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Chen Z, Cai Y, Liu Y, Liu H, Wei XE, Lin C, Liu D, Xiao L, Rong L. Altered thalamus functional connectivity in patients with acute unilateral vestibulopathy: a resting-state fMRI study. Front Neurosci 2024; 18:1388213. [PMID: 39010942 PMCID: PMC11246849 DOI: 10.3389/fnins.2024.1388213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/31/2024] [Indexed: 07/17/2024] Open
Abstract
Objective Acute unilateral vestibulopathy (AUVP) is the second leading cause of peripheral vestibular vertigo. Full recovery of AUVP is related to sufficient central vestibular compensation. It has been confirmed that the vestibular nucleus and vestibular cortex are involved in the process of vestibular compensatory in AUVP patients. However, few studies have focused on the functional compensation of thalamus in patients with AUVP. This study aimed to explore the alterations of resting-state functional connectivity (FC) focused on thalamus using functional magnetic resonance imaging (fMRI) in AUVP patients. Methods Data of 3D-T1 and resting-state fMRI were collected from 40 AUVP patients and 35 healthy controls (HC). Seeds-based (bilateral thalamus) FC was analyzed to investigate the changes in FC between the two groups. Furthermore, we evaluated the associations between altered thalamus FC and clinical features in AUVP patients using Pearson's partial correlation. Results Compared with HC, AUVP patients showed decreased FC between bilateral thalamus and left insula. We also observed decreased FC between right thalamus and left supramarginal gyrus. Additionally, we found increased FC between left thalamus and right postcentral gyrus (PCG), as well as increased FC between right thalamus and regions of bilateral PCG, right middle frontal gyrus and right middle occipital gyrus in AUVP patients. Furthermore, the FC between left thalamus and left insula was negatively correlated with values of canal paresis in patients with AUVP (p = 0.010, r = -0.434). Conclusion Our results provided first evidence for the decreased thalamo-vestibular cortex pathway, as well as increased thalamo-somatosensory and thalamo-visual cortex pathway in AUVP patients. These findings help us better understand the underlying mechanisms of central dynamic compensatory following an acute unilateral peripheral vestibular damage.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yaxian Cai
- Department of Neurology, General Hospital of the Yangtze River Shipping, Wuhan, Hubei, China
| | - Yueji Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiu-e Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Cunxin Lin
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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Aksoy S, Cekic S. The Relationship Between Vertigo/Dizziness and Somatoform Complaints: A Systematic Review. Indian J Otolaryngol Head Neck Surg 2024; 76:1434-1446. [PMID: 38440433 PMCID: PMC10908773 DOI: 10.1007/s12070-023-04233-y] [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: 07/17/2023] [Accepted: 09/11/2023] [Indexed: 03/06/2024] Open
Abstract
To systematically synthesize published literature on somatoform complaints as psychological factors in vertigo/dizziness to determine the characteristics of comorbidities, relationships and causality. Following PRISMA guidelines, systematic searches of PubMed, WOS, and Cochrane Library databases and manual follow-up reference searches were performed for articles published in English up to 2021. All original research studies and retrospective or prospective studies focusing on the relationship between vertigo/dizziness and somatoform complaints/somatization were systematically retrieved. Studies that did not include data on the association between somatoform complaints/somatization and vertigo/dizziness were excluded, as were reviews, comments, case reports, editorials, letters, and practice guidelines. Extracted data included research type, number of participants, assessment tools for vertigo/dizziness and somatoform complaints/somatization, statistical methods, and the main results. The quality of included studies was evaluated. Records identified through database searching n = 1238. After removing duplicates and unrelated articles based on abstract and title search, 155 articles recorded as relevant. Except for the 5 articles, title and abstract of all records screened and 88 of them excluded. Critically evaluating those full texts, 28 studies included. The present study highlights the relationship between the vertigo/dizziness and somatoform complaints/somatization. It is determined that somatoform complaints of the individuals suffering from vertigo/dizziness is highly prevelant and some other factor such as personality characteristics or accompanying psychopathology have affect on the prevelance. The main results of all reviewed studies emphasize the requirement for assessment and intervention of vertigo/dizziness, in collaboration with the department of psychiatry. PROSPERO REGISTRATION: PROSPERO: CRD42020222273.
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Affiliation(s)
- Songul Aksoy
- Faculty of Health Sciences, Audiology Department, Lokman Hekim University, Ankara, Turkey
| | - Sule Cekic
- Faculty of Health Sciences, Audiology Department, Ankara Yildirim Beyazit University, Ankara, Turkey
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Padovan L, Becker-Bense S, Flanagin VL, Strobl R, Limburg K, Lahmann C, Decker J, Dieterich M. Anxiety and physical impairment in patients with central vestibular disorders. J Neurol 2023; 270:5589-5599. [PMID: 37550497 PMCID: PMC10576724 DOI: 10.1007/s00415-023-11871-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND There is increasing evidence for close interrelations between vestibular and emotional brain networks. A study in patients with bilateral peripheral vestibulopathy (BVP) showed relatively low vertigo-related anxiety (VRA), despite high physical impairment. The current working hypothesis proposes the integrity of the peripheral vestibular system as a prerequisite for development of VRA. Here we contribute by evaluating VRA and vestibular-related handicap in central vestibular disorders. METHODS Of 6396 patients presenting in a tertiary vertigo centre, 306 were identified with four clear central vestibular disorders: pure cerebellar ocular motor disorder (COD; 61), cerebellar ataxia (CA; 63), atypical parkinsonian syndromes (APS; 28), vestibular migraine (VM; 154). Their results of the Vertigo Handicap Questionnaire (VHQ), with its subscales for anxiety and handicapped activity, were compared to those of 65 BVP patients. Postural instability was measured on a force-plate. Multivariate linear regression was used to adjust for patient demographics. RESULTS Patients with chronic central vestibular disorders (COD, CA, APS) had relatively low VRA levels comparable to those in BVP, independent of increased handicapped activity or postural instability. Only VM patients showed significantly higher VRA, although their activity impairment and postural instability were lowest. No significant differences within chronic central vestibular disorders were found for VRA and subjective activity impairment. CONCLUSIONS Subjective and objective vestibular-related impairment are not necessarily correlated with vestibular-related anxiety in central vestibular disorders. Our findings rather support the hypothesis that, in addition to an intact peripheral, an intact central vestibular system could also serve as a prerequisite to develop specific VRA.
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Affiliation(s)
- Lena Padovan
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany.
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Virginia L Flanagin
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Medical Information Processing Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karina Limburg
- Clinic for Conservative Orthopaedics, Manual Medicine and Pain Medicine, Sana Klinik München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Julian Decker
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Li F, Xu J, Liu D, Wang J, Lu L, Gao R, Zhou X, Zhuang J, Zhang S. Optimizing vestibular neuritis management with modular strategies. Front Neurol 2023; 14:1243034. [PMID: 37780705 PMCID: PMC10538530 DOI: 10.3389/fneur.2023.1243034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study proposes a "modular management" approach for vestibular neuritis (VN) to reduce chronicization and improve patient prognosis. The approach involves multi-factor grading and hierarchical intervention and was found to be more effective than traditional treatment strategies. Methods This retrospective analysis compared two groups of VN patients from two medical institutions. The intervention group of 52 patients received "modular management," while the control group of 51 patients did not receive this kind of management. Analyzed the early treatment strategies, 6-month prognosis, and other indicators of the two groups of patients, compared and analyzed their overall prognosis, and identified the risk factors affecting the chronicization. Results The modular management group had lower dizziness severity, better balance, lower anxiety, and higher video head impulse testing (v-HIT) gain after 6 months of onset. Analysis of factors related to persistent postural-perceptual dizziness (PPPD) in patients with VN showed positive correlations between the time from onset to diagnosis and PPPD, and Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), anxiety, and depression. Normalized vestibular rehabilitation was negatively correlated with PPPD, while gender, age, and early steroid use had no significant correlation. The multi-factor logistic regression model correctly classified 93.20% of the study subjects with a sensitivity of 87.50% and specificity of 94.90%. Conclusion The proposed "modular management" scheme for VN is a comprehensive and dynamic approach that includes health education, assessment, rehabilitation, therapy, evaluation, and prevention. It can significantly improve patient prognosis and reduce chronicization by shifting from simple acute treatment to continuous management.
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Affiliation(s)
- Fei Li
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jin Xu
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingmei Lu
- Department of Neurology, Qidong People's Hospital, Qidong Liver Cancer Institute, Affiliated Qidong Hospital of Nantong University, Qidong, China
| | - Rui Gao
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiaowen Zhou
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jianhua Zhuang
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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6
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Elyoseph Z, Geisinger D, Zaltzman R, Hartman TG, Gordon CR, Mintz M. The overarching effects of vestibular deficit: Imbalance, anxiety, and spatial disorientation. J Neurol Sci 2023; 451:120723. [PMID: 37393737 DOI: 10.1016/j.jns.2023.120723] [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: 01/17/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Comorbid Balance, Anxiety, and Spatial symptoms are observed in neurodevelopmental disorders and aging. Each of these symptoms was studied separately in association with vestibular hypofunction. We aimed to investigate whether such a diffuse range of symptoms has common vestibular pathophysiology. Specifically, we tested whether this Triad of dysfunctions is associated with central or peripheral vestibular hypofunction. We also assessed the possible contribution of semicircular canals (SCCs) vs. saccular function. METHODS We tested patients with Peripheral bilateral and unilateral Vestibular Hypofunction (PVH), Machado Joseph Disease (MJD) with cerebellar and central bilateral vestibular hypofunction, and healthy controls. SCCs and sacculi functioning were evaluated by the video Head Impulse Test (vHIT) and cervical Vestibular Evoked Myogenic Potentials (cVEMP), respectively. Balance was assessed by the Activities-specific Balance Confidence scale (ABC), anxiety by the Hamilton Anxiety Rating Scale (HAM-A), and spatial orientation by the Object Perspective Taking test (OPT-t). RESULTS PVH patients with vestibular SCCs and saccular hypofunction presented the Triad of symptoms, imbalance, anxiety, and spatial disorientation. MJD patients with SCCs-related vestibular hypofunction but preserved saccular-related vestibular function presented with a partial profile of imbalance and spatial disorientation. CONCLUSIONS The present study provides evidence that peripheral vestibular hypofunction is associated with the Triad of dysfunctions, i.e., imbalance, anxiety, and spatial disorientation. The combination of SCCs and saccular hypofunction seems to contribute to the emergence of the Triad of symptoms.
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Affiliation(s)
- Zohar Elyoseph
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; The Center for Psychobiological Research, Department of Educational Psychology and Educational Counseling, Max Stern Yezreel Valley College, Jezreel Valley, Israel.
| | - Dario Geisinger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Zaltzman
- Department of Neurology, Meir Medical Center, Kfar Saba, Israel
| | - Tamar G Hartman
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Carlos R Gordon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Meir Medical Center, Kfar Saba, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Matti Mintz
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Chen JY, Guo ZQ, Wang J, Liu D, Tian E, Guo JQ, Kong WJ, Zhang SL. Vestibular migraine or Meniere's disease: a diagnostic dilemma. J Neurol 2023; 270:1955-1968. [PMID: 36562849 PMCID: PMC10025214 DOI: 10.1007/s00415-022-11532-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Meniere's disease (MD) represents one of the vertigo disorders characterized by triad symptoms (recurrent vertigo, fluctuating hearing loss, tinnitus or ear fullness). The diagnosis of MD relies on the accurate and detailed taking of medical history, and the differentiation between MD and vestibular migraine (VM) is of critical importance from the perspective of the treatment efficacy. VM is a highly prevalent vertigo condition and its typical symptoms (headache, vestibular symptoms, cochlear symptoms) mimic those of MD. Furthermore, the misdiagnosis in MD and VM could lead to VM patients mistakenly receiving the traumatic treatment protocol designed for MD, and sustaining unnecessary damage to the inner ear. Fortunately, thanks to the advances in examination technologies, the barriers to their differentiation are being gradually removed. These advances enhance the diagnostic accuracy of vertigo diseases, especially VM and MD. This review focused on the differentiation of VM and MD, with an attempt to synthesize existing data on the relevant battery of differentiation diagnosis (covering core symptoms, auxiliary tests [audiometry, vestibular tests, endolymphatic hydrops tests]) and longitudinal follow-up. Since the two illnesses are overlapped in all aspects, no single test is sufficiently specific on its own, however, patterns containing all or at least some features boost specificity.
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Affiliation(s)
- Jing-Yu Chen
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhao-Qi Guo
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Wang
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Liu
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - E Tian
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Qi Guo
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-Jia Kong
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China.
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
| | - Su-Lin Zhang
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China.
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
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Dale R, Limburg K, Schmid-Mühlbauer G, Probst T, Lahmann C. Somatic symptom distress and gender moderate the effect of integrative group psychotherapy for functional vertigo on vertigo handicap: A moderation analysis of a randomised controlled trial. J Psychosom Res 2023; 167:111175. [PMID: 36753945 DOI: 10.1016/j.jpsychores.2023.111175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Psychotherapeutic treatments for functional vertigo have shown promising results in recent years but it is still to be determined for whom these treatments work best. The aim of this study was to run a moderation analysis to identify which baseline factors may moderate the success of integrative psychotherapeutic group treatment (IPGT) as compared to a self-help group (SHG) active control. METHODS Data from 159 patients included in a 16-week randomised controlled trial were analysed. The outcome was vertigo-related handicap at post-treatment and gender, age, baseline somatisation, depression and anxiety were taken as putative moderators. RESULTS We found that baseline somatic symptoms (i.e. PHQ-15 score, p = 0.04, ∆R2 = 0.02) and gender (p = 0.04, ∆R2 = 0.02) significantly moderated the effect of treatment type on post-treatment vertigo handicap. Patients with higher PHQ-15 scores at baseline and women reduced their vertigo handicap more in IPGT as compared to in the control condition. CONCLUSION A possible explanation for this result is that somatic symptom distress is the central aetiopathogenetic factor of functional vertigo, while depressiveness and anxiety are rather epiphenomena in the sense of comorbidity. Although the results are not entirely consistent, according to some studies, female gender seems to be a favourable predictor of better therapy outcome. Given the high impairment and healthcare costs in those with vertigo/dizziness and psychiatric comorbidity, it is important to effectively treat these patients as early as possible. This study provides a prescriptive tool for practitioners, allowing for more patient-tailored treatment decisions.
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Affiliation(s)
- Rachel Dale
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Austria.
| | - Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany.
| | | | - Thomas Probst
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Austria.
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, 79104 Freiburg, Germany.
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Yang SY, Lin ZX, Xian YF, Zhang HM, Xu HX. Traditional uses, chemical compounds, pharmacological activities and clinical studies on the traditional Chinese prescription Yi-Gan San. JOURNAL OF ETHNOPHARMACOLOGY 2023; 302:115859. [PMID: 36280017 DOI: 10.1016/j.jep.2022.115859] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE A widely used traditional prescription, Yi-Gan San (YGS) is a remedy for neurodegenerative disorders. The formulation consists of seven Chinese medicinal materials in specific proportions, namely Uncariae Ramulus cum Uncis (Uncaria rhynchophylla (Miq.) Miq. ex Havil.), Bupleuri Radix (Bupleurum chinense DC.), Angelicae Sinensis Radix (Angelica sinensis (Oliv.) Diels), Chuanxiong Rhizoma (Ligusticum wallichii Franch.), Poria (Poria cocos (Schw.) Wolf), Atractylodis Macrocephalae Rhizoma (Atractylodes macrocephala Koidz.) and Glycyrrhizae Radix et Rhizoma (Glycyrrhiza uralensis Fisch.). Using YGS has been shown to alleviate various behavioural and psychological symptoms of dementia (BPSD). AIM OF THIS REVIEW The goal of this review is to give up-to-date information about the traditional uses, chemistry, pharmacology and clinical efficacy of YGS based on the scientific literature and to learn the current focus and provide references in the next step. MATERIALS AND METHODS The database search room was accessed using the search terms "Yi-Gan San" and "Yokukansan" to obtain results from resources such as Web of Science, PubMed, Google Scholar and Sci Finder Scholar. We not only consulted the literature of fellow authors for this review but also explored classical medical books. RESULTS YGS has been used to cure neurosis, sleeplessness, night weeping and restlessness in infants. Its chemical components primarily consist of triterpenes, flavonoids, phenolics, lactones, alkaloids and other types of compounds. These active ingredients displayed diverse pharmacological activities to ameliorate BPSD by regulating serotonergic, glutamatergic, cholinergic, dopaminergic, adrenergic, and GABAergic neurotransmission. In addition, YGS showed neuroprotective, antistress, and anti-inflammatory effects. The majority of cases of neurodegenerative disorders are treated with YGS, including Alzheimer's disease and dementia with Lewy bodies. CONCLUSIONS Based on previous studies, YGS has been used as a traditional prescription in East Asia, such as Japan, Korea and China, and it has diverse chemical compounds and multiple pharmacological activities. Nevertheless, few experimental studies have focused on chemical and quantitative YGS studies, suggesting that further comprehensive research on its chemicals and quality assessments is critical for future evaluations of drug efficacy.
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Affiliation(s)
- Si-Yu Yang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, 201203, China
| | - Zhi-Xiu Lin
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, 999077, China; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Yan-Fang Xian
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Hong-Mei Zhang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Hong-Xi Xu
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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How vestibular dysfunction transforms into symptoms of depersonalization and derealization? J Neurol Sci 2023; 444:120530. [PMID: 36586207 DOI: 10.1016/j.jns.2022.120530] [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: 05/24/2022] [Revised: 11/01/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Psychiatric Depersonalization/Derealization (DPDR) symptoms were demonstrated in patients with peripheral vestibular disorders. However, only semicircular canals (SCCs) dysfunction was evaluated, therefore, otoliths' contribution to DPDR is unknown. Also, DPDR symptoms in patients with central vestibular dysfunction are presently unknown. DPDR was also studied in the context of spatial disorientation and anxiety, but the relation of these cognitive and emotional functions to vestibular dysfunction requires clarification. METHODS We tested patients with peripheral Bilateral Vestibular Hypofunction (pBVH), Machado Joseph Disease (MJD) with cerebellar and central bilateral vestibular hypofunction, and healthy controls. Participants completed the video Head Impulse Test (vHIT) for SCCs function, cervical Vestibular Evoked Myogenic Potentials test (cVEMPt) for sacculi function, Body Sensation Questionnaire (BSQ) for panic anxiety, Object Perspective-Taking test (OPTt) for spatial orientation and Cox & Swinson DPDR inventory for DPDR symptoms. RESULTS pBVH patients showed significant SCCs and sacculi dysfunction, spatial disorientation, elevated panic anxiety, and DPDR symptoms. MJD patients showed significant SCCs hypofunction but preserved sacculi function, spatial disorientation but normal levels of panic anxiety and DPDR symptoms. Only pBVH patients demonstrated a positive correlation between the severity of the DPDR and spatial disorientation and panic anxiety. CONCLUSIONS DPDR develops in association with sacculi dysfunction, either with or without SSCs dysfunction. Spatial disorientation and anxiety seem to mediate the transformation of vestibular dysfunction into DPDR symptoms. DPDR does not develop in MJD with central vestibular hypofunction but a normal saccular response. We propose a three-step model that describes the development of DPDR symptoms in vestibular patients.
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Maywald M, Pogarell O, Levai S, Paolini M, Tschentscher N, Rauchmann BS, Krause D, Stöcklein S, Goerigk S, Röll L, Ertl-Wagner B, Papazov B, Keeser D, Karch S, Chrobok A. Neurofunctional differences and similarities between persistent postural-perceptual dizziness and anxiety disorder. Neuroimage Clin 2023; 37:103330. [PMID: 36696807 PMCID: PMC9879992 DOI: 10.1016/j.nicl.2023.103330] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) share behavioural symptoms like anxiety, avoidance, social withdrawal, hyperarousal, or palpitation as well as neurological symptoms like vertigo, stance and gait disorders. Furthermore, previous studies have shown a bidirectional link between vestibulo-spatial and anxiety neural networks. So far, there have been no neuroimaging-studies comparing these groups. OBJECTIVES The aim of this explorative study was to investigate differences and similarities of neural correlates between these two patient groups and to compare their findings with a healthy control group. METHODS 63 participants, divided in two patient groups (ANX = 20 and PPPD = 14) and two sex and age matched healthy control groups (HC-A = 16, HC-P = 13) were included. Anxiety and dizziness related pictures were shown during fMRI-measurements in a block-design in order to induce emotional responses. All subjects filled in questionnaires regarding vertigo (VSS, VHQ), anxiety (STAI), depression (BDI-II), alexithymia (TAS), and illness-perception (IPQ). After modelling the BOLD response with a standard canonical HRF, voxel-wise t-tests between conditions (emotional-negative vs neutral stimuli) were used to generate statistical contrast maps and identify relevant brain areas (pFDR < 0.05, cluster size >30 voxels). ROI-analyses were performed for amygdala, cingulate gyrus, hippocampus, inferior frontal gyrus, insula, supramarginal gyrus and thalamus (p ≤ 0.05). RESULTS Patient groups differed from both HC groups regarding anxiety, dizziness, depression and alexithymia scores; ratings of the PPPD group and the ANX group did differ significantly only in the VSS subscale 'vertigo and related symptoms' (VSS-VER). The PPPD group showed increased neural responses in the vestibulo-spatial network, especially in the supramarginal gyrus (SMG), and superior temporal gyrus (STG), compared to ANX and HC-P group. The PPPD group showed increased neural responses compared to the HC-P group in the anxiety network including amygdala, insula, lentiform gyrus, hippocampus, inferior frontal gyrus (IFG) and brainstem. Neuronal responses were enhanced in visual structures, e.g. fusiform gyrus, middle occipital gyrus, and in the medial orbitofrontal cortex (mOFC) in healthy controls compared to patients with ANX and PPPD, and in the ANX group compared to the PPPD group. CONCLUSIONS These findings indicate that neuronal responses to emotional information in the PPPD and the ANX group are comparable in anxiety networks but not in vestibulo-spatial networks. Patients with PPPD revealed a stronger neuronal response especially in SMG and STG compared to the ANX and the HC group. These results might suggest higher sensitivity and poorer adaptation processes in the PPPD group to anxiety and dizziness related pictures. Stronger activation in visual processing areas in HC subjects might be due to less emotional and more visual processing strategies.
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Affiliation(s)
- Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Levai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nadja Tschentscher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Boris Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniela Krause
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sophia Stöcklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Röll
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Papazov
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Agnieszka Chrobok
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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Chari DA, Madhani A, Sharon JD, Lewis RF. Evidence for cognitive impairment in patients with vestibular disorders. J Neurol 2022; 269:5831-5842. [PMID: 35930032 DOI: 10.1007/s00415-022-11289-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Extensive animal research has shown that vestibular damage can be associated with cognitive deficits. More recently, new evidence has emerged linking vestibular disorders to cognitive impairment in humans. Herein, we review contemporary research on the pathophysiology of cognitive-vestibular interactions and discuss its emerging clinical relevance. DATA SOURCES PubMed, Embase, and Cochrane databases. REVIEW METHODS A systematic literature search was performed with combinations of search terms: "cognition," "cognitive impairment," "chronic fatigue," "brain fog," "spatial navigation," "attention," "memory," "executive function," "processing speed," and "vestibular hypofunction." Relevant articles were considered for inclusion, including basic and clinical studies, case series, and major reviews. CONCLUSIONS Patients with vestibular disorders can demonstrate long-term deficits in both spatial and nonspatial cognitive domains. The underlying mechanism(s) linking the vestibular system to cognitive function is not well characterized, but several neuro-biologic correlates have been identified. Additional screening tools are required to identify individuals at risk for cognitive impairment, and further research is needed to determine whether treatment of vestibular dysfunction has the capacity to improve cognitive function. IMPLICATIONS FOR PRACTICE Physicians should be aware of emerging data supporting the presence of cognitive deficits in patients with vestibular disorders. Prevention and treatment of long-term cognitive deficits may be possible through screening and rehabilitation.
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Affiliation(s)
- Divya A Chari
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
- Department of Otolaryngology - Head and Neck Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
- Jenks Vestibular Physiology Lab, Massachusetts Eye and Ear, Boston, MA, USA.
| | - Amsal Madhani
- Jenks Vestibular Physiology Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jeffrey D Sharon
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Richard F Lewis
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Jenks Vestibular Physiology Lab, Massachusetts Eye and Ear, Boston, MA, 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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Molnár A, Maihoub S, Mavrogeni P, Tamás L, Szirmai Á. Depression scores and quality of life of vertiginous patients, suffering from different vestibular disorders. Eur Arch Otorhinolaryngol 2022; 279:5173-5179. [PMID: 35434778 PMCID: PMC9519666 DOI: 10.1007/s00405-022-07366-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022]
Abstract
Purpose To contrast the quality of life (QoL) impairment and depression scores of patients suffering from different vestibular disorders. Methods 301 patients were examined due to vertiginous complaints at the Neurotology Centre of the Department of Otolaryngology and Head and Neck Surgery of Semmelweis University. These patients completed the Hungarian version of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory, and the Symptom Checklist-90-Revised questionnaires. Results According to neurotological examination, the distribution of the different diagnoses was as follows: Menière’s disease (n = 101), central vestibular disorders (n = 67), BPPV (n = 47), vestibular neuritis (n = 39), other unilateral peripheral vestibulopathy (n = 18), PPPD (Persistent Postural-Perceptual Dizziness) (n = 16), vestibular migraine (n = 8), and vestibular Schwannoma (n = 5). The results of the DHI questionnaire have indicated worsened QoL in 86.4%, out of which 33.6% was defined as severe. The Beck scale has shown depressive symptoms in 42.3% of the cases, with severe symptoms in 6.3%. Significantly higher total DHI and Beck scale results were observed in patients with central vestibular disorders, vestibular migraine, PPPD and peripheral vestibulopathy, contrasted to the results of the other four diagnosis groups. The onset of the symptoms did not significantly affect the severity of QoL worsening and depression symptoms. Conclusion In this study, the QoL of vertiginous patients was worse in general, with the occurrence of depression symptoms. A difference was observed in the case of the values of patients with different vestibular disorders, indicating the importance of different factors, e.g., central vestibular compensation, behavioural strategies and psychological factors.
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Affiliation(s)
- András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36., 1083, Budapest, Hungary.
| | - Stefani Maihoub
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36., 1083, Budapest, Hungary
| | - Panayiota Mavrogeni
- Tóth Ilona Health Service Clinical Medical Institute, Görgey Artúr tér 8., 1212, Budapest, Hungary
| | - László Tamás
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36., 1083, Budapest, Hungary
| | - Ágnes Szirmai
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36., 1083, Budapest, Hungary
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Sui Lin CT, Prepageran N. The impact of disease duration in persistent postural-perceptual dizziness (PPPD) on the quality of life, dizziness handicap and mental health. J Vestib Res 2021; 32:373-380. [PMID: 34924408 DOI: 10.3233/ves-210087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional disorder which interferes with the way individuals experience their personal, social and work life. OBJECTIVE To study the impact of disease duration in PPPD on the quality of life (QOL), dizziness handicap and mental health on the patients. METHODS A prospective study comparing the EQ-5D for QOL, Dizziness Handicap Inventory (DHI) and DASS-21 between 27 patients with PPPD and 27 of those who have recovered from an acute vestibular event. Similar parameters between PPPD patients with symptoms less than one year and more than a year were compared. RESULTS The PPPD patients were predominantly females and middle-aged with significantly higher DHI scores (mean 48.3 + 25.7, p = 0.00002), higher total mean scores in the DASS-21 (mean 21.6 + 13.7, p = 0.009) and poorer QOL with mean EQ-5D VAS of 67.9 + 17.3 (p < 0.00001). PPPD patients with symptoms for more than a year had significant increase in physical handicap (p = 0.041) as well as anxiety levels (p = 0.008). CONCLUSIONS PPPD is predominantly seen in females and middle-aged which significantly reduces the QOL, increases dizziness handicap and increases depression, anxiety and stress levels. The increase in duration of illness further increases the anxiety levels and physical handicap.
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Affiliation(s)
- Carren Teh Sui Lin
- Department of Otorhinolaryngology, Hospital Sungai Buloh, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Narayanan Prepageran
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan University, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Rizk HG, Liu YF. Interviewing and Counseling the Dizzy Patient with Focus on Quality of Life. Otolaryngol Clin North Am 2021; 54:853-861. [PMID: 34294434 DOI: 10.1016/j.otc.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
When interviewing a patient presenting with dizziness, it is imperative to both diagnosis and treatment for the clinician to identify the impact dizziness has on the patient's productivity, general function level and cognition. and cognition. Psychiatric comorbidities and concurrent sleep disturbances are common in this patient population and identification of these additional factors is important in implementing a holistic, multidisciplinary treatment plan and ultimately improves the patient's outcome.
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Affiliation(s)
- Habib G Rizk
- Department of Otolaryngology, Medical University of South Carolina, Otolaryngology H&N Surgery, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
| | - Yuan F Liu
- Department of Otolaryngology, Loma Linda University Health, 11234 Anderson Street, Room: 2586A, Loma Linda, CA 92354, USA
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杨 丽, 丁 伟, 吴 梅. [Anxiety and depression state among patients with different type of vertigo and dizziness]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:440-443. [PMID: 34304471 PMCID: PMC10128482 DOI: 10.13201/j.issn.2096-7993.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 11/12/2022]
Abstract
Objective:To assess the status of anxiety and depression among patients with different type of vertigo and dizziness, and to figure out the possible reason. Methods:The data of the patients with vertigo from November 2017 to June 2020 were reviewed, and their status of anxiety and depression were assessed using self-rating anxiety scale(SAS) and self-rating depression scale(SDS). Results:A total of 559 patients with vertigo were enrolled, including 94 cases for vestibular migraine (VM), 86 cases for Meniere disease (MD), 78 cases for benign paroxysmal positional vertigo (BPPV), 77 cases for sudden hearing loss(SHL) with vertigo, 74 cases for no definite diagnosis, 58 cases for vestibular neuritis (VN), 57 cases for benign recurrent vertigo (BRV) and 35 cases for persistent postural-perceptual dizziness (PPPD).The incidence of anxiety is 43.11%(no definite diagnosis=64.86%, VM=63.83%, MD=55.81%, PPPD=48.57%, BRV=47.37%), and the incidence of depression is 11.27% (no definite diagnosis=25.68%, PPPD=17.14%, VM=14.89%, BRV=14.04%, MD=12.79%). Kruskal-Wallis test was used to analyze SAS and SDS scores of patients with vertigo. The results showed that there were significant differences in each group. All patients were divided into 3 groups according to the duration of vertigo. The anxiety incidence of >2 years group was highest(58.56%), and the second one was 2 months to 2 years group(54.75%). There was no statistically significant difference between 2 groups by χ²test(P>0.05). But both of them were significantly higher than the <2 months group(17.30%). The depression incidence of >2 years group was highest(32.43%), the second one was 2 months to 2 years group(10.27%), and the lowest one was <2 months group(0%). χ² test(P<0.01) showed statistically significant differences among these three groups. Conclusion:Anxiety is more common among patients with vertigo than depression, and the patients who suffer from VM,MD,PPPD or BRV have significantly higher rates of psychiatric comorbidity.
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Affiliation(s)
- 丽 杨
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology Head and Neck Surgery, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - 伟 丁
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology Head and Neck Surgery, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - 梅 吴
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology Head and Neck Surgery, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
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Dornhoffer JR, Liu YF, Zhao EE, Rizk HG. Does Cognitive Dysfunction Correlate With Dizziness Severity in Meniére's Disease Patients. Otol Neurotol 2021; 42:e323-e331. [PMID: 33555758 DOI: 10.1097/mao.0000000000002958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Characterize the relationship between cognitive dysfunction and the dizziness severity in Meniére's disease (MD) patients. STUDY DESIGN Retrospective review. SETTING University-based tertiary medical center. PATIENTS Three hundred patients were evaluated for MD from 2015 to 2019. Excluding comorbid or alternative vestibular disorders, 29 patients with definite MD and available pre- and postintervention data were included for analysis. INTERVENTIONS A progressive protocol of salt restriction, diuretics, steroid and/or gentamycin injection, and endolymphatic sac decompression for those refractory to medical therapy. MAIN OUTCOME MEASURES Quality of life measured with the Dizziness Handicap Inventory (DHI) and cognitive function measured with the Cognitive Failures Questionnaire (CFQ). Pre- and posttreatment DHI and DHI subscale scores and change in these scores were correlated with pre- and posttreatment CFQ scores and change in CFQ with therapy. RESULTS Analysis showed a number of limited associations between improvement in DHI and improvement in CFQ. Total DHI scores failed to correlate scores or variation in scores with change in CFQ (p = 0.091 and p = 0.085, respectively). Improvement in the CFQ false-triggering domain was significantly associated with improvement in the DHI physical subscale (r = 0.491, p = 0.007) and was nonsignificantly associated with improvement in total DHI and DHI emotional subscale scores (r = 0.422, p = 0.016 and r = 0.399, p = 0.032). CONCLUSIONS The DHI correlates with several pre- and posttreatment measures of cognitive dysfunction (CFQ) in MD patients. However, change in DHI and CFQ with therapy correlate poorly. Overall, the commonly used DHI may fail to adequately assess cognitive dysfunction in MD patients possibly due to factors not directly implicated by measures of vestibular dysfunction, such as central nervous system or cognitive dysfunction; however, the specific physical and emotional subscales may offer helpful insight into cognitive dysfunction change/improvement with treatment.
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Affiliation(s)
- James R Dornhoffer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Yuan F Liu
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
| | - Elise E Zhao
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Habib G Rizk
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Efficacy of Yokukansan, a traditional Japanese herbal medicine, in patients with dizziness and irritability. Auris Nasus Larynx 2021; 48:864-869. [PMID: 33526322 DOI: 10.1016/j.anl.2021.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/03/2021] [Accepted: 01/20/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Irritability is an emotional stress symptom that causes or exacerbates dizziness. Antidepressants may be helpful for some conditions that are accompanied by irritability; however, they do not completely inhibit irritability. Yokukansan (YKS), a traditional Japanese herbal medicine, has been used for neurosis, insomnia, and children's irritability and night crying. The study investigated the efficacy of YKS in nystagmus in patients with chronic dizziness and irritability. METHODS Twenty-two cases with chronic dizziness and irritability were reviewed retrospectively. The patients were divided into two groups: control patients (0-7 days of treatment) and YKS-treated patients (YKS cases; >7 days of treatment). Dizziness before and during (after, in the controls) YKS treatment was evaluated by scoring the nystagmus intensity on a 5-point scale. The average scores were calculated within a maximum of 6 months before and during or after treatment. The normalized scores were also calculated. The optimal treatment regimen was calculated via receiver operating characteristic (ROC) curve analysis. RESULTS There were six control cases (1 male, 5 females; mean age: 59.5 years). There were 16 YKS cases (3 males, 13 females; mean age: 61.8 years). While the group mean nystagmus intensity scores significantly decreased from 1.18 to 0.73 in the YKS cases, it did not change in the control cases. The group mean of the normalized nystagmus intensity scores during treatment was 0.73 in the YKS cases. The results of the ROC curve analysis indicated the optimal cut-off period of the YKS treatment was 10 days. CONCLUSION The oral administration of YKS for more than 10 days was optimal. The treatments with YKS could be a good option for the treatments of vertigo.
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Abstract
PURPOSE OF REVIEW To present evidence of a functional interrelation between the vestibular and the anxiety systems based on a complex reciprocally organized network. The review focuses on the differential effects of various vestibular disorders, on psychiatric comorbidity, and on anxiety related to vertigo. RECENT FINDINGS Episodic vertigo syndromes such as vestibular migraine, vestibular paroxysmia, and Menière's disease are associated with a significant increase of psychiatric comorbidity, in particular anxiety/phobic disorders and depression. Chronic unilateral and bilateral vestibulopathy (BVP) do not exhibit a higher than normal psychiatric comorbidity. Anxiety related to the vertigo symptoms is also increased in episodic structural vestibular disorders but not in patients with chronic unilateral or bilateral loss of vestibular function. The lack of vertigo-related anxiety in BVP is a novel finding. Several studies have revealed special features related to anxiety in patients suffering from BVP: despite objectively impaired postural balance with frequent falls, they usually do not complain about fear of falling; they do not report an increased susceptibility to fear of heights; they do not have an increased psychiatric comorbidity; and they do not report increased anxiety related to the perceived vertigo. Subtle or moderate vestibular stimulation (by galvanic currents or use of a swing) may have beneficial effects on stress or mood state in healthy adults, and promote sleep in humans and rodents. The intimate structural and functional linkage of the vestibular and anxiety systems includes numerous nuclei, provincial and connector hubs, the thalamocortical network, and the cerebellum with many neural transmitter systems. SUMMARY The different involvement of emotional processes and anxiety - to the extent of 'excess anxiety' or 'less anxiety' - in structural vestibular disorders may be due to the specific dysfunction and whether the system activity is excited or diminished. Both psychiatric comorbidity and vertigo-related anxiety are maximal with excitation and minimal with loss of peripheral vestibular function.
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Meehan A, Hebert D, Deru K, Weaver LK. Longitudinal study of hyperbaric oxygen intervention on balance and affective symptoms in military service members with persistent post-concussive symptoms. J Vestib Res 2019; 29:205-219. [PMID: 31282447 DOI: 10.3233/ves-180671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dizziness and imbalance are common after mild traumatic brain injury (mTBI). Hyperbaric oxygen (HBO2) has been proposed for persistent post-concussive symptoms after mTBI, but its effect on vestibular function is unknown. OBJECTIVE To describe balance function in military service-members before and after intervention, and to explore the influence of post-traumatic stress disorder (PTSD), anxiety, and depression on vestibular outcomes. METHODS Seventy-one participants with mTBI and seventy-five healthy adults without brain injury were enrolled (NCT01611194 and NCT01925963). mTBI participants were randomized to 40 HBO2 sessions or 40 sham chamber sessions over 12 weeks. Normative controls received no intervention. Balance and neuropsychological function were measured at baseline, 13 weeks, and 6 months. RESULTS The mTBI cohort performed worse than healthy controls on balance and gait measures and reported more affective symptoms. Some within-group improvements were noted at 13 weeks and 6 months. Significant between-intervention differences on balance measures were minimal but effects on postural control generally favored HBO2. Those with affective symptoms, particularly PTSD, had the most improvement in postural control and otolith function following 13 weeks of HBO2. CONCLUSION HBO2 may influence balance function after mTBI, particularly in those with affective symptoms.
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Affiliation(s)
- Anna Meehan
- Lovelace Biomedical Research, Albuquerque, New Mexico, USA
| | | | - Kayla Deru
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, UT, and Intermountain LDS Hospital, Salt Lake City, UT, USA
| | - Lindell K Weaver
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, UT, and Intermountain LDS Hospital, Salt Lake City, UT, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Lehnen N, Schröder L, Henningsen P, Glasauer S, Ramaioli C. Deficient head motor control in functional dizziness: Experimental evidence of central sensory-motor dysfunction in persistent physical symptoms. PROGRESS IN BRAIN RESEARCH 2019; 249:385-400. [PMID: 31325997 DOI: 10.1016/bs.pbr.2019.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Understanding the mechanisms of symptoms that are insufficiently explained by organic dysfunction remains challenging. Recently, it has been proposed that such "functional symptoms" are based on erroneous sensory processing in the central nervous system (CNS), with internal expectations dominating sensory inputs. In a pilot study, we used a head motor control set-up to assess the interplay between sensory input and expectation on the example of patients with functional dizziness. Eight patients and 11 age-matched healthy controls performed large active eye-head gaze shifts towards visual targets in the natural situation and with the head moment of inertia 3.3-fold increased. The latter induces head oscillations and the expected sensory outcome of the movement, estimated in the CNS, does not match the actual sensory input. Head oscillations were assessed in patients and in healthy subjects and compared to prior results from patients with organic disease (vestibular loss and cerebellar ataxia). Head oscillations in patients with functional dizziness were different from those of healthy subjects (F(1,17)=27.26, P<0.001, partial η2=0.62), and similar to those of patients with cerebellar ataxia, and with vestibular loss (F(2,19)=0.56, P=0.58). Even in the natural, unweighted, condition, head oscillations were higher in functional dizziness patients than in healthy subjects (P=0.001). Since an extensive work-up failed to demonstrate any explanatory peripheral vestibular, motor, or cerebellar organic dysfunction, these motor control deficits are a first indication of erroneous interplay between expectations and sensory input in the CNS that could account for persistent physical symptoms.
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Affiliation(s)
- Nadine Lehnen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany; Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Planegg, Germany.
| | - Lena Schröder
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Planegg, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Glasauer
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany; Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Planegg, Germany
| | - Cecilia Ramaioli
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany; Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
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Transcranial direct current stimulation (tDCS) for treatment of phobic postural vertigo: an open label pilot study. Eur Arch Psychiatry Clin Neurosci 2019; 269:269-272. [PMID: 29626226 DOI: 10.1007/s00406-018-0894-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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Lee SH, Kang Y, Sohn JH, Cho SJ. Dizziness Handicap and Its Contributing Factors in Patients With Migraine. Pain Pract 2019; 19:484-490. [PMID: 30659725 DOI: 10.1111/papr.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/27/2018] [Accepted: 01/05/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Dizziness is frequently reported in patients with migraine. However, its assessment is often neglected in clinical practice. We investigated the dizziness handicap experienced by patients with migraine and its contributing factors. METHODS A total of 361 migraine outpatients (270 women, 91 men; mean age 39.01 ± 11.2 years) were given the Korean Dizziness Handicap Inventory (KDHI) questionnaire (total score: 100 points; cutoff: 29). The Headache Impact Test, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Pittsburgh Sleep Quality Index were also administered. Clinical data such as age, sex, number of headache attacks per month, pain intensity on the visual analog scale, and average sleep hours were collected to find contributing factors. Comparisons were made between chronic and episodic migraine. RESULTS A total of 153 patients were classified as having dizziness handicap (M+DH) and 208 had migraine without dizziness handicap (M-DH). Patients with M+DH experienced more headache attacks per month than patients with M-DH (P = 0.010). The proportion of patients with chronic migraine was larger in the M+DH group (29.4% vs. 17.3%, P = 0.006). Patients with M+DH showed higher scores than patients with M-DH in all the KDHI subscales. Multivariable logistic regression showed headache impact, pain intensity, anxiety, and depression to be significantly associated with dizziness handicap. CONCLUSION The data suggest that patients with migraine, especially those with chronic-type migraine, experience physical, emotional, and functional handicaps due to dizziness. Dizziness handicap is related to headache impact, anxiety, and depression. Targeted management of such factors is required to reduce the severity of subjective discomfort.
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Affiliation(s)
- Sun Hwa Lee
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Yeonwook Kang
- Department of Psychology, Hallym University, Chuncheon, South Korea.,Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Soo-Jin Cho
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
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Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2019; 276:711-718. [DOI: 10.1007/s00405-019-05297-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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Limburg K, Dinkel A, Schmid-Mühlbauer G, Sattel H, Radziej K, Becker-Bense S, Henningsen P, Dieterich M, Lahmann C. Neurologists' Assessment of Mental Comorbidity in Patients With Vertigo and Dizziness in Routine Clinical Care-Comparison With a Structured Clinical Interview. Front Neurol 2018; 9:957. [PMID: 30483214 PMCID: PMC6242889 DOI: 10.3389/fneur.2018.00957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/25/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Mental health comorbidities are frequent in patients with vertigo and dizziness. The current study was conducted in a specialized interdisciplinary university center for vertigo and dizziness. Clinical routines consist of a structured work-up in which neuro-otological and neurological tests are performed to first detect possible organic vestibular deficits. In addition, psychiatric disorders and comorbidities are considered. The study aimed to evaluate neurologists' awareness of psychiatric next to somatic disorders within patients' first examination in terms of diagnostic congruence between neurologists' diagnoses and structured clinical assessment of mental disorders. Methods: The study involved 392 patients. Diagnostic evaluation included (a) structured history-taking (including psychosocial anamnesis), neurological, and neuro-otological diagnostics conducted by neurologists and (b) a structured clinical interview for mental disorders (SCID-I) conducted by psychologists and final-year medical or psychology students. Cohen's Kappa was calculated to determine agreement rates regarding depression and anxiety disorders; additionally, sensitivity and specificity were evaluated. Results: Neurologists' assessments led to at least one psychiatric diagnosis among the main diagnoses in 40 (10.2 %) patients, whereas the structured clinical interview led to at least one DSM-IV psychiatric diagnosis in 174 (44.4%) of the patients. Agreement was low (κ < 0.2); sensitivity was low (15%) but specificity was high (98%). Conclusions: Agreement between the diagnosis of neurologists and structured clinical interviews for psychiatric disorders is low. Since psychiatric disorders are frequent in vertigo and dizziness and tend to take a chronic course, improving early recognition and implementing appropriate care concepts is vital.
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Affiliation(s)
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany.,Cluster of Systems Neurology-SyNergy, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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An fMRI study of visuo-vestibular interactions following vestibular neuritis. NEUROIMAGE-CLINICAL 2018; 20:1010-1017. [PMID: 30336357 PMCID: PMC6197146 DOI: 10.1016/j.nicl.2018.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 10/01/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022]
Abstract
Vestibular neuritis (VN) is characterised by acute vertigo due to a sudden loss of unilateral vestibular function. A considerable proportion of VN patients proceed to develop chronic symptoms of dizziness, including visually induced dizziness, specifically during head turns. Here we investigated whether the development of such poor clinical outcomes following VN, is associated with abnormal visuo-vestibular cortical processing. Accordingly, we applied functional magnetic resonance imaging to assess brain responses of chronic VN patients and compared these to controls during both congruent (co-directional) and incongruent (opposite directions) visuo-vestibular stimulation (i.e. emulating situations that provoke symptoms in patients). We observed a focal significant difference in BOLD signal in the primary visual cortex V1 between patients and controls in the congruent condition (small volume corrected level of p < .05 FWE). Importantly, this reduced BOLD signal in V1 was negatively correlated with functional status measured with validated clinical questionnaires. Our findings suggest that central compensation and in turn clinical outcomes in VN are partly mediated by adaptive mechanisms associated with the early visual cortex. VN clinical status related to V1 response to congruent visuo-vestibular stimuli Reduced V1 BOLD signal during congruent stimulation correlates with subjective dizziness scores No association between V1 BOLD signal and incongruent visuo-vestibular stimulation Changes in V1 activity may reflect cortical adaptive mechanisms following VN
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Goto F, Sugaya N, Arai M, Masuda K. Psychiatric disorders in patients with intractable dizziness in the department of otolaryngology. Acta Otolaryngol 2018; 138:646-647. [PMID: 29385877 DOI: 10.1080/00016489.2018.1429652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vertigo and dizziness are often not fully explained by organic illnesses, but instead may be related to psychiatric disorders. It is important to determine the types of psychiatric comorbidities that are frequent in cases of intractable dizziness. METHOD The study subjects were 90 patients who had experienced intractable dizziness for more than three months and were referred to a psychiatrist when their symptoms could not be fully explained based on their physical illness. The patients' final diagnosis and questionnaire (DHI,SDS and STAI) scores were evaluated. RESULTS Seventy percent (63/90) of patients with intractable dizziness had been diagnosed as having psychiatric conditions by the study psychiatrists. The most common diagnosis was unspecified depressive disorder. CONCLUSIONS Psychiatric comorbidities seem to be more prevalent in certain subgroups of organic dizziness. We found a higher rate of depressive disorders in the sequelae of sudden deafness and migraine-related dizziness.
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Affiliation(s)
- Fumiyuki Goto
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Nagisa Sugaya
- Department of Epidemiology and Public Health, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Miki Arai
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kanako Masuda
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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The Longitudinal Effect of Vertigo and Dizziness Symptoms on Psychological Distress: Symptom-Related Fears and Beliefs as Mediators. J Nerv Ment Dis 2018; 206:277-285. [PMID: 29394194 DOI: 10.1097/nmd.0000000000000791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the frequent observation that vertigo and dizziness (VD) disorders may trigger or exacerbate secondary psychiatric comorbidities, there is limited understanding of the mechanisms underlying this development. To address this gap, we investigated whether symptom-related fears and cognitions as indicated by questionnaire-based measures are mediators of the longitudinal effect of VD symptoms on anxiety and depression after 1 year. We analyzed data from a large study with patients of a treatment center specialized in vertigo (N = 210). Simple and multiple parallel mediation models strengthened our hypothesis that fear of bodily sensations and cognitions about these symptoms play a mediating role in the relationship between VD symptoms and psychopathology at follow-up after baseline scores of the outcome were controlled for. Results are discussed within a cognitive theory framework and point to the potential benefits of interventions that modify symptom-related beliefs and fears via cognitive psychotherapy in this therapeutically underserved population.
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Kozak HH, Dündar MA, Uca AU, Uğuz F, Turgut K, Altaş M, Tekin G, Aziz SK. Anxiety, Mood, and Personality Disorders in Patients with Benign Paroxysmal Positional Vertigo. Noro Psikiyatr Ars 2018; 55:49-53. [PMID: 30042641 PMCID: PMC6045803 DOI: 10.5152/npa.2016.18143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/26/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study presents the current prevalence of anxiety, mood, and personality disorders as well as factors associated with the existence of psychiatric disorders in patients with benign paroxysmal positional vertigo (BPPV). METHODS The study sample comprised 46 patients with BPPV and 74 control subjects. Anxiety and mood disorders were ascertained via the Structured Clinical Interview for the Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth Edition/Clinical Version. Personality disorders were diagnosed via the Structured Clinical Interview for DSM, Revised Third Edition, Personality Disorders. RESULTS Of the 46 patients, 18 (39.1%) had at least one mood or anxiety disorder and 13 (28.3%) had at least one personality disorder. The most common Axis I and Axis II disorders in the patient group were major depression in 8 (17.4%) and obsessive-compulsive personality disorder in 10 (21.7%) patients, respectively. It was found that major depression (p=0.021), generalized anxiety disorder (p=0.026) and obsessive- compulsive personality disorder (p=0.001) were more prevalent in the BPPV group compared with the control group. CONCLUSION Results suggest that psychiatric disturbances should be carefully checked in patients with BPPV due to the relatively high rate of comorbidity.
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Affiliation(s)
- Hasan Hüseyin Kozak
- Department of Neurology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Mehmet Akif Dündar
- Department of Otorhinolaryngology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Ali Ulvi Uca
- Department of Neurology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Faruk Uğuz
- Department of Psychiatry, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Keziban Turgut
- Department of Psychiatry, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Mustafa Altaş
- Department of Neurology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Gonca Tekin
- Department of Psychiatry, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Suhayb Kuria Aziz
- Department of Otorhinolaryngology, Necmettin Erbakan University School of Medicine, Konya, Turkey
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Kamalvand A, Ghahraman MA, Jalaie S. Development of the Persian version of the Vertigo Symptom Scale: Validity and reliability. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:58. [PMID: 28616045 PMCID: PMC5461587 DOI: 10.4103/jrms.jrms_996_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 01/22/2017] [Accepted: 02/26/2016] [Indexed: 11/17/2022]
Abstract
Background: Vertigo Symptom Scale (VSS) is a proper instrument for assessing the patient status, clarifying the symptoms, and examining the relative impact of the vertigo and anxiety on reported handicap. Our aim is the translation and cross-cultural adaptation of the VSS into Persian language (VSS-P) and investigating its validity and reliability in patients with peripheral vestibular disorders. Materials and Methods: VSS was translated into Persian. Cross-cultural adaptation was carried out on 101 patients with peripheral vestibular disorders and 34 participants with no history of vertigo. They completed the Persian versions of VSS, dizziness handicap inventory (DHI), and Beck anxiety inventory (BAI). Internal, discriminant, and convergent validities, internal consistency, and test-retest reliability were determined. Results: The VSS-P showed good face validity. Internal validity was confirmed and demonstrated the presence of two vertigo (VSS-VER) and autonomic-anxiety (VSS-AA) subscales. Significant difference between the median scores for patient and healthy groups was reported in discriminate validity (P <0.001). Convergent validity revealed high correlation between both BAI and DHI with VSS-P. There was a high test-retest reliability; with intraclass correlation coefficient of 0.89, 0.86, and 0.91 for VSS-AA, VER, and VSS-P, respectively. The internal consistency was good with Cronbach's alpha 0.90 for VER subscale, 0.86 for VSS-AA subscale, and 0.92 for the overall VSS-P. Conclusion: The Persian version of the VSS could be used clinically as a valid and reliable tool. Thus, it is a key instrument to focus on the symptoms associated with dizziness.
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Affiliation(s)
- Atefeh Kamalvand
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Adel Ghahraman
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaie
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Probst T, Dinkel A, Schmid-Mühlbauer G, Radziej K, Limburg K, Pieh C, Lahmann C. Psychological distress longitudinally mediates the effect of vertigo symptoms on vertigo-related handicap. J Psychosom Res 2017; 93:62-68. [PMID: 28107895 DOI: 10.1016/j.jpsychores.2016.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Vertigo symptoms can lead to more or less vertigo-related handicap. This longitudinal study investigated whether depression, anxiety, and/or somatization mediate the relationship between vertigo symptoms and vertigo-related handicap. METHODS N=111 patients with vertigo/dizziness provided complete data on the following measures: Vertigo symptoms at baseline, depression at 6-month follow-up, anxiety at 6-month follow-up, somatization at 6-month follow-up, and vertigo handicap at 12-month follow-up. Mediation analyses with bootstrapping were performed to investigate the mediating role of anxiety, depression, and somatization in the relationship between vertigo symptoms and vertigo-related handicap. RESULTS When the mediating role of anxiety, depression, and somatization was evaluated separately from each other in single mediation models, the effect vertigo symptoms at baseline exerted on vertigo-related handicap at 12-month follow-up was significantly mediated by depression at 6-month follow-up (p<0.05), by anxiety at 6-month follow-up (p<0.05), as well as by somatization at 6-month follow-up (p<0.05). When statistically controlling for the other mediators in a multiple mediator model, only depression at 6-month follow-up mediated the effect of vertigo symptoms at baseline on vertigo-related handicap at 12-month follow-up (p<0.05). CONCLUSION Psychological distress is an important mechanism in the process how vertigo symptoms lead to vertigo-related handicap.
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Affiliation(s)
- Thomas Probst
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany; Department of Psychology, Regensburg University, Regensburg, Germany.
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany.
| | | | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany.
| | - Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany.
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria; Department of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany.
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
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Gauvin DV, Yoder JD, Tapp RL, Baird TJ. Small Compartment Toxicity: CN VIII and Quality of Life: Hearing Loss, Tinnitus, and Balance Disorders. Int J Toxicol 2017; 36:8-20. [PMID: 27194512 DOI: 10.1177/1091581816648905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Life experiences, industrial/environmental exposures, and administration of Food and Drug Administration (FDA)-approved drugs may have unintended but detrimental effects on peripheral and central auditory pathways. Most relevant to the readership of this journal is the role that drug treatments approved by the FDA as safe and effective appear to interact with 3 independent modes of toxicity within the small compartment of the ear. What may seem to be trivial drug-induced toxicity has the potential to change important measures of quality of life and functional capacity of mid- to late-life patients. Drugs meant to treat can become the source of interference in the activities of daily living, and as a result, treatment compliance may be jeopardized. Ototoxicity has been defined as the tendency of certain therapeutic agents and other chemical substances to cause functional impairments and cellular degeneration of the tissues of the inner ear resulting in hearing loss. However, one of the largest contributors to hospitalizations is fall-related injuries in the elderly patients associated with disorders of vestibular function linked to progressive and drug-induced toxicities. Tinnitus affects 35 to 50 million adults representing approximately 25% of the US population, with 12 million seeking medical care and 2 to 3 million reporting symptoms that were severely debilitating. This review is intended to highlight these targets of neurotoxicity that threaten the usefulness of drug treatments deemed safe and effective prior to access by the general public.
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Affiliation(s)
- David V Gauvin
- Neurobehavioral Sciences, MPI Research Inc, Mattawan, MI, USA
| | - Joshua D Yoder
- Neurobehavioral Sciences, MPI Research Inc, Mattawan, MI, USA
| | - Rachel L Tapp
- Neurobehavioral Sciences, MPI Research Inc, Mattawan, MI, USA
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Kim SK, Kim YB, Park IS, Hong SJ, Kim H, Hong SM. Clinical Analysis of Dizzy Patients with High Levels of Depression and Anxiety. J Audiol Otol 2016; 20:174-178. [PMID: 27942604 PMCID: PMC5144818 DOI: 10.7874/jao.2016.20.3.174] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Some patients experiencing dizziness also report psychological distress. However, the association between vestibular deficits and psychological symptoms remains controversial. Thus, the aim of this paper is to report the proportion of patients who complained of dizziness who also had high depression and anxiety indices. Also we investigated the severity of their dizziness and the distribution of the diseases underlying this symptom. Subjects and Methods We assessed the dizziness and psychological distress of 544 patients experiencing dizziness using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We also reviewed the audio-vestibular symtoms of patients with high levels of depression and anxiety. Results The incidences of high depression and anxiety scores were 11% (60/544) and 18% (98/544), respectively. Patients with vestibular migraine were most likely to have high depression and anxiety indices. Patients in the high-BDI or high-STAI groups (117/544) obtained significantly higher DHI scores than those in neither the high-BDI nor the high-STAI group (427/544). We noticed that about 20% of the patients experiencing dizziness had high levels of psychological distress in this study; this group also suffered from various vestibular diseases and more symptoms of dizziness. Conclusions The results of the study suggest that psychological evaluation should be considered when assessing patients with vertigo.
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Affiliation(s)
- Sung Kyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yong Bok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Seok Jin Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Seok Min Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Bigelow RT, Semenov YR, du Lac S, Hoffman HJ, Agrawal Y. Vestibular vertigo and comorbid cognitive and psychiatric impairment: the 2008 National Health Interview Survey. J Neurol Neurosurg Psychiatry 2016; 87:367-72. [PMID: 25886779 DOI: 10.1136/jnnp-2015-310319] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/19/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Patients with vestibular disease have been observed to have concomitant cognitive and psychiatric dysfunction. We evaluated the association between vestibular vertigo, cognitive impairment and psychiatric conditions in a nationally representative sample of US adults. METHODS We performed a cross-sectional analysis using the 2008 National Health Interview Survey (NHIS), which included a Balance and Dizziness Supplement, and questions about cognitive function and psychiatric comorbidity. We evaluated the association between vestibular vertigo, cognitive impairment (memory loss, difficulty concentrating, confusion) and psychiatric diagnoses (depression, anxiety and panic disorder). RESULTS We observed an 8.4% 1-year prevalence of vestibular vertigo among US adults. In adjusted analyses, individuals with vestibular vertigo had an eightfold increased odds of 'serious difficulty concentrating or remembering' (OR 8.3, 95% CI 4.8 to 14.6) and a fourfold increased odds of activity limitation due to difficulty remembering or confusion (OR 3.9, 95% CI 3.1 to 5.0) relative to the rest of the US adults. Individuals with vestibular vertigo also had a threefold increased odds of depression (OR 3.4, 95% CI 2.9 to 3.9), anxiety (OR 3.2, 95% CI 2.8 to 3.6) and panic disorder (OR 3.4, 95% CI 2.9 to 4.0). CONCLUSIONS Our findings indicate that vestibular impairment is associated with increased risk of cognitive and psychiatric comorbidity. The vestibular system is anatomically connected with widespread regions of the cerebral cortex, hippocampus and amygdala. Loss of vestibular inputs may lead to impairment of these cognitive and affective circuits. Further longitudinal research is required to determine if these associations are causal.
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Affiliation(s)
- Robin T Bigelow
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yevgeniy R Semenov
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sascha du Lac
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Howard J Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
Functional and psychiatric disorders that cause vestibular symptoms (i.e., vertigo, unsteadiness, and dizziness) are common. In fact, they are more common than many well-known structural vestibular disorders. Neurologists and otologists are more likely to encounter patients with vestibular symptoms due to persistent postural-perceptual dizziness or panic disorder than Ménière's disease or bilateral vestibular loss. Successful approaches to identifying functional and psychiatric causes of vestibular symptoms can be incorporated into existing practices without much difficulty. The greatest challenge is to set aside dichotomous thinking that strongly emphasizes investigations of structural diseases in favor of a three-pronged approach that assesses structural, functional, and psychiatric disorders simultaneously. The pathophysiologic mechanisms underlying functional and psychiatric causes of vestibular symptoms are better understood than many clinicians realize. Research methods such as advanced posturographic analysis and functional brain imaging will push this knowledge further in the next few years. Treatment plans that include patient education, vestibular rehabilitation, cognitive and behavioral therapies, and medications substantially reduce morbidity and offer the potential for sustained remission when applied systematically. Diagnostic and therapeutic approaches are necessarily multidisciplinary in nature, but they are well within the purview of collaborative care teams or networks of clinicians coordinated with the neurologists and otologists whom patients consult first.
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Affiliation(s)
- M Dieterich
- Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany.
| | - J P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - T Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany
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Abstract
This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
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Affiliation(s)
- H K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
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STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness. Behav Neurol 2015; 2015:456850. [PMID: 26843786 PMCID: PMC4710932 DOI: 10.1155/2015/456850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 11/17/2022] Open
Abstract
Patients with somatoform vertigo and dizziness (SVD) disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI) using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (QH/V), reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n = 28); baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ). Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: QH/V = 0.31 versus controls: QH/V = 0.38; p = 0.022). After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles.
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Holle D, Schulte-Steinberg B, Wurthmann S, Naegel S, Ayzenberg I, Diener HC, Katsarava Z, Obermann M. Persistent Postural-Perceptual Dizziness: A Matter of Higher, Central Dysfunction? PLoS One 2015; 10:e0142468. [PMID: 26569392 PMCID: PMC4646356 DOI: 10.1371/journal.pone.0142468] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/22/2015] [Indexed: 02/01/2023] Open
Abstract
Objective Persistent postural-perceptual dizziness (PPPD) is the most common vestibular disorder in the age group between 30 and 50 years. It is considered to be based on a multisensory maladjustment involving alterations of sensory response pattern including vestibular, visual and motion stimuli. Previous data supported a link between vestibular and pain mechanism. The aim of the study was to investigate whether other sensory inputs such as pain stimuli might be altered in terms of a more widespread central perception dysfunction in this disorder. Methods Nociceptive blink reflex was measured in 27 patients with PPPD and compared with 27 healthy, age and gender matched controls. The habituation of the R2 component of the blink reflex was evaluated as the percentage area-under-the curve (AUC) decrease in ten consecutive blocks of five averaged rectified responses. Additionally, clinical characteristics were evaluated. Results In patients with PPPD a lack of habituation was observed compared to healthy controls. Relative AUC decreased between the first and the tenth block by 19.48% in PPPD patients and by 31.63% (p = 0.035) in healthy controls. There was no correlation between clinical data (course of disease, comorbid depression, medication, trigger factors) or electrophysiological data (perception threshold, pain threshold, stimulus intensity) and habituation pattern. No trigeminal sensitization in terms of facilitation of absolute values could be detected. Conclusion Our study results supports the hypothesis of the multisensory dimension of impaired sensory processing in patients with PPPD extends beyond vestibular/visual motion stimuli and reflexive postural/oculomotor control mechanisms to other sensory inputs such as pain perception in terms of a more generalized disturbed habituation pattern.
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Affiliation(s)
- Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| | | | | | - Steffen Naegel
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Ilya Ayzenberg
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | | | - Zaza Katsarava
- Department of Neurology, Evangelical hospital Unna, Unna, Germany
| | - Mark Obermann
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
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Langhagen T, Albers L, Heinen F, Straube A, Filippopulos F, Landgraf MN, Gerstl L, Jahn K, von Kries R. Period Prevalence of Dizziness and Vertigo in Adolescents. PLoS One 2015; 10:e0136512. [PMID: 26361225 PMCID: PMC4567278 DOI: 10.1371/journal.pone.0136512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/04/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To assess the period prevalence and severity of dizziness and vertigo in adolescents. METHODS In 1661 students in 8th-10th grade in twelve grammar schools in Munich, Germany information on vertigo/dizziness was assessed by a questionnaire in the class room setting. Three month prevalence of dizziness/vertigo was estimated; symptoms were categorized as orthostatic dizziness, spinning vertigo, swaying vertigo or unspecified dizziness. Duration of symptoms and impact on daily life activities were assessed. RESULTS 72.0% (95%-CI = [69.8-74.2]; N = 1196) of the students (mean age 14.5±1.1) reported to suffer from at least one episode of dizziness or vertigo in the last three months. Most adolescents ticked to have symptoms of orthostatic dizziness (52.0%, 95%-CI = [49.5-54.4], N = 863). The period prevalence for the other types of vertigo were spinning vertigo: 11.6%, 95%-CI = [10.1-13.3], N = 193; swaying vertigo: 12.2%, 95%-CI = [10.6-13.8], N = 202; and unspecified dizziness: 15.2%, 95%-CI = [13.5-17.1], N = 253. About 50% of students with spinning vertigo and swaying vertigo also report to have orthostatic dizziness. Most vertigo/dizziness types were confined to less than one minute on average. The proportion of students with any dizziness/vertigo accounting for failure attending school, leisure activities or obliging them to stay in bed were more pronounced for spinning or swaying vertigo. CONCLUSION Dizziness and vertigo in grammar school students appear to be as common as in adults. In face of the high period prevalence and clinical relevance of dizziness/vertigo in adolescents there is a need for prevention strategies. Risk factors for dizziness/vertigo need to be assessed to allow for conception of an intervention programme.
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Affiliation(s)
- Thyra Langhagen
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Lucia Albers
- Institut of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Heinen
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Straube
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Filipp Filippopulos
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Mirjam N. Landgraf
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Lucia Gerstl
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
- Schön Klinik Bad Aibling, Bad Aibling, Germany
| | - Rüdiger von Kries
- Institut of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig-Maximilians-University, Munich, Germany
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Psychological traumatization and adverse life events in patients with organic and functional vestibular symptoms. J Psychosom Res 2015; 79:123-9. [PMID: 26094009 DOI: 10.1016/j.jpsychores.2015.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 05/07/2015] [Accepted: 05/10/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE . A relationship has frequently been found between a history of traumatization and the existence of somatoform symptoms. The objective of this study was to examine whether this relationship is also observed for functional, i.e. medically not sufficiently explained, vestibular symptoms (FVS). We tested whether patients with FVS and organically explained vestibular symptoms (OVS) differ with regard to frequencies of previous traumatic experiences and posttraumatic stress symptoms. We also explored whether the impact of previous trauma was associated with characteristics of vestibular symptoms and handicap. METHODS . Patients with a diagnosis of OVS (N=185) or FVS (N=158) completed questionnaires about potentially traumatizing experiences (e.g., Childhood Trauma Questionnaire, Impact of Events Scale) and vertigo-related symptoms and handicap (Vertigo Symptom Scale, Vertigo Handicap Questionnaire). RESULTS . We found no differences between the two patient groups with regard to number or impact of traumatic life events. However, regression analyses across groups revealed that, regardless of their diagnosis, prior traumatic experiences and the presence of posttraumatic stress symptoms including avoidance and intrusion predicted to some extent higher overall balance symptoms and autonomic symptoms of vertigo-related anxiety. CONCLUSION . Exposure to trauma and symptoms of posttraumatic stress can contribute to symptom severity and handicap experienced by patients with vestibular symptoms irrespective of their original cause, most likely serving as predisposing, modulating or perpetuating factors.
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Obermann M, Bock E, Sabev N, Lehmann N, Weber R, Gerwig M, Frings M, Arweiler-Harbeck D, Lang S, Diener HC. Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the Dizziness and Vertigo Registry (DiVeR) Study. J Neurol 2015; 262:2083-91. [PMID: 26092518 DOI: 10.1007/s00415-015-7803-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 11/28/2022]
Abstract
To investigate the long-term outcome of interdisciplinary treatment in a tertiary care neuro-otology institution after 2 years as part of the Dizziness and Vertigo Registry study. Risk factors associated with unfavourable outcome were assessed. 3113 consecutive patients with disorders of vertigo and dizziness were recruited prospectively between March 2010 and February 2012. Patients were clinically assessed and treated according to their diagnosis. Standardized instruments were used at baseline and at 2-year follow-up [Dizziness Handicap Inventory (DHI), Quality of Life Questionnaire, General Depression Scale, Stait-Trait Anxiety Index], as well as a custom health-related questionnaire. The primary outcome variable of this observational study was the change in DHI after 2 years. Patients suffered from phobic postural vertigo (23%), benign peripheral paroxysmal vertigo (14.4%), unilateral vestibulopathy (10.5%), central vestibular disorders (8%), Menière's disease (9.8%), vestibular migraine (6.9%), bilateral vestibulopathy (5.5%), and vestibular paroxysmia (3.1%). Mean disease duration was 4.6 ± 6.3 years. 1272 patients were available for follow-up, 1159 completed the DHI score. 72.1% of patients improved in DHI score from baseline to 2 years follow-up. Mean reduction in DHI score was 14 points (p = 0.02). Long-term outcome following diagnosis and treatment in a specialized tertiary care centre is good and persistent after 2 years. Risk factors for an unfavourable outcome were advanced age, severe disability, constant vertigo or dizziness, and concomitant back pain, while depression and anxiety did not contribute to this risk considerably.
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Affiliation(s)
- Mark Obermann
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. .,Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany.
| | - Eva Bock
- Institute for Medical Informatics Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
| | - Nikolay Sabev
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Nils Lehmann
- Institute for Medical Informatics Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
| | - Ralph Weber
- Department of Neurology, Alfried-Krupp-Hospital Essen, Essen, Germany.
| | - Marcus Gerwig
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Markus Frings
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | | | - Stephan Lang
- Department of Otorhinolaryngology, University of Duisburg-Essen, Essen, Germany.
| | - Hans-Christoph Diener
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Tailored care for somatoform vertigo/dizziness: study protocol for a randomised controlled trial evaluating integrative group psychotherapy. J Neurol 2015; 262:1867-75. [PMID: 26001913 DOI: 10.1007/s00415-015-7784-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 12/12/2022]
Abstract
UNLABELLED Vertigo/dizziness (VD) ranks high in lifetime prevalence and clinical relevance. Nearly half of the complex VD disorders presenting at specialised units for vertigo or otoneurological disorders are not fully explained by an identifiable medical illness, but instead are related to anxiety, depressive, or somatoform disorders. Although there is some evidence that psychotherapy may be effective for these patients, therapeutic options remain unsatisfactory. This report describes the objectives, design and methods of a randomised, controlled clinical trial, evaluating the efficacy of manualised, multimodal group psychotherapy, based on integrative psychotherapy (IPT) and tailored to subgroups of mental disorders in medically unexplained VD. This psychotherapeutic approach will be compared to self-help groups (n = 172; n = 86 per study arm). Improvements with regard to handicap due to VD at 12 months follow-up will serve as primary outcome. Additionally, measures of generic quality of life, severity of vertigo, depression, anxiety, somatisation as well as Head Impulse Test and Computerized Static Posturography will be applied. We will also analyse the cost-effectiveness of this trial. The study aims to improve treatment of this therapeutically underserved population who are often severely impaired in their working and daily lives. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02320851. TRIAL STATUS This is an on-going study; recruitment for the study is about to start.
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Abstract
BACKGROUNDS Psychiatric comorbidity is common in vertiginous patients. The risk of psychiatric disorder is increased in patients with previous mental problems, but earlier mentally healthy may develop symptoms as well. Especially in chronic phase of vertigo, psychological factors have a significant role in the morbidity. AIMS The aim of this study was to evaluate the prevalence of psychiatric problems in vertiginous patients in a community sample. METHODS A prospective evaluation of psychiatric symptoms based on self-rating scales [Beck Depression Inventory (BDI), Zung Anxiety Scale (SAS), DSM-IV and ICD-10 Personality Questionnaire (DIP-Q)] in a community sample of 100 vertiginous subjects in the Academic Tertiary Otolaryngology Department at the Helsinki University Hospital, Finland. RESULTS The prevalence of any psychiatric problem was 68% (68 patients); 19% had depressiveness and 12% symptoms of anxiety. Altogether 63 (63%) patients met the criteria of personality disorder. The most prevalent personality disorder was obsessive-compulsive (46 patients). Personality disorder alone seems not to affect functional capacity and is of importance only when comorbid with symptoms of anxiety and depression. The prevalence of psychiatric symptoms did not correlate with severity of vertigo symptoms or other co-occurring diseases. CONCLUSIONS The prevalence of any psychiatric symptoms was high among vertiginous patients. In the chronic phase of vertigo, it seems that vertigo symptoms themselves do not influence on subjective feelings of debilitation. Psychiatric disorders worsen the clinical picture of vertigo along a more debilitating and disabling course. Psychiatric differential diagnoses should accompany the neuro-otology diagnostic procedure in patients with a chronic state of vertigo and greater disability.
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Affiliation(s)
- Sirpa Ketola
- Sirpa Ketola, M.D., Huhtiniemenkatu 27 D 14, 53810 Lappeenranta , Finland
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Lahmann C, Henningsen P, Brandt T, Strupp M, Jahn K, Dieterich M, Eckhardt-Henn A, Feuerecker R, Dinkel A, Schmid G. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J Neurol Neurosurg Psychiatry 2015; 86:302-8. [PMID: 24963122 DOI: 10.1136/jnnp-2014-307601] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Vertigo and dizziness are often not fully explained by an organic illness, but instead are related to psychiatric disorders. This study aimed to evaluate psychiatric comorbidity and assess psychosocial impairment in a large sample of patients with a wide range of unselected organic and non-organic (ie, medically unexplained) vertigo/dizziness syndromes. METHODS This cross-sectional study involved a sample of 547 patients recruited from a specialised interdisciplinary treatment centre for vertigo/dizziness. Diagnostic evaluation included standardised neurological examinations, structured clinical interview for major mental disorders (SCID-I) and self-report questionnaires regarding dizziness, depression, anxiety, somatisation and quality of life. RESULTS Neurological diagnostic workup revealed organic and non-organic vertigo/dizziness in 80.8% and 19.2% of patients, respectively. In 48.8% of patients, SCID-I led to the diagnosis of a current psychiatric disorder, most frequently anxiety/phobic, somatoform and affective disorders. In the organic vertigo/dizziness group, 42.5% of patients, particularly those with vestibular paroxysmia or vestibular migraine, had a current psychiatric comorbidity. Patients with psychiatric comorbidity reported more vertigo-related handicaps, more depressive, anxiety and somatisation symptoms, and lower psychological quality of life compared with patients without psychiatric comorbidity. CONCLUSIONS Almost half of patients with vertigo/dizziness suffer from a psychiatric comorbidity. These patients show more severe psychosocial impairment compared with patients without psychiatric disorders. The worst combination, in terms of vertigo-related handicaps, is having non-organic vertigo/dizziness and psychiatric comorbidity. This phenomenon should be considered when diagnosing and treating vertigo/dizziness in the early stages of the disease.
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Affiliation(s)
- Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany Department of Clinical Neuroscience, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany Department of Neurology, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany Department of Neurology, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany Department of Neurology, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Annegret Eckhardt-Henn
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany
| | - Regina Feuerecker
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany Department of Neurology, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Gabriele Schmid
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany
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Fife TD, Kalra D. Persistent vertigo and dizziness after mild traumatic brain injury. Ann N Y Acad Sci 2015; 1343:97-105. [DOI: 10.1111/nyas.12678] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Terry D. Fife
- Barrow Neurological Institute; Phoenix Arizona
- Department of Neurology; University of Arizona College of Medicine; Phoenix Arizona
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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: 26] [Impact Index Per Article: 2.9] [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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Zur O, Schoen G, Dickstein R, Feldman J, Berner Y, Dannenbaum E, Fung J. Anxiety among individuals with visual vertigo and vestibulopathy. Disabil Rehabil 2015; 37:2197-202. [DOI: 10.3109/09638288.2014.1002577] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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