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Cengiz DU, İnceoğlu F, Karababa E, Polat AP, Yılmaz T, Kuntman BD, Men AF, Hızal E. Effects of the Kahramanmaras, Turkey 2023 earthquakes on balance perception, dizziness and post-traumatic stress: A relational screening model between subjective balance problems and post-traumatic stress. Auris Nasus Larynx 2024; 51:531-536. [PMID: 38522358 DOI: 10.1016/j.anl.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The aim of the present study was to investigate the effects of the February 6, 2023, earthquakes in Turkey and recurrent aftershocks on balance and post-traumatic stress in surviving victims. METHODS Our study included 1004 participants aged 18-65 years who were exposed to the February 6 earthquakes and aftershocks in Turkey. After obtaining online consent from all participants, the Vertigo Symptom Scale (VSS), the Dizziness Handicap Index (DHI), and the Posttraumatic Post-Traumatic Disorder Checklist Scale (PCL-5) were administered online, and the interactions between the variable sets were examined using a correlational screening model. RESULTS As a result of the structural equation model established with the observed variables, it was found that VSS total scores had a statistically significant positive effect on PCL-5 (β1 = 0.56; p = 0.001 < 0.05). In addition, statistically significant positive high-level correlations were found between VSS and DHI (covVSS-DHI = 0.71), and a positive low level correlation with the number of days with dizziness (covVSS-number of days with dizziness = 0.34), and a positive low level correlation with frequency of days with dizziness (covVSS-frequency of days with dizziness = 0.37). A statistically significant positive low-level relationship was found between DHI and the number of days with dizziness (covDHI-number of days with dizziness = 0.34) and a positive low-level correlation between DHI and the frequency of days with dizziness (covDHI-frequency of days with dizziness = 0.29). CONCLUSION The structural equation modeling analysis showed that post-traumatic stress disorder had a significant effect on balance and dizziness.
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Affiliation(s)
- Deniz Uğur Cengiz
- Inonu University, Faculty of Health Sciences, Department of Audiology, Malatya, Turkey
| | - Feyza İnceoğlu
- Malatya Turgut Ozal University, Faculty of Medicine, Department of Biostatistics, Malatya, Turkey
| | - Ercan Karababa
- University of Health Sciences, Department of Audiology, Ankara, Turkey
| | | | - Tuğba Yılmaz
- University of Health Sciences, Department of Audiology, Ankara, Turkey
| | | | - Asya Fatma Men
- University of Health Sciences, Department of Audiology, İstanbul, Turkey
| | - Evren Hızal
- University of Health Sciences, Department of Audiology, Ankara, Turkey
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Bozduman Çelebi S, Akdağ B. Post-earthquake dizziness and its psychiatric comorbidities among adolescents following the 2023 Kahramanmaraş earthquakes in Turkey. Auris Nasus Larynx 2024; 51:636-639. [PMID: 38626698 DOI: 10.1016/j.anl.2024.03.006] [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: 11/28/2023] [Revised: 02/22/2024] [Accepted: 03/14/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE Natural disasters, such as earthquakes, have detrimental effects on mental health. The occurrence of dizziness following earthquakes, termed post-earthquake dizziness syndrome (PEDS), has been noted in the epicenter and surrounding areas. The current study aimed to explore the prevalence of PEDS and its association with psychiatric disorders among adolescents. METHODS The sample consisted of 100 adolescents, aged 10-17 years, who had no history of vertigo or dizziness and were treated at a child and adolescent psychiatry outpatient clinic. RESULTS In the aftermath of the earthquake, 68.0% of the adolescents reported experiencing PEDS. A higher prevalence of PEDS was found among female adolescents compared to males. The most frequently reported symptom of PEDS was a sensation of ground shaking, typically experienced indoors within a week following the earthquake. Unpaired t-test analysis revealed that adolescents with PEDS had significantly higher scores on scales measuring panic disorder, generalized anxiety disorder, and post-traumatic stress disorder compared to those without PEDS. CONCLUSIONS In summary, the findings highlight the potential association between PEDS and psychiatric disorders in adolescents. However, the underlying mechanisms remain elusive, necessitating further research to elucidate the connections between PEDS and psychiatric conditions for more effective treatment strategies.
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Affiliation(s)
- Seda Bozduman Çelebi
- Department of Child and Adolescent Psychiatry, Adana City Training and Research Hospital, Adana, Turkey.
| | - Berhan Akdağ
- Department of Child and Adolescent Psychiatry, Silifke State Hospital, Mersin, Turkey
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Ichijo K, Oka M, Koda K, Kamogashira T, Kinoshita M, Kawahara T, Takashima I, Demura S, Yamasoba T, Fujimoto C. Analysis of postural stability using foam posturography in patients with persistent postural-perceptual dizziness. J Vestib Res 2024; 34:133-144. [PMID: 38073358 DOI: 10.3233/ves-230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND/OBJECTIVE Persistent postural-perceptual dizziness (PPPD) is worsened in a standing posture, or by body movement, or visual stimulation. We aimed to evaluate postural stability in PPPD patients using foam posturography and to investigate the dependence on visual and somatosensory input in the standing posture. METHODS Foam posturography was performed on 53 PPPD patients, and data from the PPPD patients were compared with the data from an age- and sex-matched healthy controls. The PPPD patients were divided into four groups based on the findings of vestibular function tests and the effect of vestibular function on posturographic data was examined. RESULTS Romberg's ratios were significantly higher in PPPD patients than in controls. The median Romberg's ratios in PPPD patients with normal vestibular function were also higher than those in controls. However, foam ratio was significantly lower in PPPD patients than in controls. The median foam ratios in PPPD patients with vestibular dysfunction were also lower than those in controls. CONCLUSIONS In a standing posture, PPPD patients may be more dependent on visual input and less dependent on somatosensory input than healthy subjects. Higher dependence on visual and lower dependence on somatosensory input in PPPD may be a feature unaffected by vestibular function.
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Affiliation(s)
- Kentaro Ichijo
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mineko Oka
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kento Koda
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Teru Kamogashira
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Ikumi Takashima
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinichi Demura
- Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chisato Fujimoto
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Balatková Z, Bonaventurová M, Černý R, Lisý J, Brennerová S, Koucký V, Bandúrová V, Svobodová V, Fík Z, Komarc M, Mrázková E, Kučerová K, Hermann P, Čada Z. Does vestibular function correlate with objective MRI findings after vestibular schwannoma surgery? ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:212-220. [PMID: 37204846 DOI: 10.14639/0392-100x-n2367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/15/2023] [Indexed: 05/20/2023]
Abstract
Objective Vestibular schwannoma surgery leads to acute unilateral vestibular loss. In some patients, however, the process of post-operatively initiated central compensation proceeds more rapidly than in others. This study aimed to evaluate post-operative vestibular function and correlate it with morphological findings of MRI scans. Methods The study included 29 patients who underwent surgery for vestibular schwannoma. Vestibular function was analysed post-operatively by video head impulse test (vHIT). Subjective symptoms were evaluated using validated questionnaires. All patients underwent MRI 3 months post-operatively, and the presence of the facial and vestibulocochlear nerves in the internal auditory canal was assessed. Results The vestibulo-ocular reflex gain measured by the vHIT correlated positively with audiological findings. Subjective perception of vestibular disorder did not correlate with objectively measured vestibular impairment or with MRI findings. Conclusions After the resection of vestibular schwannoma, some patients may still have preserved vestibular function as measured by vHIT. The preserved function does not correlate with subjective symptoms. Patients with partially deteriorated vestibular function showed lower sensitivity to combined stimuli.
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Affiliation(s)
- Zuzana Balatková
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Post-graduate Medical School, Prague, Czech Republic
| | - Markéta Bonaventurová
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Post-graduate Medical School, Prague, Czech Republic
| | - Rudolf Černý
- Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Post-graduate Medical School, Prague, Czech Republic
| | - Jiří Lisý
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Silvie Brennerová
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Post-graduate Medical School, Prague, Czech Republic
| | - Vladimír Koucký
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Post-graduate Medical School, Prague, Czech Republic
| | - Veronika Bandúrová
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Post-graduate Medical School, Prague, Czech Republic
| | - Veronika Svobodová
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Post-graduate Medical School, Prague, Czech Republic
| | - Zdeněk Fík
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Post-graduate Medical School, Prague, Czech Republic
| | - Martin Komarc
- Department of Anthropomotorics and Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Eva Mrázková
- Department of Otorhinolaryngology and Head and Neck Surgery, Havířov Hospital, Czech Republic
| | - Klára Kučerová
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Pavel Hermann
- Department of Otorhinolaryngology and Head and Neck Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zdeněk Čada
- Department of Otorhinolaryngology and Head and Neck Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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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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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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Gonzalez Eslait FJ, Escudero Triviño PA, Giraldo Vergara YV, Morales García MA, Lucero Gutiérrez VF. Implementation outcomes of a sensory integration therapy program with computerized dynamic posturography in patients with balance and sensory dysfunction. J Otol 2023; 18:26-32. [PMID: 36820156 PMCID: PMC9937828 DOI: 10.1016/j.joto.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Objective We describe the first-year implementation experience of an Instrumented Sensory Integration Therapy Program in Audiological & Balance Center patients. Design This is a retrospective descriptive study. Participants included Seventy-three adults with diagnoses of acute, episodic, or chronic vestibular syndromes. They were classified into the following two groups: group 1 included 46 individuals treated with ISIT plus VRT, and group 2 included 27 individuals treated only with ISIT. Results The Sensory Organization Test (SOT) for both groups showed a statistical significance for all three sensory inputs; visual systems (G1: p = 0.0003; G2: p = 0.0337), vestibular system (G1: p < 0.0001; G2: p = 0.0003), and balance as demonstrated by compound balance score (G1: p < 0.0001; G2: p = 0.0035), and balance percentage deficit (G1: p < 0.0001; G2: p = 0.0078). Conclusions The severity and complexity of functional neurological disorders in the context of vestibular syndromes seem to require between 10 and 20 therapy sessions, and combined ISIT plus VRT appears to be more effective than ISIT as a monotherapy.
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Affiliation(s)
| | - Paola Andrea Escudero Triviño
- Universidad del Valle, Audiological and Otological Balance Center, Imbanaco Clinic - Grupo Quirón Salud, Cali, Colombia
| | - Yaidy Viviana Giraldo Vergara
- Universidad del Valle, Audiological and Otological Balance Center, Imbanaco Clinic - Grupo Quirón Salud, Cali, Colombia
| | | | - Vanessa Fernanda Lucero Gutiérrez
- Universidad del Valle, Audiological and Otological Balance Center, Imbanaco Clinic - Grupo Quirón Salud, Cali, Colombia,Corresponding author. Vestibular Certified Physical Therapist. Audiological and Otological Balance Center, Imbanaco Clinic - Grupo Quirón Salud, Cali, Colombia.
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Gamble R, Sumner P, Wilson-Smith K, Derry-Sumner H, Rajenderkumar D, Powell G. Using interpretative phenomenological analysis to probe the lived experiences of persistent postural-perceptual dizziness (PPPD). J Vestib Res 2023; 33:89-103. [PMID: 36710692 PMCID: PMC10041438 DOI: 10.3233/ves-220059] [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: 05/20/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Persistent Postural-Perceptual Dizziness (PPPD) is a chronic neuro-vestibular condition characterised by subjective dizziness, non-spinning vertigo, and postural imbalance. Symptoms are typically induced by situations of visuo-vestibular conflict and intense visual-motion. OBJECTIVE Little research has focused on the lived experiences of people with PPPD. Therefore, our objective was to present an in-depth exploration of patient experiences and sense-making, and the effect of PPPD on psycho-social functioning. METHODS We conducted semi-structured interviews with 6 people with PPPD, who were recruited from an Audiovestibular department in Wales. We present a case-by-case Interpretive Phenomenological Analysis (IPA) for each participant and present common themes. RESULTS Our analysis revealed a range of superordinate and subordinate themes, individualised to each participant, but broadly described under the following headings: dismissal and non-belief, identity loss, dissociative experiences, poor psychological well-being and processes of sense-making. CONCLUSION The qualitative experiences documented in this study will help clinicians and researchers to better understand the lived experiences of PPPD, how PPPD patients make sense of their symptoms, and the psycho-social impacts of the condition.
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Affiliation(s)
- Ryan Gamble
- School of Psychology, Cardiff University, Cardiff, UK
| | - Petroc Sumner
- School of Psychology, Cardiff University, Cardiff, UK
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Elkjær E, Mikkelsen MB, Michalak J, Mennin DS, O'Toole MS. Motor alterations in depression and anxiety disorders: A systematic review and meta-analysis. J Affect Disord 2022; 317:373-387. [PMID: 36037990 DOI: 10.1016/j.jad.2022.08.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 05/19/2022] [Accepted: 08/21/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Psychomotor retardation has long been recognized as a major feature of depression, and anxiety disorders have been linked with freeze and flight motor responses. This systematic review and meta-analysis aimed a) to synthesize available evidence of motor alterations comparing individuals with depression and anxiety disorders to healthy individuals and b) to evaluate the effect of experimental manipulations of motor displays within these clinical groups. METHOD The databases PubMed and PsycINFO were searched for studies either assessing motor differences between clinical and healthy control groups or manipulating the motor system within a clinical group. RESULTS The literature search yielded 87 relevant papers, comprising 82 studies comparing a clinical group to a healthy group and 5 studies investigating motor manipulations within a clinical sample. The results of the meta-analysis (K = 71) indicated a statistically significant combined estimate of differences between healthy and clinical groups (g = 0.38 [0.31, 0.45], adjusted for publication bias g = 0.26 [0.19, 0.33]) of a small size. This effect did not vary according to type of disorder (anxiety vs. depression, p = .468). From a narrative review of experimental studies within clinical groups, four out of five studies reported statistically significant effects of manipulating the motor system on affective outcomes. DISCUSSION This synthesis adds to the accumulating empirical evidence of motor alterations in depression and anxiety disorders. Future research will need to investigate how individuals suffering from depression or anxiety disorders could benefit from psychological, behavioral, and physical interventions directly aimed at the motor system.
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Affiliation(s)
- Emma Elkjær
- Department for Psychology and Behavioral Sciences, Aarhus University, Denmark.
| | - Mai B Mikkelsen
- Department for Psychology and Behavioral Sciences, Aarhus University, Denmark
| | - Johannes Michalak
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Germany
| | - Douglas S Mennin
- Department of Psychology, Teachers College, Columbia University, New York, NY, United States of America
| | - Mia S O'Toole
- Department for Psychology and Behavioral Sciences, Aarhus University, Denmark.
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Pharmacological Properties of Jaeumgeonbi-Tang on Redox System and Stress-Related Hormones in Chronic Subjective Dizziness: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Trial. Pharmaceuticals (Basel) 2022; 15:ph15111375. [PMID: 36355547 PMCID: PMC9696700 DOI: 10.3390/ph15111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022] Open
Abstract
Jaeumgeonbi-Tang (JGT), a traditional herbal medicine, has been used to treat dizziness and vertigo in Korea and China for hundreds of years. The purpose of this study was to evaluate the pharmacological properties of JGT in chronic subjective dizziness (CSD) patients. A randomized, double-blind, parallel-group and placebo-controlled trial was performed with a total of 50 CSD patients. The patients were randomly assigned to one of two groups: JGT or placebo (n = 25 for each). All participants received the treatment (placebo or JGT, 24 g/day) for 4 weeks. We analyzed the serum levels of oxidative stressors, antioxidants, and stress hormones. Serum levels of lipid peroxidation, but not nitric oxide, were significantly decreased in the JGT group. JGT not only prevented the decline of serum total glutathione contents and total antioxidant capacity, but it also increased superoxide dismutase and catalase activities. Serum levels of stress hormones including cortisol, adrenaline, and serotonin were notably normalized by JGT treatment, but noradrenaline levels were not affected. Regarding the safety and tolerability of JGT, we found no allergic, adverse, or side effects in any of the participants. JGT showed beneficial effects on CSD patients by improving redox status and balancing psycho-emotional stress hormones.
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Persistent Postural Perceptual Dizziness in Episodic Vestibular Disorders. Audiol Res 2022; 12:589-595. [PMID: 36412653 PMCID: PMC9680392 DOI: 10.3390/audiolres12060058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022] Open
Abstract
Benign Paroxysmal Positional Vertigo (BPPV), Vestibular Migraine (VM), and Meniere Disease (MD) are among the most common episodic vestibulopathies. Persistent Postural Perceptual Dizziness (PPPD) is a chronic functional vestibular disorder that can arise in patients suffering from one or more of these conditions. We analyzed the role of these vestibular disorders as single or multiple associated comorbidities and as a precipitating condition for PPPD. A total of 376 patients suffering from dizziness with a known history of single or multiple vestibular disorders were preliminarily evaluated. We conducted a careful anamnesis to determine whether the reported dizziness could meet the diagnostic criteria for PPPD. PPPD was diagnosed in 24 cases; its incidence in patients with history of a single comorbidity or multiple vestibular comorbidities was 3.9% and 22.4%, respectively. BPPV, VM, and MD were identified as a precipitating condition in 2.34%, 16.45%, and 3.92%, respectively. BPPV constituted a precipitating condition mainly at the first episode. We observed that the presence of multiple vestibular comorbidities (BPPV, VM, and MD) in patients' clinical history increased the risk of PPPD. VM plays a significant role in representing a precipitating condition for PPPD, both when present individually or in association with the other vestibular disorders.
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The Walls Are Closing In: Postural Responses to a Virtual Reality Claustrophobic Simulation. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Changes in the visual environment and thereby, the spatial orientation, can induce postural instability leading to falls. Virtual reality (VR) has been used to expose individuals to virtual environments (VE) that increase postural threats. Claustrophobia is an anxiety disorder categorized under situational phobias and can induce such postural threats in a VE. Purpose: The purpose of the study was to investigate if VR-generated claustrophobic simulation has any impact on postural threats that might lead to postural instability. Methods: Thirty healthy men and women (age: 20.7 ± 1.2 years; height: 166.5 ± 7.3 cm; mass: 71.7 ± 16.2 kg) were tested for postural stability while standing on a force platform, upon exposure to five different testing trials, including a normal stance (NoVR), in stationary VE (VR), and three consecutive, randomly initiated, unexpected claustrophobia trials (VR CP1, VR CP2, VR CP3). The claustrophobia trials involved all four walls closing in towards the center of the room. Center of pressure (COP)-derived postural sway variables were analyzed with a one-way repeated measures analysis of variance at an alpha level of 0.05. Results: Significant main effect differences existed in all but one dependent COP-derived postural sway variables, at p < 0.05. Post-hoc pairwise comparisons with a Bonferroni correction revealed that, predominantly, postural sway excursions were significantly lower in claustrophobia trials compared to NoVR and VR, but only accomplished with significantly increased sway velocity. Conclusion: The VR CP trials induced lower postural sway magnitude, but with increased velocity, suggesting a bracing and co-contraction strategy when exposed to virtual claustrophobic postural threats. Additionally, postural sway decreased with subsequent claustrophobia trials, suggesting potential motor learning effects. Findings from the study offer insights to postural control behavior under virtual claustrophobic simulations and can aid in VR exposure therapy for claustrophobia.
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Singh K, García-Gomar MG, Cauzzo S, Staab JP, Indovina I, Bianciardi M. Structural connectivity of autonomic, pain, limbic, and sensory brainstem nuclei in living humans based on 7 Tesla and 3 Tesla MRI. Hum Brain Mapp 2022; 43:3086-3112. [PMID: 35305272 PMCID: PMC9188976 DOI: 10.1002/hbm.25836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 11/18/2022] Open
Abstract
Autonomic, pain, limbic, and sensory processes are mainly governed by the central nervous system, with brainstem nuclei as relay centers for these crucial functions. Yet, the structural connectivity of brainstem nuclei in living humans remains understudied. These tiny structures are difficult to locate using conventional in vivo MRI, and ex vivo brainstem nuclei atlases lack precise and automatic transformability to in vivo images. To fill this gap, we mapped our recently developed probabilistic brainstem nuclei atlas developed in living humans to high‐spatial resolution (1.7 mm isotropic) and diffusion weighted imaging (DWI) at 7 Tesla in 20 healthy participants. To demonstrate clinical translatability, we also acquired 3 Tesla DWI with conventional resolution (2.5 mm isotropic) in the same participants. Results showed the structural connectome of 15 autonomic, pain, limbic, and sensory (including vestibular) brainstem nuclei/nuclei complex (superior/inferior colliculi, ventral tegmental area‐parabrachial pigmented, microcellular tegmental–parabigeminal, lateral/medial parabrachial, vestibular, superior olivary, superior/inferior medullary reticular formation, viscerosensory motor, raphe magnus/pallidus/obscurus, parvicellular reticular nucleus‐alpha part), derived from probabilistic tractography computation. Through graph measure analysis, we identified network hubs and demonstrated high intercommunity communication in these nuclei. We found good (r = .5) translational capability of the 7 Tesla connectome to clinical (i.e., 3 Tesla) datasets. Furthermore, we validated the structural connectome by building diagrams of autonomic/pain/limbic connectivity, vestibular connectivity, and their interactions, and by inspecting the presence of specific links based on human and animal literature. These findings offer a baseline for studies of these brainstem nuclei and their functions in health and disease, including autonomic dysfunction, chronic pain, psychiatric, and vestibular disorders.
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Affiliation(s)
- Kavita Singh
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - María Guadalupe García-Gomar
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Escuela Nacional de Estudios Superiores, Juriquilla, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Simone Cauzzo
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Life Sciences Institute, Sant'Anna School of Advanced Studies, Pisa, Italy.,Research Center E. Piaggio, University of Pisa, Pisa, Italy
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Iole Indovina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy.,Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marta Bianciardi
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Sleep Medicine, Harvard University, Boston, Massachusetts, USA
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14
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Cauzzo S, Singh K, Stauder M, García-Gomar MG, Vanello N, Passino C, Staab J, Indovina I, Bianciardi M. Functional connectome of brainstem nuclei involved in autonomic, limbic, pain and sensory processing in living humans from 7 Tesla resting state fMRI. Neuroimage 2022; 250:118925. [PMID: 35074504 DOI: 10.1016/j.neuroimage.2022.118925] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/24/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
Despite remarkable advances in mapping the functional connectivity of the cortex, the functional connectivity of subcortical regions is understudied in living humans. This is the case for brainstem nuclei that control vital processes, such as autonomic, limbic, nociceptive and sensory functions. This is because of the lack of precise brainstem nuclei localization, of adequate sensitivity and resolution in the deepest brain regions, as well as of optimized processing for the brainstem. To close the gap between the cortex and the brainstem, on 20 healthy subjects, we computed a correlation-based functional connectome of 15 brainstem nuclei involved in autonomic, limbic, nociceptive, and sensory function (superior and inferior colliculi, ventral tegmental area-parabrachial pigmented nucleus complex, microcellular tegmental nucleus-prabigeminal nucleus complex, lateral and medial parabrachial nuclei, vestibular and superior olivary complex, superior and inferior medullary reticular formation, viscerosensory motor nucleus, raphe magnus, pallidus, and obscurus, and parvicellular reticular nucleus - alpha part) with the rest of the brain. Specifically, we exploited 1.1mm isotropic resolution 7 Tesla resting-state fMRI, ad-hoc coregistration and physiological noise correction strategies, and a recently developed probabilistic template of brainstem nuclei. Further, we used 2.5mm isotropic resolution resting-state fMRI data acquired on a 3 Tesla scanner to assess the translatability of our results to conventional datasets. We report highly consistent correlation coefficients across subjects, confirming available literature on autonomic, limbic, nociceptive and sensory pathways, as well as high interconnectivity within the central autonomic network and the vestibular network. Interestingly, our results showed evidence of vestibulo-autonomic interactions in line with previous work. Comparison of 7 Tesla and 3 Tesla findings showed high translatability of results to conventional settings for brainstem-cortical connectivity and good yet weaker translatability for brainstem-brainstem connectivity. The brainstem functional connectome might bring new insight in the understanding of autonomic, limbic, nociceptive and sensory function in health and disease.
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Affiliation(s)
- Simone Cauzzo
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Life Sciences Institute, Sant'Anna School of Advanced Studies, Pisa, Italy.
| | - Kavita Singh
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Matthew Stauder
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - María Guadalupe García-Gomar
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Nicola Vanello
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, Pisa, Italy
| | - Claudio Passino
- Life Sciences Institute, Sant'Anna School of Advanced Studies, Pisa, Italy; Dipartimento di Ingegneria dell'Informazione, University of Pisa, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Jeffrey Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Iole Indovina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy; Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marta Bianciardi
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Sleep Medicine, Harvard University, Boston, MA.
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15
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Waterston J, Chen L, Mahony K, Gencarelli J, Stuart G. Persistent Postural-Perceptual Dizziness: Precipitating Conditions, Co-morbidities and Treatment With Cognitive Behavioral Therapy. Front Neurol 2022; 12:795516. [PMID: 35027907 PMCID: PMC8749949 DOI: 10.3389/fneur.2021.795516] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
Persistent postural perceptual dizziness (PPPD) is a common chronic vestibular disorder characterized by persistent vestibular symptoms, including postural instability and non-spinning vertigo, which is aggravated by motion, upright posture and moving or complex visual stimuli. In our review of 198 cases seen over a 5 year period, we have confirmed a number of common precipitating conditions for PPPD, including anxiety disorders and vestibular migraine. Vestibular abnormalities, including a unilateral loss of vestibular hypofunction and isolated otolith abnormalities, were found on investigation in just under half the cases. The use of cognitive behavioral therapy (CBT) as a treatment for PPPD resulted in impressive reductions in anxiety and measures of dizziness over follow up periods of up to 6 months.
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Affiliation(s)
- John Waterston
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Oto-Neurology Department, Alfred Hospital, Melbourne, VIC, Australia
| | - Luke Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Oto-Neurology Department, Alfred Hospital, Melbourne, VIC, Australia
| | - Kate Mahony
- Private Practice, Lyttleton Street Medical Clinic, Castlemaine, VIC, Australia
| | - Jamila Gencarelli
- Oto-Neurology Department, Alfred Hospital, Melbourne, VIC, Australia
| | - Geoff Stuart
- Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia.,School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
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16
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Persistent Postural-Perceptual Dizziness Interventions—An Embodied Insight on the Use Virtual Reality for Technologists. ELECTRONICS 2022. [DOI: 10.3390/electronics11010142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Persistent and inconsistent unsteadiness with nonvertiginous dizziness (persistent postural-perceptual dizziness (PPPD)) could negatively impact quality of life. This study highlights that the use of virtual reality (VR) systems offers bimodal benefits to PPPD, such as understanding symptoms and providing a basis for treatment. The aim is to develop an understanding of PPPD and its interventions, including current trends of VR involvement to extrapolate and re-evaluate VR design strategies. Therefore, recent virtual-reality-based research work that progressed in understanding PPPD is identified, collected, and analysed. This study proposes a novel approach to the understanding of PPPD, specifically for VR technologists, and examines the principles of effectively aligning VR development for PPPD interventions.
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17
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Powell G, Penacchio O, Derry-Sumner H, Rushton SK, Rajenderkumar D, Sumner P. Visual stress responses to static images are associated with symptoms of Persistent Postural Perceptual Dizziness (PPPD). J Vestib Res 2022; 32:69-78. [PMID: 34151873 DOI: 10.3233/ves-190578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Images that deviate from natural scene statistics in terms of spatial frequency and orientation content can produce visual stress (also known as visual discomfort), especially for migraine sufferers. These images appear to over-activate the visual cortex. OBJECTIVE To connect the literature on visual discomfort with a common chronic condition presenting in neuro-otology clinics known as persistent postural perceptual dizziness (PPPD). Patients experience dizziness when walking through highly cluttered environments or when watching moving stimuli. This is thought to arise from maladaptive interaction between vestibular and visual signals for balance. METHODS We measured visual discomfort to stationary images in patients with PPPD (N = 30) and symptoms of PPPD in a large general population cohort (N = 1858) using the Visual Vertigo Analogue Scale (VVAS) and the Situational Characteristics Questionnaire (SCQ). RESULTS We found that patients with PPPD, and individuals in the general population with more PPPD symptoms, report heightened visual discomfort to stationary images that deviate from natural spectra (patient comparison, F (1, 1865) = 29, p < 0.001; general population correlations, VVAS, rs (1387) = 0.46, p < 0.001; SCQ, rs (1387) = 0.39, p < 0.001). These findings were not explained by co-morbid migraine. Indeed, PPPD symptoms showed a significantly stronger relationship with visual discomfort than did migraine (VVAS, zH = 8.81, p < 0.001; SCQ, zH = 6.29, p < 0.001). CONCLUSIONS We speculate that atypical visual processing -perhaps due to a visual cortex more prone to over-activation -may predispose individuals to PPPD, possibly helping to explain why some patients with vestibular conditions develop PPPD and some do not.
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Affiliation(s)
- Georgina Powell
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Olivier Penacchio
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
| | - Hannah Derry-Sumner
- Department of Audiovestibular Medicine, University Hospital of Wales, Cardiff, UK
| | - Simon K Rushton
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Deepak Rajenderkumar
- Department of Audiovestibular Medicine, University Hospital of Wales, Cardiff, UK
| | - Petroc Sumner
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
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18
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Coto J, Alvarez CL, Cejas I, Colbert BM, Levin BE, Huppert J, Rundek T, Balaban C, Blanton SH, Lee DJ, Loewenstein D, Hoffer M, Liu XZ. Peripheral vestibular system: Age-related vestibular loss and associated deficits. J Otol 2021; 16:258-265. [PMID: 34548873 PMCID: PMC8438634 DOI: 10.1016/j.joto.2021.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Given the interdependence of multiple factors in age-related vestibular loss (e.g., balance, vision, cognition), it is important to examine the individual contributions of these factors with ARVL. While the relationship between the vestibular and visual systems has been well studied (Bronstein et al., 2015), little is known about the association of the peripheral vestibular system with neurodegenerative disorders (Cronin et al., 2017). Further, emerging research developments implicate the vestibular system as an opportunity for examining brain function beyond balance, and into other areas, such as cognition and psychological functioning. Additionally, the bidirectional impact of psychological functioning is understudied in ARVL. Recognition of ARVL as part of a multifaceted aging process will help guide the development of integrated interventions for patients who remain at risk for decline. In this review, we will discuss a wide variety of characteristics of the peripheral vestibular system and ARVL, how it relates to neurodegenerative diseases, and correlations between ARVL and balance, vision, cognitive, and psychological dysfunction. We also discuss clinical implications as well as future directions for research, with an emphasis on improving care for patients with ARVL.
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Affiliation(s)
- Jennifer Coto
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | | | - Ivette Cejas
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Brett M. Colbert
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
- Medical Scientist Training Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie E. Levin
- University of Miami Miller School of Medicine, Department of Neurology and the Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Joshua Huppert
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Tatjana Rundek
- University of Miami Miller School of Medicine, Department of Neurology and the Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Carey Balaban
- University of Pittsburgh, Departments of Otolaryngology, Neurobiology, Communication Sciences & Disorders, and Bioengineering, Pittsburgh, PA, USA
| | - Susan H. Blanton
- University of Miami Miller School of Medicine, Dr. John T. Macdonald Department of Human Genetics, Miami, FL, USA
| | - David J. Lee
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL, USA
| | - David Loewenstein
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA
| | - Michael Hoffer
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Xue Zhong Liu
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
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19
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Johkura K, Takahashi K, Kudo Y, Soma T, Asakawa S, Hasegawa N, Imamichi S, Kurihara K. Cerebral perfusion changes in chronic dizziness: A single-photon emission computed tomography study. eNeurologicalSci 2021; 25:100367. [PMID: 34504962 PMCID: PMC8413887 DOI: 10.1016/j.ensci.2021.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/08/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background and purpose Dizziness may persist even after the causative vestibular imbalance subsides. Although the precise mechanism of chronic dizziness is unknown, various cerebral activity changes associated with it have been reported. To understand its mechanism in the absence of the causative vestibular imbalance, we compared cerebral changes in chronic dizziness with and without persistent vestibular imbalance. Methods Between September 2014 and March 2020, we examined regional cerebral blood flow (rCBF) in 12 patients having chronic post-lateral medullary infarction dizziness with persistent brainstem vestibular imbalance and 23 patients having chronic dizziness without currently active vestibular imbalance using single-photon emission computed tomography (SPECT) with 99m Technetium-ethyl cysteinate dimer. Further, we analyzed the SPECT images using a voxel-based group comparison. Results We observed a decreased rCBF in the occipital lobe and increased rCBF in the medial and inferior parts of the temporal lobe in patients having chronic dizziness with and without active vestibular imbalance compared to healthy controls. However, only patients having chronic dizziness without active vestibular imbalance exhibited increased rCBF in the frontal lobe, including the orbitofrontal cortex. Conclusion This is the first study to highlight the difference in rCBF changes between patients having chronic dizziness with and without active vestibular imbalance. Decreased occipital lobe activity and increased medial and inferior temporal lobe activity may be related to keeping dizziness perception triggered regardless of the presence or absence of active vestibular imbalance, whereas increased frontal lobe activity may explain the dizziness background to persist after the disappearance of vestibular imbalance. Dizziness may persist even when the causative vestibular imbalance (VI) subsided. Changes in cerebral activity are associated with chronic dizziness (CD). We compared cerebral activity changes in CD patients with and without VI. Regional cerebral blood flow differs in CD patients with and without VI. Cerebral activity changes either can be associated with CD or can trigger CD.
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Affiliation(s)
- Ken Johkura
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Koji Takahashi
- Department of Clinical Laboratory, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Yosuke Kudo
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Tsutomu Soma
- RI Software Development Group, Quality Assurance Dept, Quality, Safety Management & Regulatory Affairs Div. FUJIFILM Toyama Chemical Co., Ltd., Japan.,Department of Nuclear Medicine and Medical Physics, International University of Health and Welfare School of Medicine, Japan
| | - Shinobu Asakawa
- Department of Radiology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Nami Hasegawa
- Department of Radiology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Shizuho Imamichi
- Department of Radiology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Kiyokazu Kurihara
- Department of Radiology, Yokohama Brain and Spine Center, Yokohama, Japan
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20
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Tropiano P, Lacerenza LM, Agostini G, Barboni A, Faralli M. Persistent postural perceptual dizziness following paroxysmal positional vertigo in migraine. ACTA ACUST UNITED AC 2021; 41:263-269. [PMID: 34264920 PMCID: PMC8283405 DOI: 10.14639/0392-100x-n1017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022]
Abstract
Objective This prospective study aimed to investigate the role of migraine in favouring the onset of persistent postural perceptual dizziness (PPPD) following paroxysmal positional vertigo (PPV). Methods A group of patients who came to our attention suffering of PPV with or without migraine and/or vestibular migraine (VM) was examined. Three months after the resolution, an anamnestic research was conducted aimed at establishing whether any patient-related dizziness could meet the diagnostic criteria for PPPD. Results 12 of the 240 patients recruited met the diagnostic criteria for PPPD for an overall incidence of 5%, with 3 (1.85%) belonging to the non-migraine group and 9 (11.5%) to the migraine group. In the latter, 6 (28.6%) patients with VM and 3 (5.26%) without VM were affected. Conclusions The study shows a significant increase of PPPD diagnosis in migraine compared to patients without migraine (p = 0.003). Within migraine there was a significant increase in those with VM compared to patients without VM (p = 0.0016). No difference emerged between patients without migraine and migraine patients without VM (p > 0.05). The presence of VM in patient’s history, but not migraine without VM, appears to significantly increase the incidence of PPPD in patients with PPV.
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Affiliation(s)
- Paolo Tropiano
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Luca Maria Lacerenza
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Giovanni Agostini
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Annalisa Barboni
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Mario Faralli
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
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21
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D'Silva LJ, Chalise P, Obaidat S, Rippee M, Devos H. Oculomotor Deficits and Symptom Severity Are Associated With Poorer Dynamic Mobility in Chronic Mild Traumatic Brain Injury. Front Neurol 2021; 12:642457. [PMID: 34381408 PMCID: PMC8350131 DOI: 10.3389/fneur.2021.642457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Oculomotor deficits, vestibular impairments, and persistent symptoms are common after a mild traumatic brain injury (mTBI); however, the relationship between visual-vestibular deficits, symptom severity, and dynamic mobility tasks is unclear. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI, who were between 3 months to 2 years post-injury were compared with 23 age and sex-matched controls. Oculomotor deficits [depth perception, near-point convergence, baseline visual acuity (BLVA), perception time], vestibular deficits (dynamic visual acuity in the pitch and yaw planes), dynamic mobility measured by the Functional Gait Assessment (FGA), and symptoms measured by the Post-Concussion Symptom Scale (PCSS) and Dizziness Handicap Inventory (DHI) were compared between groups. Participants with mTBI had poorer performance on the FGA (p < 0.001), higher symptom severity on the PCSS (p < 0.001), and higher DHI scores (p < 0.001) compared to controls. Significant differences were seen on specific items of the FGA between individuals with mTBI and controls during walking with horizontal head turns (p = 0.002), walking with vertical head tilts (p < 0.001), walking with eyes closed (p = 0.003), and stair climbing (p = 0.001). FGA performance was correlated with weeks since concussion (r = −0.67, p < 0.001), depth perception (r = −0.5348, p < 0.001), near point convergence (r = −0.4717, p = 0.001), baseline visual acuity (r = −0.4435, p = 0.002); as well as with symptoms on the PCSS (r = −0.668, p < 0.001), and DHI (r = −0.811, p < 0.001). Dynamic balance deficits persist in chronic mTBI and may be addressed using multifaceted rehabilitation strategies to address oculomotor dysfunction, post-concussion symptoms, and perception of handicap due to dizziness.
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Affiliation(s)
- Linda J D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Prabhakar Chalise
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, MO, United States
| | - Sakher Obaidat
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Health System, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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22
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Limburg K, Radziej K, Sattel H, Henningsen P, Dieterich M, Probst T, Dale R, Lahmann C. A Randomized Controlled Trial Evaluating Integrative Psychotherapeutic Group Treatment Compared to Self-Help Groups in Functional Vertigo/Dizziness. J Clin Med 2021; 10:jcm10102215. [PMID: 34065517 PMCID: PMC8161006 DOI: 10.3390/jcm10102215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
We tested the efficacy of an integrative psychotherapeutic group treatment (IPGT) in reducing vertigo/dizziness-related impairment along with depression, anxiety, and somatization by conducting a randomized controlled superiority trial comparing IPGT to self-help groups moderated by a clinical psychologist (SHG). Adult patients with functional vertigo and dizziness symptoms were randomly allocated to either the IPGT or SHG as active control group. Outcomes were assessed at baseline (t0), after treatment lasting 16 weeks (t1), and 12 months after treatment (t2). A total of 81 patients were assigned to IPGT and 78 patients were assigned to SHG. Vertigo-related impairment was reduced in both conditions (IPGT: t0–t1: d = 1.10, t0–t2: d = 1.06; SHG: t0–t1: d = 0.86, t0–t2: d = 1.29), showing the efficiency of both IPGT and SHG. Clinically relevant improvements were also obtained for depression in both groups. Linear mixed model analyses revealed no differences between groups for all outcomes (effect of group for the primary outcome: b = −1.15, SE = 2.13, t = −0.54, p = 0.59). Attrition rates were higher in SHG (52.6%) than in IPGT (28.4%). Both conditions improved primary and secondary outcomes while IPGT was better accepted by patients than SHG. Trial registration: ClinicalTrials.gov, Identifier: NCT02320851.
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Affiliation(s)
- Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany; (K.R.); (H.S.); (P.H.)
- Correspondence: (K.L.); (C.L.); Tel.: +49-761-270-68060 (C.L.)
| | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany; (K.R.); (H.S.); (P.H.)
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany; (K.R.); (H.S.); (P.H.)
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany; (K.R.); (H.S.); (P.H.)
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, University Hospital, 81377 Munich, Germany;
- Department of Neurology, Ludwig-Maximilians-University, University Hospital, 81677 Munich, Germany
- Cluster of Systems Neurology-SyNergy, 81377 Munich, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (T.P.); (R.D.)
| | - Rachel Dale
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (T.P.); (R.D.)
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, 79104 Freiburg, Germany
- Correspondence: (K.L.); (C.L.); Tel.: +49-761-270-68060 (C.L.)
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Yagi C, Morita Y, Kitazawa M, Yamagishi T, Ohshima S, Izumi S, Takahashi K, Horii A. Subtypes of Persistent Postural-Perceptual Dizziness. Front Neurol 2021; 12:652366. [PMID: 33935950 PMCID: PMC8085253 DOI: 10.3389/fneur.2021.652366] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Persistent postural-perceptual dizziness (PPPD) is a persistent chronic vestibular syndrome exacerbated by upright posture/walking, active or passive motion, and exposure to moving or complex visual stimuli. PPPD has four precursors: phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness. These four diseases share clinical features that form the basis of the diagnostic criteria for PPPD. Semiological similarities do not necessarily mean that PPPD is a single entity. However, if PPPD is not a single disorder but just a composite of four precursors, it may be subdivided according to the characteristics of each precursor. Objective: To test whether PPPD is a single disorder, we attempted a subtyping of PPPD. Methods: One-hundred-eight untreated patients with PPPD were enrolled in the study, who filled out the Niigata PPPD Questionnaire (NPQ) that consists of 12 questions on exacerbating factors for PPPD. A factor analysis of the patients' answers to the NPQ and a subsequent cluster analysis of the patients with PPPD using factors revealed by the factor analysis were performed. To validate our cluster classification, cluster differences were assessed using analysis of variance. Multiple comparison analyses were performed on demographical data, precipitating diseases, the Dizziness Handicap Inventory, the Hospital Anxiety and Depression Scale, and several vestibular tests to characterize each cluster. Results: Factor analysis revealed three underlying factors among the exacerbating factors in the NPQ. Exacerbation by visual stimuli (visual factor) accounted for 47.4% of total variance in the questionnaire. Exacerbation by walking/active motion (active-motion factor) and by passive motion/standing (passive-motion/standing factor) accounted for 12.0 and 7.67% of variance, respectively. Cluster analysis revealed three clusters: the visual-dominant subtype (n = 49); the active motion-dominant subtype (n = 20); and the mixed subtype (n = 39). The patients in the active motion-dominant subtype were significantly older than those in the visual-dominant subtype. There were no significant differences among the subtypes in other demographical data or conventional vestibular tests. Conclusions: The most common main exacerbating factor of PPPD was the visual factor. PPPD may be categorized into three subtypes. Conventional vestibular tests failed to point the characteristics of each subtype.
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Affiliation(s)
- Chihiro Yagi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuka Morita
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Meiko Kitazawa
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Yamagishi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shinsuke Ohshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shuji Izumi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kuniyuki Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Li K, Si L, Cui B, Ling X, Shen B, Yang X. Altered spontaneous functional activity of the right precuneus and cuneus in patients with persistent postural-perceptual dizziness. Brain Imaging Behav 2021; 14:2176-2186. [PMID: 31313022 DOI: 10.1007/s11682-019-00168-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder, and is the most common cause of chronic vestibular syndrome. However, the pathogenesis of PPPD is currently unclear. This study aimed to analyze the changes of brain spontaneous functional activities in PPPD patients during the resting state, and to explore the underlying pathogenesis of PPPD, particularly the abnormal integration of visual and vestibular information. Ten PPPD patients and 10 healthy controls were enrolled from January to June 2018, and baseline data were collected from all subjects. Videonystagmography (VNG), the vestibular caloric test, the video head impulse test (vHIT) and vestibular evoked myogenic potentials (VEMPs) were measured to exclude peripheral vestibular lesions. Functional MRI (fMRI) was conducted in PPPD patients and healthy controls. The amplitude of low frequency fluctuation (ALFF) and regional homogeneity (ReHo), and functional connectivity were calculated to explore changes in brain spontaneous functional activity during the resting state. Compared with healthy controls, ALFF and ReHo values in the right precuneus and cuneus were significantly lower in PPPD patients (both P < 0.05). Further seed-based functional connectivity analysis showed decreased functional connectivity between precuneus, cuneus and left precentral gyrus (P < 0.05). Our findings suggest that the spontaneous functional activity of cuneus and precuneus in PPPD patients were altered, potentially leading to abnormal integration of visual and vestibular information. Weakened functional connectivity between the precuneus and the precentral gyrus may be associated with aggravated symptoms during upright posture, active or passive movements.
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Affiliation(s)
- Kangzhi Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Lihong Si
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Bin Cui
- Department of Radiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Xia Ling
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Bo Shen
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, People's Republic of China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China.
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Abstract
PURPOSE OF REVIEW Conditions causing recurrent spontaneous episodes of dizziness or vertigo span several medical specialties, making it challenging for clinicians to gain confidence in evaluating and managing the spectrum of episodic vestibular disorders. Patients are often asymptomatic and have normal examinations at the time of evaluation. Thus, diagnosis depends heavily on eliciting key features from the history. Overreliance on symptom quality descriptions commonly leads to misdiagnosis. The goal of this article is to provide the reader with a straightforward approach to the diagnosis and management of conditions that cause episodic spontaneous dizziness. RECENT FINDINGS Consensus diagnostic criteria have been established for vestibular migraine, Ménière disease, vestibular paroxysmia, and hemodynamic orthostatic dizziness/vertigo. Vertigo has been recognized as a common symptom in vertebrobasilar ischemia, cardiogenic dizziness, and orthostatic hypotension. Treatment recommendations for vestibular migraine still lack high-quality evidence, but controlled trials are occurring. SUMMARY The evaluation should start with a detailed description of the episodes from the patient and any observers. Rather than focusing first on whether the symptom quality is most consistent with vertigo, dizziness, lightheadedness, or unsteadiness, the clinician should clarify the timing (episode frequency and duration), possible triggers or circumstances (eg, position changes, upright posture), and accompanying symptoms. History should identify any auditory symptoms, migraine features, posterior circulation ischemic symptoms, vascular risk factors, clues for anxiety, and potentially relevant medications. Carefully selected testing can help secure the diagnosis, but excessive and indiscriminate testing can lead to more confusion. Treatments for these conditions are vastly different, so an accurate diagnosis is critical.
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Miwa T. Vestibular Function After the 2016 Kumamoto Earthquakes: A Retrospective Chart Review. Front Neurol 2021; 11:626613. [PMID: 33551981 PMCID: PMC7864085 DOI: 10.3389/fneur.2020.626613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022] Open
Abstract
This retrospective chart review aimed to examine both the vestibular function and causes of dizziness experienced by individuals following a series of major earthquakes and repetitive aftershocks. All patients with balance disorders who experienced the 2016 Kumamoto earthquakes and their aftershocks completed questionnaires relevant to balance disorders and were enrolled in this study after providing informed consent. There were 2.8 times more patients with balance disorders post the earthquake. Anxiety (P = 0.02), orthostatic dysregulation (P = 0.005), and motion sickness scores (P = 0.03) were all significantly higher after the earthquakes. A subset of participants underwent clinical equilibrium testing, showing significant deteriorations in the equilibrium test results (stabilometry: P = 0.01), cervical vestibular-evoked myogenic potentials (P = 0.04), and head-up tilt (P = 0.03) after the earthquake. The findings of this study also suggest that earthquake-induced disequilibrium may be further influenced by physical stressors, including sensory disruptions induced by earthquake vibrations, changes in the living conditions, and autonomic stress. This study increases our understanding of human equilibrium in response to natural disasters. Moreover, these findings will facilitate the management of dizziness experienced during or after such disasters. Future studies should identify strategies for mitigating autonomic dysfunction to prevent post-earthquake dizziness.
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Affiliation(s)
- Toru Miwa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Otolaryngology and Head and Neck Surgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan
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Habs M, Strobl R, Grill E, Dieterich M, Becker-Bense S. Primary or secondary chronic functional dizziness: does it make a difference? A DizzyReg study in 356 patients. J Neurol 2020; 267:212-222. [PMID: 32852579 PMCID: PMC7718176 DOI: 10.1007/s00415-020-10150-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/20/2022]
Abstract
In 2017, the term “persistent postural-perceptual dizziness” (PPPD) was coined by the Bárány Society, which provided explicit criteria for diagnosis of functional vertigo and dizziness disorders. PPPD can originate secondarily after an organic disorder (s-PPPD) or primarily on its own, in the absence of somatic triggers (p-PPPD). The aim of this database-driven study in 356 patients from a tertiary vertigo center was to describe typical demographic and clinical features in p-PPPD and s-PPPD patients. Patients underwent detailed vestibular testing with neurological and neuro-orthoptic examinations, video-oculography during water caloric stimulation, video head-impulse test, assessment of the subjective visual vertical, and static posturography. All patients answered standardized questionnaires (Dizziness Handicap Inventory, DHI; Vestibular Activities and Participation, VAP; and Euro-Qol-5D-3L). One hundred and ninety-five patients (55%) were categorized as p-PPPD and 162 (45%) as s-PPPD, with female gender slightly predominating (♀:♂ = 56%:44%), particularly in the s-PPPD subgroup (64%). The most common somatic triggers for s-PPPD were benign paroxysmal positional vertigo (27%), and vestibular migraine (24%). Overall, p-PPPD patients were younger than s-PPPD patients (44 vs. 48 years) and showed a bimodal age distribution with an additional early peak in young adults (about 30 years of age) beside a common peak at the age of 50–55. The most sensitive diagnostic tool was posturography, revealing a phobic sway pattern in 50% of cases. s-PPPD patients showed higher handicap and functional impairment in DHI (47 vs. 42) and VAP (9.7 vs. 8.9). There was no difference between both groups in EQ-5D-3L. In p-PPPD, anxiety (20% vs. 10%) and depressive disorders (25% vs. 9%) were more frequent. This retrospective study in a large cohort showed relevant differences between p- and s-PPPD patients in terms of demographic and clinical features, thereby underlining the need for careful syndrome subdivision for further prospective studies.
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Affiliation(s)
- Maximilian Habs
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany.
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Grill
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
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Powell G, Derry-Sumner H, Rajenderkumar D, Rushton SK, Sumner P. Persistent postural perceptual dizziness is on a spectrum in the general population. Neurology 2020; 94:e1929-e1938. [PMID: 32300064 PMCID: PMC7274923 DOI: 10.1212/wnl.0000000000009373] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To examine the idea that symptoms of persistent postural perceptual dizziness (PPPD) are more common than previously assumed and lie on a spectrum in the general population, thus challenging current theories that PPPD is only a consequence of a vestibular insult. Methods We collected 2 common clinical questionnaires of PPPD (Visual Vertigo Analogue Scale [VVAS] and Situational Characteristics Questionnaire [SCQ]) in 4 cohorts: community research volunteers (n = 1941 for VVAS, n = 1,474 for SCQ); paid online participants (n = 190 for VVAS, n = 125 for SCQ); students (n = 204, VVAS only); and patients diagnosed with PPPD (n = 25). Results We found that around 9%, 4%, and 11%, respectively, of the 3 nonclinical cohorts scored above the 25th percentile patient score on 1 PPPD measure (VVAS) and 49% and 54% scored above the 25th percentile patient score on the other measure (SCQ). Scores correlated negatively with age (counter to expectation). As expected, scores correlated with migraine in 2 populations, but this only explained a small part of the variance, suggesting that migraine is not the major factor underlying the spectrum of PPPD symptoms in the general population. Conclusion We found high levels of PPPD symptoms in nonclinical populations, suggesting that PPPD is a spectrum that preexists in the population, rather than only being a consequence of vestibular insult. Atypical visuo-vestibular processing predisposes some individuals to visually induced dizziness, which is then exacerbated should vestibular insult (or more generalized insult) occur.
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Affiliation(s)
- Georgina Powell
- From the School of Psychology (G.P., S.K.R., P.S.), Cardiff University; and University Hospital of Wales (H.D.-S., D.R.), Cardiff, UK.
| | - Hannah Derry-Sumner
- From the School of Psychology (G.P., S.K.R., P.S.), Cardiff University; and University Hospital of Wales (H.D.-S., D.R.), Cardiff, UK
| | - Deepak Rajenderkumar
- From the School of Psychology (G.P., S.K.R., P.S.), Cardiff University; and University Hospital of Wales (H.D.-S., D.R.), Cardiff, UK
| | - Simon K Rushton
- From the School of Psychology (G.P., S.K.R., P.S.), Cardiff University; and University Hospital of Wales (H.D.-S., D.R.), Cardiff, UK
| | - Petroc Sumner
- From the School of Psychology (G.P., S.K.R., P.S.), Cardiff University; and University Hospital of Wales (H.D.-S., D.R.), Cardiff, UK
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[The Bárány Classification of vestibular disorders, its clinical implementation and future prospects]. HNO 2020; 68:304-312. [PMID: 32193582 DOI: 10.1007/s00106-020-00847-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Vestibular diseases often have no or only nonspecific biomarkers. It is therefore necessary to define these disorders using operational criteria based on patterns of symptoms, i.e., the presence of inclusion and exclusion criteria, similar to the situation with headaches or psychiatric diseases. Ten years ago, the Bárány Society embarked upon development of the International Classification of Vestibular Disorders (ICVD). This entails producing the different definitions iteratively according to a structured procedure with an internal review process, resulting in an open-access publication on the diagnostic criteria in each case. It is a multidisciplinary effort, and depending on the topic, cooperation with other scientific societies is sought. The classification encompasses primary vestibular disorders and non-vestibular disorders that may manifest with prominent vestibular symptoms. The following paper describes the procedure and briefly presents definitions which have already been published as well as those presently in elaboration.
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Functional Head Impulse Test With and Without Optokinetic Stimulation in Subjects With Persistent Postural Perceptual Dizziness (PPPD): Preliminary Report. Otol Neurotol 2019; 41:e70-e75. [PMID: 31789799 DOI: 10.1097/mao.0000000000002446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Persistent postural perceptual dizziness (PPPD) is a clinical condition characterized by unsteadiness present on most days for a period of at least 3 months. The aim of our work was to assess vestibular function, the role of anxiety, and possible interactions between visual and vestibular systems in patients with PPPD. STUDY DESIGN Cross-sectional prospective study. SETTING Tertiary referral center. PATIENTS Twenty-five PPPD patients. INTERVENTIONS Clinical history was collected before examination; vestibular function was assessed through bedside examination, video and functional head impulse test (video-HIT, f-HIT). The latter test was based on having the patient identify an optotype displayed on a computer screen during passive head rotations. The test was repeated while optokinetic stimulation (OKS) was given on the screen. Results were compared with those of 25 controls. State and trait anxiety levels were measured with the State-Trait Anxiety Inventory (STAI) questionnaire. Anxiety before and after vestibular examination was assessed using a VAS scale. MAIN OUTCOME MEASURE Results of video and functional HIT with and without OKS. RESULTS Video-HIT and f-HIT showed normal values in all subjects. f-HIT with OKS provoked more reading errors in patients than in controls. The interaction of group per time detected different decreasing trends between the two groups (p = 0.0002).Patients presented a reduction in anxiety levels after examination. Nine patients fulfilled diagnostic criteria for vestibular migraine, eight of whom presented nystagmus either to positional tests or vibration test. Only anxiety levels before testing were predictive of worsening of f-HIT with optokinetic stimulation (p = 0.0007). CONCLUSIONS Our data support the hypothesis that increased anxiety may play a role in visuo-vestibular interactions; moreover, they are not inconsistent with the hypothesis that OKS might provoke a "threatening effect," leading to gaze bias during examination.
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Balatkova Z, Cada Z, Hruba S, Komarc M, Cerny R. Assessment of visual sensation, psychiatric profile and quality of life following vestibular schwannoma surgery in patients prehabituated by chemical vestibular ablation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:444-453. [PMID: 31796939 DOI: 10.5507/bp.2019.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/04/2019] [Indexed: 01/12/2023] Open
Abstract
AIMS Preoperative chemical vestibular ablation can reduce vestibular symptoms in patients who have gone through vestibular schwannoma resection. The goal of this study was to determine whether chemical vestibular prehabituation influences the patients' post-operative perception of visual stimulation, mental status and quality of life. We also tried to find out whether increases of optokinetic nystagmus, measured by routine electronystagmography, correlate with subjective symptoms. METHODS We preoperatively administered (2 months prior to surgery) 0.5 - 1.0 mL of 40 mg/mL nonbuffered gentamicin in three intratympanic instillations in 11 patients. Head impulse and caloric tests confirmed reduction of vestibular function in all patients. The control group consisted of 21 patients. Quality of life in both groups was evaluated using the Glasgow Benefit Inventory, the Glasgow Health Status Inventory and the Dizziness Handicap Inventory questionnaires. Visual symptoms and optokinetic sensation were evaluated using a specific questionnaire developed by our team and by measuring gains preoperatively and postoperatively in both groups using routine electronystagmography. The psychological profile was evaluated using the Zung Self-Rating Depression Scale and the Generalised Anxiety Disorder Assessment questionnaires. RESULTS There were no statistically significant differences between both groups with regards to the results of the questionnaires. Patients who received preoperative gentamicin were less sensitive to visual stimulation (P<0.10) and many of them had a significantly higher gain in the optokinetic nystagmus than the control group in the preoperative stage. CONCLUSION Pre-treatment with gentamicin helps to lower anxiety levels in patients and improves their general postoperative status. Pre-treated patients are also less sensitive to optokinetic stimulation. TRIAL REGISTRATION ClinicalTrials.gov, NCT03638310.
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Affiliation(s)
| | - Zdenek Cada
- Department of Otorhinolaryngology and Head and Neck Surgery, 1
| | - Silvie Hruba
- Department of Otorhinolaryngology and Head and Neck Surgery, 1
| | - Martin Komarc
- Department of Anthropomotorics and Methodology, Faculty of Physical Education and Sport, Charles Univerzity in Prague, Czech Republic
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Indovina I, Conti A, Lacquaniti F, Staab JP, Passamonti L, Toschi N. Lower Functional Connectivity in Vestibular-Limbic Networks in Individuals With Subclinical Agoraphobia. Front Neurol 2019; 10:874. [PMID: 31456740 PMCID: PMC6701404 DOI: 10.3389/fneur.2019.00874] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/26/2019] [Indexed: 02/02/2023] Open
Abstract
Background: Agoraphobia was described in 1871 as a condition of fear-related alterations in spatial orientation and locomotor control triggered by places or situations that might cause a patient to panic and feel trapped. In contemporary nosology, however, this original concept of agoraphobia was split into two diagnostic entities, i.e., the modern anxiety disorder of agoraphobia, consisting solely of phobic/avoidant symptoms in public spaces, and the recently defined vestibular disorder of persistent postural perceptual dizziness (PPPD), characterized by dizziness, and unsteadiness exacerbated by visual motion stimuli. Previous neuroimaging studies found altered brain activity and connectivity in visual-vestibular networks of patients with PPPD vs. healthy controls. Neuroticism and introversion, which pre-dispose to both agoraphobia and PPPD, influenced brain responses to vestibular and visual motion stimuli in patients with PPPD. Similar neuroimaging studies have not been undertaken in patients with agoraphobia in its current definition. Given their shared history and pre-disposing factors, we sought to test the hypotheses that individuals with agoraphobic symptoms have alterations in visual-vestibular networks similar to those of patients with PPPD, and that these alterations are influenced by neuroticism and introversion. Methods: Drawing from the Human Connectome Project (HCP) database, we matched 52 participants with sub-clinical agoraphobia and 52 control subjects without agoraphobic symptoms on 19 demographic and psychological/psychiatric variables. We then employed a graph-theoretical framework to compare resting-state functional magnetic resonance images between groups and evaluated the interactive effects of neuroticism and introversion on the brain signatures of agoraphobia. Results: Individuals with subclinical agoraphobia had lower global clustering, efficiency and transitivity relative to controls. They also had lower connectivity metrics in two brain networks, one positioned to process incoming visual space-motion information, assess threat, and initiate/inhibit behavioral responses (visuospatial-emotional network) and one positioned to control and monitor locomotion (vestibular-navigational network). Introversion interacted with agoraphobic symptoms to lower the connectivity of the visuospatial-emotional network. This contrasted with previous findings describing neuroticism-associated higher connectivity in a narrower visual-spatial-frontal network in patients with PPPD. Conclusion: Functional connectivity was lower in two brain networks in subclinical agoraphobia as compared to healthy controls. These networks integrate visual vestibular and emotional response to guide movement in space.
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Affiliation(s)
- Iole Indovina
- Department of Medicine and Surgery, Saint Camillus International University of Health and Medical Sciences, Rome, Italy,Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy,*Correspondence: Iole Indovina
| | - Allegra Conti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy,Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, Rome, Italy
| | - Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom,Institute of Bioimaging and Molecular Physiology, National Research Council, Milan, Italy,Luca Passamonti
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, United States
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Preliminary study on the mechanism underlying the interaction of balance dysfunction and anxiety disorder. Neuroreport 2019; 30:53-59. [PMID: 30571662 DOI: 10.1097/wnr.0000000000000977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study aims to explore the anxiety-related behavioral changes and the concentration alterations of monoamine neurotransmitters in balance/anxiety-related nuclei of intratympanic gentamicin (GT)-induced balance disorder models. GT was administrated intratympanically in the adult male Sprague-Dawley rats to establish the vestibular impaired animal model. Rotarod was applied to test the vestibular function, and elevated plus maze and open field test were harnessed to evaluate the anxiety level. Monoamines and their metabolites were assayed by high-performance liquid chromatography. Rotarod test revealed that 6 days after GT administration, the average latency decreased significantly compared with the control group. Three days after GT administration, the travel distance and the central zone time obtained from open field and the duration of open arm stay and the times of open arm entries from elevated plus maze were apparently lower than those of the control group, whereas no significant differences were noted between 2-week group and the control group. Three days after GT administration, the concentration of norepinephrine (NE) and 5-hydroxyindoleacetic acid (5-HIAA) within medial vestibular nucleus (MVN); the concentration of NE, serotonin (5-HT), and 5-HIAA within locus coeruleus (LC); and the concentration of NE, 5-HT, 5-HIAA, and 3,4-dihydroxyphenylacetic acid within dorsal raphe nucleus (DRN) increased significantly compared with the control group. Two weeks after the administration, the concentrations of part of the neurotransmitters were lower than those of the 3-day group, indicating the rapid activation and slow deactivation of MVN-LC and MVN-DRN pathways. Vestibular impairment could lead to elevated anxiety level. The elevated anxiety levels might be attributed to increased monoamine concentrations within MVN, LC, and DRN.
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Talaat HS, Moaty AS, Koura YAEA. Arabic version of situational characteristic questionnaire for diagnosis of visual vertigo syndrome. HEARING, BALANCE AND COMMUNICATION 2018; 16:220-226. [DOI: 10.1080/21695717.2018.1539316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
| | - Asmaa Salah Moaty
- Otolaryngology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Gordon CR, Tamir R, Furas R, Klein C, Roth R. A pilot study of a novel specs for chronic dizziness. Acta Neurol Scand 2018; 138:344-351. [PMID: 29862507 DOI: 10.1111/ane.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A pilot study to assess the efficacy and safety of a novel specs device developed to alleviate chronic dizziness using eyeglasses with referential marks fixed on the lenses. MATERIALS AND METHODS Forty patients with stable symptoms of chronic dizziness for more than 3 months participated in a 4-week, double-blind, randomized treatment with Active-Specs or Sham-Specs. Efficacy was assessed using validated semiquantitative scales and questionnaires of vertigo, dizziness and anxiety. Safety evaluation included monitoring of any adverse event. RESULTS Thirty-six participants were included in the efficacy analysis, 18 in each group. Twelve of 18 subjects (67%) treated with Active-Specs reported substantial improvement of symptoms compared to six (33%) with Sham-Specs showing a significant improvement on Clinical Global Impressions scale (P = .017). The Active-Specs group showed significant reduction in the Vertigo Visual Analogue Scale (P = .017) and a nonsignificant but consistent trend of improvement measured by the Dizziness Handicap Inventory and Beck Anxiety Inventory. There were no adverse events related to the treatment. CONCLUSIONS This novel specs device seems to be a safe and promising novel treatment for chronic dizziness. We hypothesize that marks in specific zones of the peripheral visual field could strengthen information of real head motion counteracting the mismatch sensory and locomotor information causing chronic dizziness. The results of this pilot study should be followed up by additional studies aimed at confirming the present encouraging findings.
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Affiliation(s)
- C. R. Gordon
- Department of Neurology; Meir Medical Center; Kfar-Saba Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel-Aviv Israel
- Sagol School of Neuroscience; Tel Aviv University; Tel-Aviv Israel
| | - R. Tamir
- Department of Physical Therapy; Meir Medical Center; Kfar-Saba Israel
| | - R. Furas
- Department of Physical Therapy; Meir Medical Center; Kfar-Saba Israel
| | - C. Klein
- Department of Neurology; Meir Medical Center; Kfar-Saba Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel-Aviv Israel
| | - R. Roth
- SpotOn Therapeutics Ltd; Tel-Aviv Israel
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Morisod B, Mermod M, Maire R. Posturographic pattern of patients with chronic subjective dizziness before and after vestibular rehabilitation. J Vestib Res 2018; 27:305-311. [PMID: 29125531 DOI: 10.3233/ves-170628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic subjective dizziness (CSD) is frequently encountered in neurotology clinics. This diagnosis is mainly clinical, but computerized dynamic posturography (CDP) could be a helpful instrumental tool in the identification of these patients and validation of the treatment. This study was aimed to look for a specific posturographic pattern among patients diagnosed with CSD, and to eventually visualize improvement after vestibular rehabilitation. METHODS Single center, retrospective review from 2009 to 2014. We included patients diagnosed with CSD who underwent CDP in their neurotologic assessment. For those patients who benefited from vestibular rehabilitation, we compared their pre- and post-rehabilitation posturographies. RESULTS We included 114 patients, of whom 74% had known anxiety disorders and 33% a history of past vestibular disorder. 62% of the assessment posturographies were abnormal. The most affected sub-items were limit of stability, composite score of sensory organization tests and condition 5 in respectively 34%, 23% and 20% of the cases. In univariate analysis, only pathologic videonystagmography and history of unilateral vestibular dysfunction were significantly related to abnormal posturography. In the 42 patients who had vestibular rehabilitation and a post rehabilitation posturography, the proportion of abnormal posturography significantly dropped from 79% to 33% (p < 0.001). When it was assessed, 79% of the patients reported a subjective improvement. CONCLUSION Patients with CSD have a high rate of abnormal posturography, but without a specific pattern. Vestibular rehabilitation is an effective tool in the therapeutic armamentarium.
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Affiliation(s)
- Benoît Morisod
- Department of Otorhinolaryngology, Head and Neck Surgery, Neurotology Unit, Lausanne University Hospital, Switzerland
| | - Maxime Mermod
- Department of Otorhinolaryngology, Head and Neck Surgery, Neurotology Unit, Lausanne University Hospital, Switzerland
| | - Raphaël Maire
- Department of Otorhinolaryngology, Head and Neck Surgery, Neurotology Unit, Lausanne University Hospital, Switzerland
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Lee JO, Lee ES, Kim JS, Lee YB, Jeong Y, Choi BS, Kim JH, Staab JP. Altered brain function in persistent postural perceptual dizziness: A study on resting state functional connectivity. Hum Brain Mapp 2018; 39:3340-3353. [PMID: 29656497 DOI: 10.1002/hbm.24080] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 11/09/2022] Open
Abstract
This study used resting state functional magnetic resonance imaging (rsfMRI) to investigate whole brain networks in patients with persistent postural perceptual dizziness (PPPD). We compared rsfMRI data from 38 patients with PPPD and 38 healthy controls using whole brain and region of interest analyses. We examined correlations among connectivity and clinical variables and tested the ability of a machine learning algorithm to classify subjects using rsfMRI results. Patients with PPPD showed: (a) increased connectivity of subcallosal cortex with left superior lateral occipital cortex and left middle frontal gyrus, (b) decreased connectivity of left hippocampus with bilateral central opercular cortices, left posterior opercular cortex, right insular cortex and cerebellum, and (c) decreased connectivity between right nucleus accumbens and anterior left temporal fusiform cortex. After controlling for anxiety and depression as covariates, patients with PPPD still showed decreased connectivity between left hippocampus and right inferior frontal gyrus, bilateral temporal lobes, bilateral insular cortices, bilateral central opercular cortex, left parietal opercular cortex, bilateral occipital lobes and cerebellum (bilateral lobules VI and V, and left I-IV). Dizziness handicap, anxiety, and depression correlated with connectivity in clinically meaningful brain regions. The machine learning algorithm correctly classified patients and controls with a sensitivity of 78.4%, specificity of 76.9%, and area under the curve = 0.88 using 11 connectivity parameters. Patients with PPPD showed reduced connectivity among the areas involved in multisensory vestibular processing and spatial cognition, but increased connectivity in networks linking visual and emotional processing. Connectivity patterns may become an imaging biomarker of PPPD.
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Affiliation(s)
- Jin-Ok Lee
- Department of Neurology, Seoul National University of College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University of College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Young-Beom Lee
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea.,KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - Yong Jeong
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea.,KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Republic of Korea
| | - Jae-Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Republic of Korea
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Whitney SL, Alghadir A, Alghwiri A, Alshebber KM, Alshehri M, Furman JM, Mueller M, Grill E. The development of the ICF vestibular environmental scale. J Vestib Res 2018; 26:297-302. [PMID: 27392833 DOI: 10.3233/ves-160580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED People with vestibular disorders report changes in symptoms based on their environment with many situations increasing their symptoms. The purpose of this paper was to utilize the International Classification of Functioning Disability and Health (ICF) from the World Health Organization (WHO) to describe common environmental triggers for dizziness in persons living with balance and vestibular disorders. A multi-centre cross-sectional study was conducted with four different centres on three different continents, including patients from the United States (Pittsburgh), Germany (Munich), Jordan (Amman) and Saudi Arabia (Riyadh). SUBJECTS Three hundred eighty one persons with vestibular disorders participated. METHODS A 9-item questionnaire (the Vestibular Environmental Scale) was developed from existing ICF items, which were compared to Dizziness Handicap Inventory (DHI) scores. Sixty-five percent of participants reported that "quick movements in the vicinity" increased symptoms, "crowds" at 45%, and "design of buildings, e.g. narrow hallways, stairs, elevators" at 42%. The "crowds" item was a good positive predictor of psychogenic vertigo (OR 1.8, 95% Confidence Interval 1.03-3.16), while "food" (OR 0.47, 95% Confidence Interval 0.17-1.29) and "light" (OR 0.41 95% Confidence Interval 0.23-0.75) were negative predictors of psychogenic vertigo. There also was a positive correlation between the number of triggers and DHI score (Spearman correlation coefficient 0.47, p < 0.0001). Sixty-eight percent of the subjects reported an increase in symptoms with between 1 and 4 environmental triggers. In our cross cultural sample, environmental triggers affect dizziness in persons living with balance and vestibular disorders. The use of items from the ICF of the WHO may help to promote cross cultural sharing of information in persons with dizziness.
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Affiliation(s)
- Susan L. Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Alia Alghwiri
- Faculty of Rehabilitation Sciences, Department of Physical Therapy, The University of Jordan, Amman, Jordan
| | - Kefah M. Alshebber
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mohammed Alshehri
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph M. Furman
- Department of Otolaryngology and Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin Mueller
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany and the German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany and the German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. Munich, Germany
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Functional dizziness: from phobic postural vertigo and chronic subjective dizziness to persistent postural-perceptual dizziness. Curr Opin Neurol 2018; 30:107-113. [PMID: 28002123 DOI: 10.1097/wco.0000000000000417] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Functional dizziness is the new term for somatoform or psychogenic dizziness. The aim of this study is to review arguments for the new nomenclature, clinical features, possible pathomechanisms, and comorbidities of functional dizziness. RECENT FINDINGS The prevalence of functional dizziness as a primary cause of vestibular symptoms amounts to 10% in neuro-otology centers. Rates of psychiatric comorbidity in patients with structural vestibular syndromes are much higher with nearly 50% and with highest rates in patients with vestibular migraine, vestibular paroxysmia, and Ménière's disease. Pathophysiologic processes seem to include precipitating events that trigger anxiety-related changes in postural strategies with an increased attention to head and body motion and a cocontraction of leg muscles. Personality traits with high levels of neuroticism and low levels of extraversion appear as risk factors for anxiety and depressive disorders and increased morbidity in functional disorders. SUMMARY Correct and early diagnosis of functional dizziness, as primary cause or secondary disorder after a structural vestibular syndrome, is very important to prevent further chronification and enable adequate treatment. 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.
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Abstract
The assessment and treatment of sport-related concussion (SRC) often requires a multifaceted approach. Vestibular dysfunction represents an important profile of symptoms and pathology following SRC, with high prevalence and association with prolonged recovery. Signs and symptoms of vestibular dysfunction may include dizziness, vertigo, disequilibrium, nausea, and visual impairment. Identifying the central and peripheral vestibular mechanisms responsible for pathology can aid in management of SRC. The most common vestibular disturbances after SRC include benign paroxysmal positional vertigo, vestibulo-ocular reflex impairment, visual motion sensitivity, and balance impairment. A variety of evidence-based screening and assessment tools can help to identify the various types of vestibular pathology in SRC. When vestibular dysfunction is identified, there is emerging support for applying targeted vestibular rehabilitation to manage this condition.
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Colnaghi S, Rezzani C, Gnesi M, Manfrin M, Quaglieri S, Nuti D, Mandalà M, Monti MC, Versino M. Validation of the Italian Version of the Dizziness Handicap Inventory, the Situational Vertigo Questionnaire, and the Activity-Specific Balance Confidence Scale for Peripheral and Central Vestibular Symptoms. Front Neurol 2017; 8:528. [PMID: 29066999 PMCID: PMC5641311 DOI: 10.3389/fneur.2017.00528] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/22/2017] [Indexed: 11/24/2022] Open
Abstract
Neurophysiological measurements of the vestibular function for diagnosis and follow-up evaluations provide an objective assessment, which, unfortunately, does not necessarily correlate with the patients' self-feeling. The literature provides many questionnaires to assess the outcome of rehabilitation programs for disequilibrium, but only for the Dizziness Handicap Inventory (DHI) is an Italian translation available, validated on a small group of patients suffering from a peripheral acute vertigo. We translated and validated the reliability and validity of the DHI, the Situational Vertigo Questionnaire (SVQ), and the Activities-Specific Balance Confidence Scale (ABC) in 316 Italian patients complaining of dizziness due either to a peripheral or to a central vestibular deficit, or in whom vestibular signs were undetectable by means of instrumental testing or clinical evaluation. Cronbach's coefficient alpha, the homogeneity index, and test-retest reproducibility, confirmed reliability of the Italian version of the three questionnaires. Validity was confirmed by correlation test between questionnaire scores. Correlations with clinical variables suggested that they can be used as a complementary tool for the assessment of vestibular symptoms. In conclusion, the Italian versions of DHI, SVQ, and ABC are reliable and valid questionnaires for assessing the impact of dizziness on the quality of life of Italian patients with peripheral or central vestibular deficit.
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Affiliation(s)
- Silvia Colnaghi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Laboratory of Neuro-otology and Neuro-ophthalmology, C. Mondino National Neurological Institute, Pavia, Italy
| | - Cristiana Rezzani
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Marco Gnesi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Marco Manfrin
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | - Daniele Nuti
- Department of Otology and Skull Base, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Maurizio Versino
- Laboratory of Neuro-otology and Neuro-ophthalmology, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Naranjo EN, Cleworth TW, Allum JHJ, Inglis JT, Lea J, Westerberg BD, Carpenter MG. Threat effects on human oculo-motor function. Neuroscience 2017; 359:289-298. [PMID: 28733210 DOI: 10.1016/j.neuroscience.2017.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 06/11/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022]
Abstract
Neuro-anatomical evidence supports the potential for threat-related factors, such as fear, anxiety and vigilance, to influence brainstem motor nuclei controlling eye movements, as well as the vestibular nuclei. However, little is known about how threat influences human ocular responses, such as eye saccades (ES), smooth pursuit eye tracking (SP), and optokinetic nystagmus (OKN), and whether these responses can be facilitated above normal baseline levels with a natural source of threat. This study was designed to examine the effects of height-induced postural threat on the gain of ES, SP and OKN responses in humans. Twenty participants stood at two different surface heights while performing ES (ranging from 8° to 45° from center), SP (15, 20, 30°/s) and OKN (15, 30, 60°/s) responses in the horizontal plane. Height did not significantly increase the slope of the relationship between ES peak velocity and initial amplitude, or the gain of ES amplitude. In contrast height significantly increased SP and OKN gain. Significant correlations were found between changes in physiological arousal and OKN gain. Observations of changes with height in OKN and SP support neuro-anatomical evidence of threat-related mechanisms influencing both oculo-motor nuclei and vestibular reflex pathways. Although further study is warranted, the findings suggest that potential influences of fear, anxiety and arousal/alertness should be accounted for, or controlled, during clinical vestibular and oculo-motor testing.
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Affiliation(s)
- E N Naranjo
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - T W Cleworth
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - J H J Allum
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; Department of ORL, University of Basel Hospital, Basel, Switzerland
| | - J T Inglis
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - J Lea
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - B D Westerberg
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - M G Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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Diukova GM, Zamergrad MV, Golubev VL, Adilova SM, Makarov SA. Functional (psychogenic) vertigo. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:91-98. [DOI: 10.17116/jnevro20171176191-98] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Horii A. Anxiety, depression, and persistent postural perceptual dizziness:International classification of vestibular disorders by Bárány Society. ACTA ACUST UNITED AC 2017. [DOI: 10.3757/jser.76.316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arata Horii
- Department of Otolaryngology Head and Neck Surgry, Niigata University Graduate School of Medical and Dental Sciences
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Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, Bronstein A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res 2017; 27:191-208. [PMID: 29036855 PMCID: PMC9249299 DOI: 10.3233/ves-170622] [Citation(s) in RCA: 334] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
This paper presents diagnostic criteria for persistent postural-perceptual dizziness (PPPD) to be included in the International Classification of Vestibular Disorders (ICVD). The term PPPD is new, but the disorder is not. Its diagnostic criteria were derived by expert consensus from an exhaustive review of 30 years of research on phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness. PPPD manifests with one or more symptoms of dizziness, unsteadiness, or non-spinning vertigo that are present on most days for three months or more and are exacerbated by upright posture, active or passive movement, and exposure to moving or complex visual stimuli. PPPD may be precipitated by conditions that disrupt balance or cause vertigo, unsteadiness, or dizziness, including peripheral or central vestibular disorders, other medical illnesses, or psychological distress. PPPD may be present alone or co-exist with other conditions. Possible subtypes await future identification and validation. The pathophysiologic processes underlying PPPD are not fully known. Emerging research suggests that it may arise from functional changes in postural control mechanisms, multi-sensory information processing, or cortical integration of spatial orientation and threat assessment. Thus, PPPD is classified as a chronic functional vestibular disorder. It is not a structural or psychiatric condition.
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Affiliation(s)
- Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Arata Horii
- Department of Otorhinolaryngology, Niigata University, Niigata, Japan
| | - Rolf Jacob
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Germany
| | - Thomas Brandt
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Germany
| | - Adolfo Bronstein
- Neuro-Otology Unit, Division of Brain Sciences, Imperial College London, London, UK
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Haber YO, Chandler HK, Serrador JM. Symptoms Associated with Vestibular Impairment in Veterans with Posttraumatic Stress Disorder. PLoS One 2016; 11:e0168803. [PMID: 28033352 PMCID: PMC5199023 DOI: 10.1371/journal.pone.0168803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a chronic and disabling, anxiety disorder resulting from exposure to life threatening events such as a serious accident, abuse or combat (DSM IV definition). Among veterans with PTSD, a common complaint is dizziness, disorientation and/or postural imbalance in environments such as grocery stores and shopping malls. The etiology of these symptoms in PTSD is poorly understood and some attribute them to anxiety or traumatic brain injury. There is a possibility that an impaired vestibular system may contribute to these symptoms since, symptoms of an impaired vestibular system include dizziness, disorientation and postural imbalance. To our knowledge, this is the first report to describe the nature of vestibular related symptoms in veterans with and without PTSD. We measured PTSD symptoms using the Posttraumatic Stress Disorder Checklist (PCL-C) and compared it to responses on vestibular function scales including the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Scale Short Form (VSS-SF), the Chambless Mobility Inventory (CMI), and the Neurobehavioral Scale Inventory (NSI) in order to identify vestibular-related symptoms. Our findings indicate that veterans with worse PTSD symptoms report increased vestibular related symptoms. Additionally veterans with PTSD reported 3 times more dizziness related handicap than veterans without PTSD. Veterans with increased avoidance reported more vertigo and dizziness related handicap than those with PTSD and reduced avoidance. We describe possible contributing factors to increased reports of vestibular symptoms in PTSD, namely, anxiety, a vestibular component as well as an interactive effect of anxiety and vestibular impairment. We also present some preliminary analyses regarding the contribution of TBI. This data suggests possible evidence for vestibular symptom reporting in veterans with PTSD, which may be explained by possible underlying vestibular impairment, worthy of further exploration.
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Affiliation(s)
- Yaa O. Haber
- Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, New Jersey, United States of America
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, New Jersey, United States of America
| | - Helena K. Chandler
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, New Jersey, United States of America
- * E-mail:
| | - Jorge M. Serrador
- Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, New Jersey, United States of America
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, New Jersey, United States of America
- Cardiovascular Electronics, National University of Ireland Galway, Galway, Ireland
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Welgampola MS, Akdal G, Halmagyi GM. Neuro-otology- some recent clinical advances. J Neurol 2016; 264:188-203. [PMID: 27632181 PMCID: PMC5225204 DOI: 10.1007/s00415-016-8266-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/25/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022]
Abstract
Vestibular disorders manifesting as vertigo, chronic dizziness and imbalance are common problems in neurological practice. Here, we review some recent interesting and important advances in diagnosis of vestibular disorders using the video head impulse test and in the management of benign positional vertigo and migrainous vertigo.
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Affiliation(s)
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
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49
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Kotova OV, Zamergrad MV. Dizziness and anxiety disorders in the elderly. TERAPEVT ARKH 2016. [DOI: 10.17116/terarkh2016889131-134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Perhaps each dizzy patient feels anxiety. Varying emotional disorders are particularly common in elderly patients with dizziness. The causes of the frequent concurrence of dizziness and mental disorders (anxiety and depression) are diverse. Amongst these there are two chief conditions: 1) vestibular vertigo may cause anxiety to a greater extent than many other symptoms; 2) anxiety and depression are themselves frequently manifested by the sensations resembling vestibular ones that patients are inclined to call dizziness. On the contrary, anxiety may appear in some cases as the sensations resembling dizziness. Besides the latter, the patient may present a lot of complaints, which serves as a manifestation of psychoautonomic syndrome (the basis for which is anxiety and depression). At the same time, the term «phobic postural instability» is proposed to describe psychogenic disorders, in which dizziness becomes virtually the only chief complaint. The treatment of dizziness and anxiety disorders in the elderly encompasses a few areas: vestibular rehabilitation, drug therapy, and psychotherapy. The paper describes the possibilities of using anvifen as a pathogenetically sound treatment in patients with anxiety disorders, as anvifen is a GABA-ergic medication.
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Saman Y, Mclellan L, Mckenna L, Dutia MB, Obholzer R, Libby G, Gleeson M, Bamiou DE. State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma. Front Neurol 2016; 7:101. [PMID: 27468274 PMCID: PMC4942454 DOI: 10.3389/fneur.2016.00101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/15/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety, and there is a relationship between increased state anxiety and worsening balance function. Aims (1) To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit. (2) To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap. Methods Two separate cohorts of vestibular schwannoma (VS) patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials, and caloric responses) and questionnaire assessments [vertigo handicap questionnaire (VHQ), vertigo symptom scale (VSS), and state-trait anxiety inventory (STAIY)]. Fifteen post-resection VS patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1). Forty-five patients with VS in situ formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (N = 15) with a complete post-resection unilateral vestibular deafferentation completed a state anxiety questionnaire before caloric assessment and again afterward with the point of maximal vertigo as the reference (Aim 1). Experiment 2: state anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of patients with VS in situ presenting with balance symptoms (Group 1, N = 26) and without balance symptoms (Group 2, N = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS–VER. Results In Experiment 1, a significant difference (p < 0.01) was found when comparing STAIY at baseline and at the peak of the subjective vertiginous response in post-resection patients with a unilateral vestibular deafferentation. In Experiment 2, VS in situ patients with balance symptoms had significantly worse state anxiety at the peak vertiginous response than patients without balance symptoms (p < 0.001), as did patients with a balance-related handicap (p < 0.001). Conclusion Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function.
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Affiliation(s)
- Yougan Saman
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, UCL, London, UK; Nelson R. Mandela School of Medicine, UKZN, Durban, South Africa
| | - Lucie Mclellan
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery , London , England
| | | | - Mayank B Dutia
- Centre for Integrative Physiology, University of Edinburgh , Edinburgh , UK
| | - Rupert Obholzer
- ENT and Skull Base Department, Guys Hospital, London, UK; ENT and Skull Base Department, Kings College Hospital, London, UK
| | - Gerald Libby
- Neurogastroenterology Group, Queen Mary University of London , London , UK
| | - Michael Gleeson
- Neuro-otology and Skull Base Department, National Hospital for Neurology and Neurosurgery , London , UK
| | - Doris-Eva Bamiou
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery, London, England; Ear Institute, UCL, London, UK
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