017; 8:538. [PMID: 29123498 PMCID: PMC5662638 DOI: 10.3389/fneur.2017.00538] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/26/2017] [Indexed: 12/13/2022] Open
Abstract
The vestibular system consists of the peripheral vestibular organs in the inner ear and the associated extensive central nervous system projections—from the cerebellum and brainstem to the thalamic relays to cortical projections. This system is important for spatial orientation and balance, both of critical ecological importance, particularly for successful navigation in our environment. Balance disorders and spatial disorientation are common presenting features of neurodegenerative diseases; however, little is known regarding central vestibular processing in these diseases. A ubiquitous aspect of central vestibular processing is its promiscuity given that vestibular signals are commonly found in combination with other sensory signals. This review discusses how impaired central processing of vestibular signals—typically in combination with other sensory and motor systems—may account for the impaired balance and spatial disorientation in common neurodegenerative conditions. Such an understanding may provide for new diagnostic tests, potentially useful in detecting early disease while a mechanistic understanding of imbalance and spatial disorientation in these patients may enable a vestibular-targeted therapy for such problems in neurodegenerative diseases. Studies with state of the art central vestibular testing are now much needed to tackle this important topic.
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Affiliation(s)
- Thomas Cronin
- Division of Brain Sciences, Department of Medicine, Charing Cross Hospital, London, United Kingdom
| | - Qadeer Arshad
- Division of Brain Sciences, Department of Medicine, Charing Cross Hospital, London, United Kingdom
| | - Barry M Seemungal
- Division of Brain Sciences, Department of Medicine, Charing Cross Hospital, London, United Kingdom
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Kataoka H, Okada Y, Kiriyama T, Kita Y, Nakamura J, Morioka S, Shomoto K, Ueno S. Can Postural Instability Respond to Galvanic Vestibular Stimulation in Patients with Parkinson's Disease? J Mov Disord 2015; 9:40-3. [PMID: 26648182 PMCID: PMC4734983 DOI: 10.14802/jmd.15030] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/05/2015] [Accepted: 09/25/2015] [Indexed: 11/24/2022] Open
Abstract
Objective Galvanic vestibular stimulation (GVS) activates the vestibular afferents, and these changes in vestibular input exert a strong influence on the subject’s posture or standing balance. In patients with Parkinson’s disease (PD), vestibular dysfunction might contribute to postural instability and gait disorders. Methods Current intensity was increased to 0.7 mA, and the current was applied to the patients for 20 minutes. To perform a sham stimulation, the current intensity was increased as described and then decreased to 0 mA over the course of 10 seconds. The patient’s status was recorded continuously for 20 minutes with the patient in the supine position. Results Three out of 5 patients diagnosed with PD with postural instability and/or abnormal axial posture showed a reduction in postural instability after GVS. The score for item 12 of the revised Unified Parkinson’s Disease Rating Scale part 3 was decreased in these patients. Conclusions The mechanism of postural instability is complex and not completely understood. In 2 out of the 5 patients, postural instability was not changed in response to GVS. Nonetheless, the GVS-induced change in postural instability for 3 patients in our study suggests that GVS might be a therapeutic option for postural instability.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Nara, Japan
| | - Yohei Okada
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Takao Kiriyama
- Department of Neurology, Nara Medical University, Nara, Japan
| | - Yorihiro Kita
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Junji Nakamura
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Shu Morioka
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Koji Shomoto
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Satoshi Ueno
- Department of Neurology, Nara Medical University, Nara, Japan
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