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Brandt T, Dieterich M, Huppert D. Human senses and sensors from Aristotle to the present. Front Neurol 2024; 15:1404720. [PMID: 39022724 PMCID: PMC11252028 DOI: 10.3389/fneur.2024.1404720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
This historical review on the semantic evolution of human senses and sensors revealed that Aristotle's list of the five senses sight, hearing, touch, taste, and smell is still in use among non-scientific lay persons. It is no surprise that his classification in the work "De Anima" (On the Soul) from 350 BC confuses the sensor "touch" with the now more comprehensively defined somatosensory system and that senses are missing such as the later discovered vestibular system and the musculotendinous proprioception of the position of parts of the body in space. However, it is surprising that in the three most influential ancient cultures, Egypt, Greece, and China-which shaped the history of civilization-the concept prevailed that the heart rather than the brain processes perception, cognition, and emotions. This "cardiocentric view" can be traced back to the "Doctrine of Aristotle," the "Book of the Dead" in ancient Egypt, and the traditional Chinese medicine of correspondence documented in the book "Huang di Neijing." In Greek antiquity the philosophers Empedocles, Democritus and Aristotle were proponents of the allocation of the spirit and the soul to the heart connected to the body via the blood vessels. Opponents were the pre-Socratic mathematician Pythagoras, the philosopher Plato, and especially the Greek physician Hippocrates who regarded the brain as the most powerful organ in humans in his work "De Morbo Sacro." The Greek physician Galen of Pergamon further elaborated on the concept of the brain ("cephalocentric hypothesis") connected to the body by a network of nerves. The fundamental concepts for understanding functions and disorders of the vestibular system, the perception of self-motion, verticality and balance control were laid by a remarkable group of 19th century scientists including Purkynӗ, Mach, Breuer, Helmholtz, and Crum-Brown. It was also in the 19th century that Bell described a new sense of a reciprocal sensorimotor loop between the brain and the muscles which he called "muscular sense," later termed "kinaesthesia" by Bastian and defined in 1906 as "proprioception" by Sherrington as "the perception of joint and body movements as well as position of the body or body segments, in space." Both, the vestibular system and proprioception could be acknowledged as senses six or seven. However, we hesitate to recommend "pain"-which is variously assigned to the somatosensory system or extero-, intero-, visceroception-as a separate sensory system. Pain sensors are often not specific but have multisensory functions. Because of this inconsistent, partly contradictory classification even by experts in the current literature on senses and sensors we consider it justified to recommend a comprehensive reorganization of classification features according to the present state of knowledge with an expansion of the number of senses. Such a project has also to include the frequent task-dependent multisensory interactions for perceptual and sensorimotor achievements, and higher functions or disorders of the visual and vestibular systems as soon as cognition or emotions come into play. This requires a cooperation of sensory physiologists, neuroscientists and experienced physicians involved in the management of patients with sensory and multisensory disorders.
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Affiliation(s)
- Thomas Brandt
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
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Guo J, Wang J, Liang P, Tian E, Liu D, Guo Z, Chen J, Zhang Y, Zhou Z, Kong W, Crans DC, Lu Y, Zhang S. Vestibular dysfunction leads to cognitive impairments: State of knowledge in the field and clinical perspectives (Review). Int J Mol Med 2024; 53:36. [PMID: 38391090 PMCID: PMC10914312 DOI: 10.3892/ijmm.2024.5360] [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: 10/08/2023] [Accepted: 01/08/2024] [Indexed: 02/24/2024] Open
Abstract
The vestibular system may have a critical role in the integration of sensory information and the maintenance of cognitive function. A dysfunction in the vestibular system has a significant impact on quality of life. Recent research has provided evidence of a connection between vestibular information and cognitive functions, such as spatial memory, navigation and attention. Although the exact mechanisms linking the vestibular system to cognition remain elusive, researchers have identified various pathways. Vestibular dysfunction may lead to the degeneration of cortical vestibular network regions and adversely affect synaptic plasticity and neurogenesis in the hippocampus, ultimately contributing to neuronal atrophy and cell death, resulting in memory and visuospatial deficits. Furthermore, the extent of cognitive impairment varies depending on the specific type of vestibular disease. In the present study, the current literature was reviewed, potential causal relationships between vestibular dysfunction and cognitive performance were discussed and directions for future research were proposed.
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Affiliation(s)
- Jiaqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Pei Liang
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, Hubei 430062, P.R. China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Dan Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jingyu Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Yuejin Zhang
- Department of Physiology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
- Institute of Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zhanghong Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Debbie C. Crans
- Cell and Molecular Biology Program, Colorado State University, Fort Collins, CO 80523, USA
| | - Yisheng Lu
- Department of Physiology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
- Institute of Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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Božanić Urbančič N, Battelino S, Vozel D. Appropriate Vestibular Stimulation in Children and Adolescents-A Prerequisite for Normal Cognitive, Motor Development and Bodily Homeostasis-A Review. CHILDREN (BASEL, SWITZERLAND) 2023; 11:2. [PMID: 38275423 PMCID: PMC10814320 DOI: 10.3390/children11010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
The structural development of the vestibular part of the inner ear is completed by birth but its central connections continue to develop until adolescence. Their development is dependent on vestibular stimulation-vestibular experience. Studies have shown that vestibular function, modulated by experience and epigenetic factors, is not solely an instrument for body position regulation, navigation, and stabilization of the head and images but also influences cognition, emotion, the autonomous nervous system and hormones. To emphasize the importance of appropriate vestibular stimulation, we present a literature review of its effect on bodily homeostasis, cognition and emotion.
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Affiliation(s)
- Nina Božanić Urbančič
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (N.B.U.); (S.B.)
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Saba Battelino
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (N.B.U.); (S.B.)
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Domen Vozel
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (N.B.U.); (S.B.)
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
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Smith JL, Diekfuss JA, Dudley JA, Ahluwalia V, Zuleger TM, Slutsky-Ganesh AB, Yuan W, Foss KDB, Gore RK, Myer GD, Allen JW. Visuo-vestibular and cognitive connections of the vestibular neuromatrix are conserved across age and injury populations. J Neuroimaging 2023; 33:1003-1014. [PMID: 37303280 DOI: 10.1111/jon.13136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Given the prevalence of vestibular dysfunction in pediatric concussion, there is a need to better understand pathophysiological disruptions within vestibular and associated cognitive, affective, and sensory-integrative networks. Although current research leverages established intrinsic connectivity networks, these are nonspecific for vestibular function, suggesting that a pathologically guided approach is warranted. The purpose of this study was to evaluate the generalizability of the previously identified "vestibular neuromatrix" in adults with and without postconcussive vestibular dysfunction to young athletes aged 14-17. METHODS This retrospective study leveraged resting-state functional MRI data from two sites. Site A included adults with diagnosed postconcussive vestibular impairment and healthy adult controls and Site B consisted of young athletes with preseason, postconcussion, and postseason time points (prospective longitudinal data). Adjacency matrices were generated from preprocessed resting-state data from each sample and assessed for overlap and network structure in MATLAB. RESULTS Analyses indicated the presence of a conserved "core" network of vestibular regions as well as areas subserving visual, spatial, and attentional processing. Other vestibular connections were also conserved across samples but were not linked to the "core" subnetwork by regions of interest included in this study. CONCLUSIONS Our results suggest that connections between central vestibular, visuospatial, and known intrinsic connectivity networks are conserved across adult and pediatric participants with and without concussion, evincing the significance of this expanded, vestibular-associated network. Our findings thus support this network as a workable model for investigation in future studies of dysfunction in young athlete populations.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vishwadeep Ahluwalia
- Georgia State University/Georgia Tech Center for Advanced Brain Imaging (CABI), Atlanta, Georgia, USA
| | - Taylor M Zuleger
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kim D Barber Foss
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
| | - Russell K Gore
- Mild TBI Brain Health and Recovery Lab, Shepherd Center, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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Clément G, Kuldavletova O, Macaulay TR, Wood SJ, Navarro Morales DC, Toupet M, Hautefort C, Van Nechel C, Quarck G, Denise P. Cognitive and balance functions of astronauts after spaceflight are comparable to those of individuals with bilateral vestibulopathy. Front Neurol 2023; 14:1284029. [PMID: 37965165 PMCID: PMC10641777 DOI: 10.3389/fneur.2023.1284029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction This study compares the balance control and cognitive responses of subjects with bilateral vestibulopathy (BVP) to those of astronauts immediately after they return from long-duration spaceflight on board the International Space Station. Methods Twenty-eight astronauts and thirty subjects with BVP performed five tests using the same procedures: sit-to-stand, walk-and-turn, tandem walk, duration judgment, and reaction time. Results Compared to the astronauts' preflight responses, the BVP subjects' responses were impaired in all five tests. However, the BVP subjects' performance during the walk-and-turn and the tandem walk tests were comparable to the astronauts' performance on the day they returned from space. Moreover, the BVP subjects' time perception and reaction time were comparable to those of the astronauts during spaceflight. The BVP subjects performed the sit-to-stand test at a level that fell between the astronauts' performance on the day of landing and 1 day later. Discussion These results indicate that the alterations in dynamic balance control, time perception, and reaction time that astronauts experience after spaceflight are likely driven by central vestibular adaptations. Vestibular and somatosensory training in orbit and vestibular rehabilitation after spaceflight could be effective countermeasures for mitigating these post-flight performance decrements.
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Affiliation(s)
- Gilles Clément
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
- KBR, Houston, TX, United States
| | - Olga Kuldavletova
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | | | - Scott J Wood
- NASA Johnson Space Center, Houston, TX, United States
| | - Deborah C Navarro Morales
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Michel Toupet
- Centre d'Explorations Fonctionnelles Oto-Neurologiques, Paris, France
| | - Charlotte Hautefort
- Université de Paris Cité, INSERM U1141, Paris, France
- Department of Otorhinolaryngology, Assistance Publique, Hôpitaux de Paris, Lariboisière Hospital, Paris, France
| | | | - Gaëlle Quarck
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Pierre Denise
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
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Lin C, Liu D, Liu Y, Chen Z, Wei X, Liu H, Wang K, Liu T, Xiao L, Rong L. Altered functional activity of the precuneus and superior temporal gyrus in patients with residual dizziness caused by benign paroxysmal positional vertigo. Front Neurosci 2023; 17:1221579. [PMID: 37901419 PMCID: PMC10600499 DOI: 10.3389/fnins.2023.1221579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Benign paroxysmal positional vertigo (BPPV) is a common clinical vertigo disease, and the most effective treatment for this disease is canal repositioning procedures (CRP). Most patients return to normal after a single treatment. However, some patients still experience residual dizziness (RD) after treatment, and this disease's pathogenesis is currently unclear. The purpose of this study is to explore whether there are abnormal brain functional activities in patients with RD by using resting-state functional magnetic resonance imaging (rs-fMRI) and to provide imaging evidence for the study of the pathogenesis of RD. Materials and methods The BPPV patients in the Second Affiliated Hospital of Xuzhou Medical University had been included from December 2021 to November 2022. All patients had been received the collection of demographic and clinical characteristics (age, gender, involved semicircular canal, affected side, CRP times, BPPV course, duration of RD symptoms, and whether they had hypertension, diabetes, coronary heart disease.), scale assessment, including Dizziness Handicap Inventory (DHI), Hamilton Anxiety Inventory (HAMA), Hamilton Depression Inventory (HAMD), rs-fMRI data collection, CRP treatment, and then a one-month follow-up. According to the follow-up results, 18 patients with RD were included. At the same time, we selected 19 healthy individuals from our hospital's physical examination center who matched their age, gender as health controls (HC). First, the amplitude of low-frequency fluctuations (ALFF) analysis method was used to compare the local functional activities of the two groups of subjects. Then, the brain regions with different ALFF results were extracted as seed points. Functional connectivity (FC) analysis method based on seed points was used to explore the whole brain FC of patients with RD. Finally, a correlation analysis between clinical features and rs-fMRI data was performed. Results Compared to the HC, patients with RD showed lower ALFF value in the right precuneus and higher ALFF value in the right superior temporal gyrus (STG). When using the right STG as a seed point, it was found that the FC between the right STG, the right supramarginal gyrus (SMG), and the left precuneus was decreased in RD patients. However, no significant abnormalities in the FC were observed when using the right precuneus as a seed point. Conclusion In patients with RD, the local functional activity of the right precuneus is weakened, and the local functional activity of the right STG is enhanced. Furthermore, the FC between the right STG, the right SMG, and the left precuneus is weakened. These changes may explain the symptoms of dizziness, floating sensation, walking instability, neck tightness, and other symptoms in patients with RD to a certain extent.
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Affiliation(s)
- Cunxin Lin
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dan Liu
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yueji Liu
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhengwei Chen
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiue Wei
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haiyan Liu
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Kai Wang
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tengfei Liu
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lijie Xiao
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Liangqun Rong
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Rossi S, Cinti A, Viberti F, Benelli A, Neri F, De Monte D, Giannotta A, Romanella S, Smeralda C, Donniacuo A, Prattichizzo D, Pasqualetti P, Santarnecchi E, Mandalà M. Frequency-dependent tuning of the human vestibular "sixth sense" by transcranial oscillatory currents. Clin Neurophysiol 2023; 153:123-132. [PMID: 37481873 DOI: 10.1016/j.clinph.2023.06.013] [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: 01/22/2023] [Revised: 05/04/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE The vestibular cortex is a multisensory associative region that, in neuroimaging investigations, is activated by slow-frequency (1-2 Hz) galvanic stimulation of peripheral receptors. We aimed to directly activate the vestibular cortex with biophysically modeled transcranial oscillatory current stimulation (tACS) in the same frequency range. METHODS Thirty healthy subjects and one rare patient with chronic bilateral vestibular deafferentation underwent, in a randomized, double-blind, controlled trial, to tACS at slow (1 or 2 Hz) or higher (10 Hz) frequency and sham stimulations, over the Parieto-Insular Vestibular Cortex (PIVC), while standing on a stabilometric platform. Subjective symptoms of motion sickness were scored by Simulator Sickness Questionnaire and subjects' postural sways were monitored on the platform. RESULTS tACS at 1 and 2 Hz induced symptoms of motion sickness, oscillopsia and postural instability, that were supported by posturographic sway recordings. Both 10 Hz-tACS and sham stimulation on the vestibular cortex did not affect vestibular function. As these effects persisted in a rare patient with bilateral peripheral vestibular areflexia documented by the absence of the Vestibular-Ocular Reflex, the possibility of a current spread toward peripheral afferents is unlikely. Conversely, the 10 Hz-tACS significantly reduced his chronic vestibular symptoms in this patient. CONCLUSIONS Weak electrical oscillations in a frequency range corresponding to the physiological cortical activity of the vestibular system may generate motion sickness and postural sways, both in healthy subjects and in the case of bilateral vestibular deafferentation. SIGNIFICANCE This should be taken into account as a new side effect of tACS in future studies addressing cognitive functions. Higher frequencies of stimulation applied to the vestibular cortex may represent a new interventional option to reduce motion sickness in different scenarios.
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Affiliation(s)
- Simone Rossi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Italy.
| | - Alessandra Cinti
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Francesca Viberti
- Otolaryngology, Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - Alberto Benelli
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Francesco Neri
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Italy
| | - David De Monte
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Alessandro Giannotta
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Sara Romanella
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Carmelo Smeralda
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Aniello Donniacuo
- Otolaryngology, Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
| | - Domenico Prattichizzo
- Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Italy; Siena Robotics and Systems (SiRS) Lab, Department of Information Engineering and Mathematics, University of Siena, Siena, Italy
| | | | - Emiliano Santarnecchi
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Mandalà
- Oto-Neuro-Tech Conjoined Lab, Policlinico Le Scotte, University of Siena, Italy; Otolaryngology, Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Italy
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8
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范 常, 黄 亚, 李 霞, 陈 芸, 李 真, 乔 淑. [Posterior inferior cerebellar artery infarction with episodic postural diplopia as the initial symptom: A case report]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:762-765. [PMID: 37534665 PMCID: PMC10398753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 08/04/2023]
Abstract
Accurate and timely diagnosis of posterior circulation ischemic stroke is a challenge for emergency neurology clinicians, even MRI scan which is believed to be sensitive to acute ischemic lesions may be negative. It is particularly important to obtain the typical or characteristic symptoms and signs of the patients through comprehensive physical examination. We report a case of posterior inferior cerebellar artery (PICA) territory infarction with "episodic postural diplopia" as the initial symptom, hoping that clinicians notice the vertical diplopia caused by the disfunction of otolith gravity conduction pathway, which is characterized by the degree of diplopia being affected by postural changes. A 44-year-old man was in hospital due to episodic postural diplopia for 4 months, dizziness and unstable walking for 5 days. In the past four months, the patient had endured episodic diplopia attack for 8 times when standing or walking, which could be relieved obviously while lying down and gradually disappeared within 5-10 minutes. He had not seen a doctor since the outbreak of the novel coronavirus. Five days before admission, diplopia worsened accompanying obvious vertigo, nausea and vomiting, left facial numbness, and hiccups. The diplopia could be relieved after taking the supine position, but not completely disappear as before. Physical examination showed a triad of ocular tilt response (OTR), namely static ocular rotation (SOT), skew deviation (SD) and head tilt (HT). And also subjective visual vertical (SVV) deviation was found. Those signs were considered for otolith gravity conduction system involvement. Combined with other clinical signs, such as Horner signs, crossed sensory disorders, ataxia, and MRI scan, it was easy to find the infarction was in the territory of the left PICA. The reasons for the patient's "episodic posi-tional diplopia" in the early stage of the disease were considered as follows: (1) the gravity was less affected in the supine position, the stimulation of the otolith gravity conduction pathway was reduced, so the degree of eye deviation was reduced in the supine position. (2) As an ischemic cerebrovascular disease, the patient experienced a process of transient ischemic attack (TIA) in the posterior circulation, the cerebral blood supply and the hypoperfusion of stenosis were increased after lying down, so the diplopia symptom disappeared. The upright-supine test was recommended for the patients with vertical diplopia. It was recommened to differentiate between otolith pathway involvement and diplopia caused by trochlear nerve palsy.
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Affiliation(s)
- 常锋 范
- 北京大学首钢医院神经内科,北京 100041Department of Neurology, Peking University Shougang Hospital, Beijing 100041, China
- 北京大学首钢医院老年医学科,北京 100041Department of Geriatrics, Peking University Shougang Hospital, Beijing 100041, China
| | - 亚平 黄
- 北京大学首钢医院神经内科,北京 100041Department of Neurology, Peking University Shougang Hospital, Beijing 100041, China
| | - 霞 李
- 北京大学首钢医院神经内科,北京 100041Department of Neurology, Peking University Shougang Hospital, Beijing 100041, China
| | - 芸 陈
- 北京大学首钢医院神经内科,北京 100041Department of Neurology, Peking University Shougang Hospital, Beijing 100041, China
| | - 真 李
- 北京大学首钢医院眼科,北京 100041Department of ophthalmology, Peking University Shougang Hospital, Beijing 100041, China
| | - 淑冬 乔
- 北京大学首钢医院神经内科,北京 100041Department of Neurology, Peking University Shougang Hospital, Beijing 100041, China
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9
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Mortazavi S, Ambati R, Dharsono F, Prentice D. Dental procedure induced cerebellar haemorrhage with visual tilt and unsuspected CADASIL. BMJ Case Rep 2023; 16:e253965. [PMID: 37532455 PMCID: PMC10401217 DOI: 10.1136/bcr-2022-253965] [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: 08/04/2023] Open
Abstract
A man in his late 60s had vertigo and vision tilt following a dental procedure. A cerebellar haemorrhage and cerebral microbleeds (CMBs) were diagnosed on imaging. Subsequent testing revealed CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). The role of the dental procedure as a trigger for intracerebral haemorrhage (ICH) is discussed. The incidence of CMBs and ICH in CADASIL is discussed. A summary of the causes and pathology associated with visual tilt is documented.
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Affiliation(s)
- Siavash Mortazavi
- Neurosurgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ravi Ambati
- Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ferry Dharsono
- The Neurological Intervention & Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - David Prentice
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
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Park JY, Choi JH, Kwon JH, Weon YC, Lee SM, Kim HJ, Choi SY, Oh EH, Kim HA, Lee H, Kim JS, Choi KD. Incidence, characteristics, and neuroanatomical substrates of vestibular symptoms in supratentorial stroke. J Neurol 2023; 270:2174-2183. [PMID: 36633670 DOI: 10.1007/s00415-023-11566-9] [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: 10/25/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
The incidence and characteristics of acute vestibular symptoms, responsible structures, and lateralization of the causative lesions in supratentorial stroke remain unknown. This study aimed to determine the incidence, clinical features, and anatomical correlation of acute vestibular symptoms in supratentorial stroke. We performed a prospective, multicenter, observational study that had recruited patients with supratentorial stroke from the neurology clinics of referral-based four university hospitals in Korea. All patients received a constructed neuro-otological evaluations, and neuroimaging. We analyzed the incidence of acute vestibular symptoms, abnormal ocular motor and vestibular function tests, and stroke lesions. Of 1301 patients with supratentorial stroke, 48 (3.7%) presented with acute vestibular symptoms, and 13 of them (1%) had the vestibular symptoms in isolation. In patients with acute vestibular symptoms, abnormal findings included spontaneous nystagmus (5%), impaired horizontal smooth pursuit (41%), and abnormal tilt of the subjective visual vertical (SVV) (20%). Video head impulse and caloric tests were normal in all the patients. There was no clear correlation between acute vestibular symptoms and involvement of specific vestibular cortex. In patients with unilateral stroke, there was also no lateralization of the causative lesions of acute vestibular symptoms (left vs. right; 52 vs. 48%), even in patients with vertigo (left vs. right; 58 vs. 42%). This study demonstrates that the incidence of acute vestibular symptoms in supratentorial stroke is 3.7%, with being isolated in 1%. The widespread lesions responsible for acute vestibular symptoms implicate diffuse multisensory cortical-subcortical networks in the cerebral hemispheres without a lateralization.
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Affiliation(s)
- Ji-Yun Park
- Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young Cheol Weon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Suk-Min Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
| | - Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea.
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11
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Smith JL, Ahluwalia V, Gore RK, Allen JW. Eagle-449: A volumetric, whole-brain compilation of brain atlases for vestibular functional MRI research. Sci Data 2023; 10:29. [PMID: 36641517 PMCID: PMC9840609 DOI: 10.1038/s41597-023-01938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Human vestibular processing involves distributed networks of cortical and subcortical regions which perform sensory and multimodal integrative functions. These functional hubs are also interconnected with areas subserving cognitive, affective, and body-representative domains. Analysis of these diverse components of the vestibular and vestibular-associated networks, and synthesis of their holistic functioning, is therefore vital to our understanding of the genesis of vestibular dysfunctions and aid treatment development. Novel neuroimaging methodologies, including functional and structural connectivity analyses, have provided important contributions in this area, but often require the use of atlases which are comprised of well-defined a priori regions of interest. Investigating vestibular dysfunction requires a more detailed atlas that encompasses cortical, subcortical, cerebellar, and brainstem regions. The present paper represents an effort to establish a compilation of existing, peer-reviewed brain atlases which collectively afford comprehensive coverage of these regions while explicitly focusing on vestibular substrates. It is expected that this compilation will be iteratively improved with additional contributions from researchers in the field.
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Affiliation(s)
- Jeremy L. Smith
- grid.189967.80000 0001 0941 6502Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia USA
| | - Vishwadeep Ahluwalia
- grid.213917.f0000 0001 2097 4943Georgia Institute of Technology, Atlanta, Georgia USA ,grid.256304.60000 0004 1936 7400GSU/GT Center for Advanced Brain Imaging, Atlanta, Georgia USA
| | - Russell K. Gore
- grid.213917.f0000 0001 2097 4943Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia USA ,grid.419148.10000 0004 0384 2537Shepherd Center, Atlanta, Georgia USA
| | - Jason W. Allen
- grid.189967.80000 0001 0941 6502Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia USA ,grid.213917.f0000 0001 2097 4943Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia USA ,grid.189967.80000 0001 0941 6502Department of Neurology, Emory University School of Medicine, Atlanta, Georgia USA
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12
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Chepisheva MK. Spatial orientation, postural control and the vestibular system in healthy elderly and Alzheimer's dementia. PeerJ 2023; 11:e15040. [PMID: 37151287 PMCID: PMC10162042 DOI: 10.7717/peerj.15040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2023] [Indexed: 05/09/2023] Open
Abstract
Background While extensive research has been advancing our understanding of the spatial and postural decline in healthy elderly (HE) and Alzheimer's disease (AD), much less is known about how the vestibular system contributes to the spatial and postural processing in these two populations. This is especially relevant during turning movements in the dark, such as while walking in our garden or at home at night, where the vestibular signal becomes central. As the prevention of falls and disorientation are of serious concern for the medical service, more vestibular-driven knowledge is necessary to decrease the burden for HE and AD patients with vestibular disabilities. Overview of the article The review briefly presents the current "non-vestibular based" knowledge (i.e. knowledge based on research that does not mention the "vestibular system" as a contributor or does not investigate its effects) about spatial navigation and postural control during normal healthy ageing and AD pathology. Then, it concentrates on the critical sense of the vestibular system and explores the current expertise about the aspects of spatial orientation and postural control from a vestibular system point of view. The norm is set by first looking at how healthy elderly change with age with respect to their vestibular-guided navigation and balance, followed by the AD patients and the difficulties they experience in maintaining their balance or during navigation. Conclusion Vestibular spatial and vestibular postural deficits present a considerable disadvantage and are felt not only on a physical but also on a psychological level by all those affected. Still, there is a clear need for more (central) vestibular-driven spatial and postural knowledge in healthy and pathological ageing, which can better facilitate our understanding of the aetiology of these dysfunctions. A possible change can start with the more frequent implementation of the "vestibular system examination/rehabilitation/therapy" in the clinic, which can then lead to an improvement of future prognostication and disease outcome for the patients.
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13
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Politi L, Salerni L, Bubbico L, Ferretti F, Carucci M, Rubegni G, Mandalà M. Risk of falls, vestibular multimodal processing, and multisensory integration decline in the elderly-Predictive role of the functional head impulse test. Front Neurol 2022; 13:964017. [PMID: 36468048 PMCID: PMC9708715 DOI: 10.3389/fneur.2022.964017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/24/2022] [Indexed: 07/28/2023] Open
Abstract
Age-related degeneration of the vestibular system, also known as presbyastasis, leads to unstable gait and higher risk of falls. These conditions affect lifestyle and may have non-negligible social repercussions due to fear-related states of anxiety and depression. In order to develop a model for predicting risk of falls, we assessed vestibulo-ocular function by video and functional Head Impulse Tests (vHIT and fHIT) and their possible correlations with Tinetti Balance Test score. Thirty-one patients over 65 years of age admitted with trauma due to falls were recruited. Vestibular evaluation (complete otoneurological assessment, vHIT, fHIT), cognitive tests (Mini Mental State Examination), anxiety and depression evaluation and Tinetti Balance Test were performed. The possibility of a correlation between the head impulse tests (vHIT, fHIT) and the Tinetti Balance Test was investigated by logistic regression analysis (Nagelkerke r 2 and Wald test). A linear correlation was found between the Tinetti Balance Test score and fHIT, whereas no correlation was found for vHIT. Functional HIT is an effective test for predicting the risk of falls in elderly patients.
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Affiliation(s)
| | - Lorenzo Salerni
- ENT Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luciano Bubbico
- Department of Sensory Neural Disability Research, National Institute for Public Politic Analysis (INAPP), Rome, Italy
| | - Fabio Ferretti
- ENT Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mario Carucci
- ENT Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giovanni Rubegni
- ENT Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Mandalà
- ENT Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
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14
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Hebert JR, Filley CM. Multisensory integration and white matter pathology: Contributions to cognitive dysfunction. Front Neurol 2022; 13:1051538. [PMID: 36408503 PMCID: PMC9668060 DOI: 10.3389/fneur.2022.1051538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
The ability to simultaneously process and integrate multiple sensory stimuli is paramount to effective daily function and essential for normal cognition. Multisensory management depends critically on the interplay between bottom-up and top-down processing of sensory information, with white matter (WM) tracts acting as the conduit between cortical and subcortical gray matter (GM) regions. White matter tracts and GM structures operate in concert to manage both multisensory signals and cognition. Altered sensory processing leads to difficulties in reweighting and modulating multisensory input during various routine environmental challenges, and thus contributes to cognitive dysfunction. To examine the specific role of WM in altered sensory processing and cognitive dysfunction, this review focuses on two neurologic disorders with diffuse WM pathology, multiple sclerosis and mild traumatic brain injury, in which persistently altered sensory processing and cognitive impairment are common. In these disorders, cognitive dysfunction in association with altered sensory processing may develop initially from slowed signaling in WM tracts and, in some cases, GM pathology secondary to WM disruption, but also because of interference with cognitive function by the added burden of managing concurrent multimodal primary sensory signals. These insights promise to inform research in the neuroimaging, clinical assessment, and treatment of WM disorders, and the investigation of WM-behavior relationships.
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Affiliation(s)
- Jeffrey R. Hebert
- Physical Performance Laboratory, Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, United States,*Correspondence: Jeffrey R. Hebert
| | - Christopher M. Filley
- Behavorial Neurology Section, Department of Neurology and Psychiatry, Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, United States
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15
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The Navigation Ability Test (NAT 2.0): From Football Player Performance to Balance Rehabilitation in Chronic Unilateral Vestibular Loss. Audiol Res 2022; 12:249-259. [PMID: 35645196 PMCID: PMC9149913 DOI: 10.3390/audiolres12030026] [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: 03/24/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 12/04/2022] Open
Abstract
Aim of the Study: in humans, spatial orientation consists of the ability to move around the environment through memorized and pre-programmed movements, according to the afferent sensory information of the body and environmental analysis of the Central Nervous System (CNS). The purpose of this study is to analyze the abilities of professional athletes, such as footballers, to use mental navigation systems, cognitive maps, and memorized motor patterns in order to obtain better physical performance and to obtain useful information for training both non-sports subjects and vestibular patients for rehabilitation purposes. Materials and Methods: all the motor performances of sportsmen, healthy non-sporting subjects, or vestibular patients are based on the acquisition of visual–spatial and training information. In this study, we analyzed the visual–spatial performance of 60 trained sportsmen (professional footballers), 60 healthy non-sports subjects, and 48 patients affected by chronic unilateral vestibular loss by means of the Navigation Ability Test 2.0. A score based on the number of targets correctly reached in the various tests quantifies the degree of performance of the subjects. Results: NAT 2.0 scores progressively improve from vestibular subjects to healthy non-sporting subjects to footballers. NAT 2.0 scores improve in all three subject groups as the number of tasks performed in all patient groups increases, regardless of gender and age. Conclusions: the analysis of performance data through NAT 2.0 in athletes (footballers) opens new perspectives for rehabilitation purposes, regardless of age, sex, and training conditions, both in healthy non-sporting subjects to improve their sporting potential and in patients affected by chronic vestibular dysfunction, in order to optimize their motor skills and prevent falls.
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16
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Smith JL, Trofimova A, Ahluwalia V, Casado Garrido JJ, Hurtado J, Frank R, Hodge A, Gore RK, Allen JW. The "vestibular neuromatrix": A proposed, expanded vestibular network from graph theory in post-concussive vestibular dysfunction. Hum Brain Mapp 2021; 43:1501-1518. [PMID: 34862683 PMCID: PMC8886666 DOI: 10.1002/hbm.25737] [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: 08/04/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022] Open
Abstract
Convergent clinical and neuroimaging evidence suggests that higher vestibular function is subserved by a distributed network including visuospatial, cognitive-affective, proprioceptive, and integrative brain regions. Clinical vestibular syndromes may perturb this network, resulting in deficits across a variety of functional domains. Here, we leverage structural and functional neuroimaging to characterize this extended network in healthy control participants and patients with post-concussive vestibular dysfunction (PCVD). Then, 27 healthy control subjects (15 females) and 18 patients with subacute PCVD (12 female) were selected for participation. Eighty-two regions of interest (network nodes) were identified based on previous publications, group-wise differences in BOLD signal amplitude and connectivity, and multivariate pattern analysis on affective tests. Group-specific "core" networks, as well as a "consensus" network comprised of connections common to all participants, were then generated based on probabilistic tractography and functional connectivity between the 82 nodes and subjected to analyses of node centrality and community structure. Whereas the consensus network was comprised of affective, integrative, and vestibular nodes, PCVD participants exhibited diminished integration and centrality among vestibular and affective nodes and increased centrality of visual, supplementary motor, and frontal and cingulate eye field nodes. Clinical outcomes, derived from dynamic posturography, were associated with approximately 62% of all connections but best predicted by amygdalar, prefrontal, and cingulate connectivity. No group-wise differences in diffusion metrics or tractography were noted. These findings indicate that cognitive, affective, and proprioceptive substrates contribute to vestibular processing and performance and highlight the need to consider these domains during clinical diagnosis and treatment planning.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vishwadeep Ahluwalia
- Georgia State University, Atlanta, Georgia, USA.,Center for Advanced Brain Imaging, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jose J Casado Garrido
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | | | | | | | - Russell K Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Shepherd Center, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine Emory University Hospital, Atlanta, Georgia, USA
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17
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Donaldson LB, Yan F, Liu YF, Nguyen SA, Rizk HG. Does cognitive dysfunction correlate with dizziness severity in patients with vestibular migraine? Am J Otolaryngol 2021; 42:103124. [PMID: 34166962 DOI: 10.1016/j.amjoto.2021.103124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize the relationship between dizziness severity and cognitive dysfunction in vestibular migraine (VM) patients. METHODS Dizziness Handicap Inventory (DHI) and Cognitive Failures Questionnaire (CFQ) scores were compared pre- and post-treatment in a cohort of definite VM patients who underwent evaluation in a multidisciplinary clinic from 2016 to 2020. RESULTS 44 patients were included. DHI reduction of 11.96 (SD 11.49) (p < 0.001) from an initial mean of 58.36 (22.05) and CFQ reduction of 4.57 (12.20) (p = 0.017) from an initial mean of 47.66 (19.12) were demonstrated. Both pre- and post-treatment DHI scores correlated with pre- and post-treatment CFQ scores (r = 0.537, p < 0.001 and r = 0.667, p < 0.001, respectively). Change in DHI score correlated with change in CFQ score (r = 0.351, p = 0.019). CONCLUSIONS Cognitive dysfunction in VM patients is correlated with dizziness severity. The DHI may fail to thoroughly assess cognitive dysfunction in VM patients. Additionally, multidisciplinary treatment of VM reduces both dizziness severity and cognitive dysfunction.
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18
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Nakul E, Bartolomei F, Lopez C. Vestibular-Evoked Cerebral Potentials. Front Neurol 2021; 12:674100. [PMID: 34621231 PMCID: PMC8490637 DOI: 10.3389/fneur.2021.674100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
The human vestibular cortex has mostly been approached using functional magnetic resonance imaging and positron emission tomography combined with artificial stimulation of the vestibular receptors or nerve. Few studies have used electroencephalography and benefited from its high temporal resolution to describe the spatiotemporal dynamics of vestibular information processing from the first milliseconds following vestibular stimulation. Evoked potentials (EPs) are largely used to describe neural processing of other sensory signals, but they remain poorly developed and standardized in vestibular neuroscience and neuro-otology. Yet, vestibular EPs of brainstem, cerebellar, and cortical origin have been reported as early as the 1960s. This review article summarizes and compares results from studies that have used a large range of vestibular stimulation, including natural vestibular stimulation on rotating chairs and motion platforms, as well as artificial vestibular stimulation (e.g., sounds, impulsive acceleration stimulation, galvanic stimulation). These studies identified vestibular EPs with short latency (<20 ms), middle latency (from 20 to 50 ms), and late latency (>50 ms). Analysis of the generators (source analysis) of these responses offers new insights into the neuroimaging of the vestibular system. Generators were consistently found in the parieto-insular and temporo-parietal junction-the core of the vestibular cortex-as well as in the prefrontal and frontal areas, superior parietal, and temporal areas. We discuss the relevance of vestibular EPs for basic research and clinical neuroscience and highlight their limitations.
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Affiliation(s)
- Estelle Nakul
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Neurosciences Cognitives (LNC), FR3C, Aix Marseille Univ, Marseille, France
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Inserm, Aix Marseille Univ, Marseille, France
- Service de Neurophysiologie Clinique, Hôpital Timone, Aix Marseille Univ, Marseille, France
| | - Christophe Lopez
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Neurosciences Cognitives (LNC), FR3C, Aix Marseille Univ, Marseille, France
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Abstract
There is a reciprocal relationship between vestibular and neuropsychological disorders. People with vertigo and dizziness are at higher risk of various psychiatric disorders, particularly anxiety, depression, and panic disorder. On the other hand, people with mood disorders are at higher risk of experiencing vertigo and dizziness. Vestibular information plays a crucial role in cognitive processes, especially visuo-spatial abilities. Consequently, vestibular disorders (both peripheral and central) often result in visuo-spatial deficits. In addition, lesions of the cortical and subcortical components of the vestibular system result in disorders of higher vestibular function, such as hemispatial neglect, pusher syndrome, and topographagnosia.
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Affiliation(s)
- Shin C Beh
- Department of Neurology, Vestibular & Neuro-Visual Disorders Clinic, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Neuroimaging studies in persistent postural-perceptual dizziness and related disease: a systematic review. J Neurol 2021; 269:1225-1235. [PMID: 34019178 DOI: 10.1007/s00415-021-10558-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Persistent Postural-Perceptual Dizziness (PPPD) is one of the most common types of chronic dizziness. The pathogenesis remains unclear. OBJECTIVE This study aimed to systematically review neuroimaging literature for investigating the central mechanism of PPPD and related disorders. METHODS PubMed, EMBASE, Medline, Cochrane, and Web of Science were searched by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles analyzing structural and functional neuroimaging features of PPPD and related disorders were selected according to eligibility criteria. RESULTS Fifteen articles, including 4 structural, 10 functional, and 1 multimodal imaging, were eligible for inclusion in this review. The whiter matter alterations in PPPD are not entirely consistent. The changes of grey matter mainly in multisensory vestibular cortices, visual cortex, cerebellum, as well as anxiety-related network. Consistent with structural imaging, functional imaging conducted during the specific tasks or in the resting state has both found abnormal functional activation and connectivity in the vestibular cortex, especially in the parieto-insular vestibular cortex (PIVC), visual cortex, cerebellum, and anxiety-related network in PPPD and related disorder. CONCLUSIONS The current review provides up-to-date knowledge and summarizes the possible central mechanism for PPPD and related disorders, and it is helpful to understanding the mechanism of PPPD.
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21
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Allen JW, Trofimova A, Ahluwalia V, Smith JL, Abidi SA, Peters MAK, Rajananda S, Hurtado JE, Gore RK. Altered Processing of Complex Visual Stimuli in Patients with Postconcussive Visual Motion Sensitivity. AJNR Am J Neuroradiol 2021; 42:930-937. [PMID: 33574098 DOI: 10.3174/ajnr.a7007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms are common after concussion. Vestibular Ocular Motor Screening identifies vestibular impairment, including postconcussive visual motion sensitivity, though the underlying functional brain alterations are not defined. We hypothesized that alterations in multisensory processing are responsible for postconcussive visual motion sensitivity, are detectable on fMRI, and correlate with symptom severity. MATERIALS AND METHODS Twelve patients with subacute postconcussive visual motion sensitivity and 10 healthy control subjects underwent vestibular testing and a novel fMRI visual-vestibular paradigm including 30-second "neutral" or "provocative" videos. The presence of symptoms/intensity was rated immediately after each video. fMRI group-level analysis was performed for a "provocative-neutral" condition. Z-statistic images were nonparametrically thresholded using clusters determined by Z > 2.3 and a corrected cluster significance threshold of P = .05. Symptoms assessed on Vestibular Ocular Motor Screening were correlated with fMRI mean parameter estimates using Pearson correlation coefficients. RESULTS Subjects with postconcussive visual motion sensitivity had significantly more Vestibular Ocular Motor Screening abnormalities and increased symptoms while viewing provocative videos. While robust mean activation in the primary and secondary visual areas, the parietal lobe, parietoinsular vestibular cortex, and cingulate gyrus was seen in both groups, selective increased activation was seen in subjects with postconcussive visual motion sensitivity in the primary vestibular/adjacent cortex and inferior frontal gyrus, which are putative multisensory visual-vestibular processing centers. Moderate-to-strong correlations were found between Vestibular Ocular Motor Screening scores and fMRI activation in the left frontal eye field, left middle temporal visual area, and right posterior hippocampus. CONCLUSIONS Increased fMRI brain activation in visual-vestibular multisensory processing regions is selectively seen in patients with postconcussive visual motion sensitivity and is correlated with Vestibular Ocular Motor Screening symptom severity, suggesting that increased visual input weighting into the vestibular network may underlie postconcussive visual motion sensitivity.
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Affiliation(s)
- J W Allen
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
- Department of Neurology (J.W.A.), Emory University, Atlanta, Georgia
- Wallace H. Coulter Department of Biomedical Engineering (J.W.A., R.K.G.), Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - A Trofimova
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
| | - V Ahluwalia
- Georgia State University/Georgia Tech Center for Advanced Brain Imaging (V.A.), Atlanta, Georgia
| | - J L Smith
- From the Department of Radiology and Imaging Sciences (J.W.A., A.T., J.L.S.), Emory University, Atlanta, Georgia
| | - S A Abidi
- School of Medicine (S.A.A.), Emory University, Atlanta, Georgia
| | - M A K Peters
- Department of Bioengineering (M.A.K.P., S.R.), University of California, Riverside, Riverside, California
| | - S Rajananda
- Department of Bioengineering (M.A.K.P., S.R.), University of California, Riverside, Riverside, California
| | | | - R K Gore
- Wallace H. Coulter Department of Biomedical Engineering (J.W.A., R.K.G.), Georgia Institute of Technology and Emory University, Atlanta, Georgia
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22
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Lee S, Liu A, McKeown MJ. Current perspectives on galvanic vestibular stimulation in the treatment of Parkinson's disease. Expert Rev Neurother 2021; 21:405-418. [PMID: 33621149 DOI: 10.1080/14737175.2021.1894928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Galvanic vestibular stimulation (GVS) is a noninvasive technique that activates vestibular afferents, influencing activity and oscillations in a broad network of brain regions. Several studies have suggested beneficial effects of GVS on motor symptoms in Parkinson's Disease (PD).Areas covered: A comprehensive overview of the stimulation techniques, potential mechanisms of action, challenges, and future research directions.Expert opinion: This emerging technology is not currently a viable therapy. However, a complementary therapy that is inexpensive, easily disseminated, customizable, and portable is sufficiently enticing that continued research and development is warranted. Future work utilizing biomedical engineering approaches, including concomitant functional neuroimaging, have the potential to significantly increase efficacy. GVS could be explored for other PD symptoms including orthostatic hypotension, dyskinesia, and sleep disorders.
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Affiliation(s)
- Soojin Lee
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada.,Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford UK
| | - Aiping Liu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Martin J McKeown
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
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23
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Ertl M, Zu Eulenburg P, Woller M, Dieterich M. The role of delta and theta oscillations during ego-motion in healthy adult volunteers. Exp Brain Res 2021; 239:1073-1083. [PMID: 33534022 PMCID: PMC8068649 DOI: 10.1007/s00221-020-06030-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
The successful cortical processing of multisensory input typically requires the integration of data represented in different reference systems to perform many fundamental tasks, such as bipedal locomotion. Animal studies have provided insights into the integration processes performed by the neocortex and have identified region specific tuning curves for different reference frames during ego-motion. Yet, there remains almost no data on this topic in humans. In this study, an experiment originally performed in animal research with the aim to identify brain regions modulated by the position of the head and eyes relative to a translational ego-motion was adapted for humans. Subjects sitting on a motion platform were accelerated along a translational pathway with either eyes and head aligned or a 20° yaw-plane offset relative to the motion direction while EEG was recorded. Using a distributed source localization approach, it was found that activity in area PFm, a part of Brodmann area 40, was modulated by the congruency of translational motion direction, eye, and head position. In addition, an asymmetry between the hemispheres in the opercular-insular region was observed during the cortical processing of the vestibular input. A frequency specific analysis revealed that low-frequency oscillations in the delta- and theta-band are modulated by vestibular stimulation. Source-localization estimated that the observed low-frequency oscillations are generated by vestibular core-regions, such as the parieto-opercular region and frontal areas like the mid-orbital gyrus and the medial frontal gyrus.
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Affiliation(s)
- M Ertl
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany.
| | - P Zu Eulenburg
- German Center for Vertigo and Balance Disorders (IFBLMU), Ludwig-Maximilians-Universität München, München, Germany
- Institute for Neuroradiology, Ludwig-Maximilians-Universität München, München, Germany
| | - M Woller
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - M Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
- German Center for Vertigo and Balance Disorders (IFBLMU), Ludwig-Maximilians-Universität München, München, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität München, München, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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24
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Dynamic whole-brain metabolic connectivity during vestibular compensation in the rat. Neuroimage 2020; 226:117588. [PMID: 33249212 DOI: 10.1016/j.neuroimage.2020.117588] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/05/2020] [Accepted: 11/19/2020] [Indexed: 12/16/2022] Open
Abstract
Unilateral damage to the inner ear results in an acute vestibular syndrome, which is compensated within days to weeks due to adaptive cerebral plasticity. This process, called central vestibular compensation (VC), involves a wide range of functional and structural mechanisms at the cellular and network level. The short-term dynamics of whole-brain functional network recruitment and recalibration during VC has not been depicted in vivo. The purpose of this study was to investigate the interplay of separate and distinct brain regions and in vivo networks in the course of VC by sequential [18F]-FDG-PET-based statistical and graph theoretical analysis with the aim of revealing the metabolic connectome before and 1, 3, 7, and 15 days post unilateral labyrinthectomy (UL) in the rat. Temporal changes in metabolic brain connectivity were determined by Pearson's correlation (|r| > 0.5, p < 0.001) of regional cerebral glucose metabolism (rCGM) in 57 segmented brain regions. Metabolic connectivity analysis was compared to univariate voxel-wise statistical analysis of rCGM over time and to behavioral scores of static and dynamic sensorimotor recovery. Univariate statistical analysis revealed an ipsilesional relative rCGM decrease (compared to baseline) and a contralesional rCGM increase in vestibular and limbic networks and an increase in bilateral cerebellar and sensorimotor networks. Quantitative analysis of the metabolic connections showed a maximal increase from baseline to day 3 post UL (interhemispheric: 2-fold, ipsilesional: 3-fold, contralesional: 12-fold) and a gradual decline until day 15 post UL, which paralleled the dynamics of vestibular symptoms. In graph theoretical analysis, an increase in connectivity occurred especially within brain regions associated with brainstem-cerebellar and thalamocortical vestibular networks and cortical sensorimotor networks. At the symptom peak (day 3 post UL), brain networks were found to be organized in large ensembles of distinct and highly connected hubs of brain regions, which separated again with progressing VC. Thus, we found rapid changes in network organization at the subcortical and cortical level and in both hemispheres, which may indicate an initial functional substitution of vestibular loss and subsequent recalibration and reorganization of sensorimotor networks during VC.
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25
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Indovina I, Bosco G, Riccelli R, Maffei V, Lacquaniti F, Passamonti L, Toschi N. Structural connectome and connectivity lateralization of the multimodal vestibular cortical network. Neuroimage 2020; 222:117247. [PMID: 32798675 PMCID: PMC7779422 DOI: 10.1016/j.neuroimage.2020.117247] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 01/05/2023] Open
Abstract
Unlike other sensory systems, the structural connectivity patterns of the human vestibular cortex remain a matter of debate. Based on their functional properties and hypothesized centrality within the vestibular network, the ‘core’ cortical regions of this network are thought to be areas in the posterior peri-sylvian cortex, in particular the retro-insula (previously named the posterior insular cortex-PIC), and the subregion OP2 of the parietal operculum. To study the vestibular network, structural connectivity matrices from n=974 healthy individuals drawn from the public Human Connectome Project (HCP) repository were estimated using multi-shell diffusion-weighted data followed by probabilistic tractography and spherical-deconvolution informed filtering of tractograms in combination with subject-specific grey-matter parcellations. Weighted graph-theoretical measures, modularity, and ‘hubness’ of the multimodal vestibular network were then estimated, and a structural lateralization index was defined in order to assess the difference in fiber density of homonym regions in the right and left hemisphere. Differences in connectivity patterns between OP2 and PIC were also estimated. We found that the bilateral intraparietal sulcus, PIC, and to a lesser degree OP2, are key ‘hub’ regions within the multimodal vestibular network. PIC and OP2 structural connectivity patterns were lateralized to the left hemisphere, while structural connectivity patterns of the posterior peri-sylvian supramarginal and superior temporal gyri were lateralized to the right hemisphere. These lateralization patterns were independent of handedness. We also found that the structural connectivity pattern of PIC is consistent with a key role of PIC in visuo-vestibular processing and that the structural connectivity pattern of OP2 is consistent with integration of mainly vestibular somato-sensory and motor information. These results suggest an analogy between PIC and the simian visual posterior sylvian (VPS) area and OP2 and the simian parieto-insular vestibular cortex (PIVC). Overall, these findings may provide novel insights to the current models of vestibular function, as well as to the understanding of the complexity and lateralized signs of vestibular syndromes.
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Affiliation(s)
- Iole Indovina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy.
| | - Gianfranco Bosco
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy; Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, 00173 Rome, Italy
| | - Roberta Riccelli
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy
| | - Vincenzo Maffei
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, via Ardeatina 354, 00179 Rome, Italy; Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, 00173 Rome, Italy
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, UK; Institute of Bioimaging & Molecular Physiology, National Research Council, Milano, Italy; IRCCS San Camillo Hospital, Venice, Italy.
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, USA
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26
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Willacker L, Roccato M, Can BN, Dieterich M, Taylor PCJ. Reducing variability of perceptual decision making with offline theta-burst TMS of dorsal medial frontal cortex. Brain Stimul 2020; 13:1689-1696. [PMID: 33035723 DOI: 10.1016/j.brs.2020.09.011] [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: 11/26/2019] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Recent evidence suggests that the dorsal medial frontal cortex (dMFC) may make an important contribution to perceptual decision-making, and not only to motor control. OBJECTIVE/HYPOTHESIS By fitting psychometric functions to behavioural data after TMS we tested whether the dMFC is critical specifically for the precision and/or bias of perceptual judgements. Additionally we aimed to disentangle potential roles of the dMFC in dealing with perceptual versus response switching. METHODS A subjective visual vertical task (SVV) was used in which participants weight visual (and other, e.g., vestibular) information to establish whether a line is oriented vertically. To ensure a high perceptual demand (putatively necessary to demonstrate a dMFC involvement) SVV lines were presented inside pop-out targets within a visual search array. Distinct features of perceptual performance were analysed before as compared to following theta-burst TMS stimulation of the dMFC, a control site, or no stimulation, in three groups, each of 20 healthy participants. RESULTS dMFC stimulation improved the precision of verticality judgments. Moreover, dMFC stimulation improved accuracy, selectively when response switches occurred with perceptual repeats. CONCLUSION These findings point to a causal role of the dMFC in establishing the precision of perceptual decision making, demonstrably dissociable from an additional role in motor control in attentionally demanding contexts.
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Affiliation(s)
- Lina Willacker
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University München, D-82152, Planegg, Germany.
| | - Marco Roccato
- Department of General Psychology, University of Padova, I- 35131, Padova, Italy.
| | - Beril Nisa Can
- Department of Psychology, Ludwig-Maximilians-Universität München, D-80802, München, Germany.
| | - Marianne Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University München, D-82152, Planegg, Germany; Synergy - Munich Cluster for Systems Neurology, Munich, D-81377, München, Germany.
| | - Paul C J Taylor
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University München, D-82152, Planegg, Germany; Department of Psychology, Ludwig-Maximilians-Universität München, D-80802, München, Germany; Faculty of Philosophy and Philosophy of Science, Ludwig-Maximilians-Universität München, München, Germany; Munich Center for Neurosciences, Ludwig-Maximilians-Universität München, München, Germany.
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27
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Lucieer FMP, Van Hecke R, van Stiphout L, Duijn S, Perez-Fornos A, Guinand N, Van Rompaey V, Kingma H, Joore M, van de Berg R. Bilateral vestibulopathy: beyond imbalance and oscillopsia. J Neurol 2020; 267:241-255. [PMID: 33030608 PMCID: PMC7718190 DOI: 10.1007/s00415-020-10243-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
Objective To optimize the current diagnostic and treatment procedures for patients with bilateral vestibulopathy (BV), this study aimed to determine the complete spectrum of symptoms associated with BV. Method A prospective mixed-method study design was used. Qualitative data were collected by performing semi-structured interviews about symptoms, context, and behavior. The interviews were recorded and transcribed until no new information was obtained. Transcriptions were analyzed in consensus by two independent researchers. In comparison to the qualitative results, quantitative data were collected using the Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS) and a health-related quality of life questionnaire (EQ-5D-5L). Results Eighteen interviews were transcribed. Reported symptoms were divided into fourteen physical symptoms, four cognitive symptoms, and six emotions. Symptoms increased in many situations, such as darkness (100%), uneven ground (61%), cycling (94%) or driving a car (56%). These symptoms associated with BV often resulted in behavioral changes: activities were performed more slowly, with greater attention, or were avoided. The DHI showed a mean score of severe handicap (54.67). The HADS questionnaire showed on average normal results (anxiety = 7.67, depression = 6.22). The EQ-5D-5L demonstrated a mean index value of 0.680, which is lower compared to the Dutch age-adjusted reference 0.839 (60–70 years). Conclusion BV frequently leads to physical, cognitive, and emotional complaints, which often results in a diminished quality of life. Importantly, this wide range of symptoms is currently underrated in literature and should be taken into consideration during the development of candidacy criteria and/or outcome measures for therapeutic interventions such as the vestibular implant. Electronic supplementary material The online version of this article (10.1007/s00415-020-10243-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F M P Lucieer
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - R Van Hecke
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - L van Stiphout
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Duijn
- Faculty of Health, Medicine and life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - A Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences,, Geneva University Hospitals, Geneva, Switzerland
| | - N Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences,, Geneva University Hospitals, Geneva, Switzerland
| | - V Van Rompaey
- Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - H Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - M Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Care and Public Health Research Institute (CAPHRI) of the Faculty of Health, Medicine and Life Sciences of Maastricht University (FHML), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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28
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Cross-Sectional Analysis of Cognitive Dysfunction in Patients With Vestibular Disorders. Ear Hear 2020; 41:1020-1027. [DOI: 10.1097/aud.0000000000000825] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Clément GR, Boyle RD, George KA, Nelson GA, Reschke MF, Williams TJ, Paloski WH. Challenges to the central nervous system during human spaceflight missions to Mars. J Neurophysiol 2020; 123:2037-2063. [DOI: 10.1152/jn.00476.2019] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Space travel presents a number of environmental challenges to the central nervous system, including changes in gravitational acceleration that alter the terrestrial synergies between perception and action, galactic cosmic radiation that can damage sensitive neurons and structures, and multiple factors (isolation, confinement, altered atmosphere, and mission parameters, including distance from Earth) that can affect cognition and behavior. Travelers to Mars will be exposed to these environmental challenges for up to 3 years, and space-faring nations continue to direct vigorous research investments to help elucidate and mitigate the consequences of these long-duration exposures. This article reviews the findings of more than 50 years of space-related neuroscience research on humans and animals exposed to spaceflight or analogs of spaceflight environments, and projects the implications and the forward work necessary to ensure successful Mars missions. It also reviews fundamental neurophysiology responses that will help us understand and maintain human health and performance on Earth.
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Affiliation(s)
| | - Richard D. Boyle
- National Aeronautics and Space Administration, Ames Research Center, Moffett Field, California
| | | | - Gregory A. Nelson
- Division of Biomedical Engineering Sciences, School of Medicine Loma Linda University, Loma Linda, California
| | - Millard F. Reschke
- National Aeronautics and Space Administration, Johnson Space Center, Houston, Texas
| | - Thomas J. Williams
- National Aeronautics and Space Administration, Johnson Space Center, Houston, Texas
| | - William H. Paloski
- National Aeronautics and Space Administration, Johnson Space Center, Houston, Texas
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30
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Dowsett J, Herrmann CS, Dieterich M, Taylor PCJ. Shift in lateralization during illusory self-motion: EEG responses to visual flicker at 10 Hz and frequency-specific modulation by tACS. Eur J Neurosci 2019; 51:1657-1675. [PMID: 31408562 DOI: 10.1111/ejn.14543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/25/2019] [Accepted: 08/05/2019] [Indexed: 01/23/2023]
Abstract
Self-motion perception is a key aspect of higher vestibular processing, suggested to rely upon hemispheric lateralization and alpha-band oscillations. The first aim of this study was to test for any lateralization in the EEG alpha band during the illusory sense of self-movement (vection) induced by large optic flow stimuli. Visual stimuli flickered at alpha frequency (approx. 10 Hz) in order to produce steady state visually evoked potentials (SSVEPs), a robust EEG measure which allows probing the frequency-specific response of the cortex. The first main result was that differential lateralization of the alpha SSVEP response was found during vection compared with a matched random motion control condition, supporting the idea of lateralization of visual-vestibular function. Additionally, this effect was frequency-specific, not evident with lower frequency SSVEPs. The second aim of this study was to test for a causal role of the right hemisphere in producing this lateralization effect and to explore the possibility of selectively modulating the SSVEP response. Transcranial alternating current stimulation (tACS) was applied over the right hemisphere simultaneously with SSVEP recording, using a novel artefact removal strategy for combined tACS-EEG. The second main result was that tACS enhanced SSVEP amplitudes, and the effect of tACS was not confined to the right hemisphere. Subsequent control experiments showed the effect of tACS requires the flicker frequency and tACS frequency to be closely matched and tACS to be of sufficient intensity. Combined tACS-SSVEPs are a promising method for future investigation into the role of neural oscillations and for optimizing tACS.
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Affiliation(s)
- James Dowsett
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Christoph S Herrmann
- Experimental Psychology Lab, Center for Excellence "Hearing4all", European Medical School, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences, LMU Munich, Munich, Germany.,SyNergy - Munich Cluster for Systems Neurology, Munich, Germany
| | - Paul C J Taylor
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Graduate School of Systemic Neurosciences, LMU Munich, Munich, Germany
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31
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Vestibular symptoms in acute hemispheric strokes. J Neurol 2019; 266:1852-1858. [DOI: 10.1007/s00415-019-09342-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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Thalamocortical network: a core structure for integrative multimodal vestibular functions. Curr Opin Neurol 2019; 32:154-164. [DOI: 10.1097/wco.0000000000000638] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Multisensory vestibular, vestibular-auditory, and auditory network effects revealed by parametric sound pressure stimulation. Neuroimage 2018; 176:354-363. [PMID: 29702184 DOI: 10.1016/j.neuroimage.2018.04.057] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/23/2022] Open
Abstract
Multisensory convergence and sensorimotor integration are important aspects for the mediation of higher vestibular cognitive functions at the cortical level. In contrast to the integration of vestibulo-visual or vestibulo-tactile perception, much less is known about the neural mechanism that mediates the integration of vestibular-otolith (linear acceleration/translation/gravity detection) and auditory processing. Vestibular-otolith and auditory afferents can be simultaneously activated using loud sound pressure stimulation, which is routinely used for testing cervical and ocular vestibular evoked myogenic potentials (VEMPs) in clinical neurotological testing. Due to the simultaneous activation of afferents there is always an auditory confound problem in fMRI studies of the neural topology of these systems. Here, we demonstrate that the auditory confounding problem can be overcome in a novel way that does not require the assumption of simple subtraction and additionally allows detection of non-linear changes in the response due to vestibular-otolith interference. We used a parametric sound pressure stimulation design that took each subject's vestibular stimulation threshold into account and analyzed for changes in BOLD-response below and above vestibular-otolith threshold. This approach helped to investigate the functional neuroanatomy of sound-induced auditory and vestibular integration using functional magnetic resonance imaging (fMRI). Results revealed that auditory and vestibular convergence are contained in overlapping regions of the caudal part of the superior temporal gyrus (STG) and the posterior insula. In addition, there are regions that were responsive only to suprathreshold stimulations, suggesting vestibular (otolith) signal processing in these areas. Based on these parametric analyses, we suggest that the caudal part of the STG and posterior insula could contain areas of vestibular contribution to auditory processing, i.e., higher vestibular cortices that provide multisensory integration that is important for tasks such as spatial localization of sound.
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Otero-Millan J, Winnick A, Kheradmand A. Exploring the Role of Temporoparietal Cortex in Upright Perception and the Link With Torsional Eye Position. Front Neurol 2018; 9:192. [PMID: 29681880 PMCID: PMC5897546 DOI: 10.3389/fneur.2018.00192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Upright perception is a key aspect of orientation constancy, as we maintain a stable perception of the world despite continuous movements of our eyes, head, and body. Torsional position of the eyes can impact perception of upright by changing orientation of the images on the retina relative to gravity. Here, we investigated the role of temporoparietal cortex in upright perception with respect to ocular torsion, by means of the inhibitory effect of continuous theta burst transcranial magnetic stimulation (TMS). We used a subjective visual vertical (SVV) paradigm to track changes in upright perception, and a custom video method to track ocular torsion simultaneously. Twelve participants were tested during a lateral head tilt of 20° to the left. TMS at the posterior aspect of the supramarginal gyrus (SMGp) resulted in an average SVV shift in the opposite direction of the head tilt compared to a sham stimulation (1.8°). Ocular torsion following TMS at SMGp showed no significant change compared to the sham stimulation (-0.1°). Thus, changes in upright perception at SMGp were dissociated from ocular torsion. This finding suggests that perception of upright at SMGp is primarily related to sensory processing for spatial orientation, as opposed to subcortical regions that have direct influence on ocular torsion.
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Affiliation(s)
- Jorge Otero-Millan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ariel Winnick
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amir Kheradmand
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Conrad J, Boegle R, Ertl M, Brandt T, Dieterich M. Recovery from Spatial Neglect with Intra- and Transhemispheric Functional Connectivity Changes in Vestibular and Visual Cortex Areas-A Case Study. Front Neurol 2018; 9:112. [PMID: 29551990 PMCID: PMC5840167 DOI: 10.3389/fneur.2018.00112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/14/2018] [Indexed: 01/24/2023] Open
Abstract
Objective Vestibular signals are involved in higher cortical functions like spatial orientation and its disorders. Vestibular dysfunction contributes, for example, to spatial neglect which can be transiently improved by caloric stimulation. The exact roles and mechanisms of the vestibular and visual systems for the recovery of neglect are not yet known. Methods Resting-state functional connectivity (fc) magnetic resonance imaging was recorded in a patient with hemispatial neglect during the acute phase and after recovery 6 months later following a right middle cerebral artery infarction before and after caloric vestibular stimulation. Seeds in the vestibular [parietal operculum (OP2)], the parietal [posterior parietal cortex (PPC); 7A, hIP3], and the visual cortex (VC) were used for the analysis. Results During the acute stage after caloric stimulation the fc of the right OP2 to the left OP2, the anterior cingulum, and the para/hippocampus was increased bilaterally (i.e., the vestibular network), while the interhemispheric fc was reduced between homologous regions in the VC. After 6 months, similar fc increases in the vestibular network were found without stimulation. In addition, fc increases of the OP2 to the PPC and the VC were seen; interhemispherically this was true for both PPCs and for the right PPC to both VCs. Conclusion Improvement of neglect after caloric stimulation in the acute phase was associated with increased fc of vestibular cortex areas in both hemispheres to the para-hippocampus and the dorsal anterior cingulum, but simultaneously with reduced interhemispheric VC connectivity. This disclosed a, to some extent, similar but also distinct short-term mechanism (vestibular stimulation) of an improvement of spatial orientation compared to the long-term recovery of neglect.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders - IFBLMU (DSGZ), Ludwig-Maximilians-Universität, Munich, Germany
| | - Rainer Boegle
- German Center for Vertigo and Balance Disorders - IFBLMU (DSGZ), Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Matthias Ertl
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders - IFBLMU (DSGZ), Ludwig-Maximilians-Universität, Munich, Germany.,Clinical Neuroscience, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders - IFBLMU (DSGZ), Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Abstract
The vestibular cortex differs in various ways from other sensory cortices. It consists of a network of several distinct and separate temporoparietal areas. Its core region, the parietoinsular vestibular cortex (PIVC), is located in the posterior insula and retroinsular region and includes the parietal operculum. The entire network is multisensory (in particular, vestibular, visual, and somatosensory). The peripheral and central vestibular systems are bilaterally organized; there are various pontomesencephalic brainstem crossings and at least two transcallosal connections of both hemispheres, between the PIVC and the motion-sensitive visual cortex areas, which also mediate vestibular input. Structural and functional vestibular dominance characterizes the right hemisphere in right-handers and the left hemisphere in left-handers. This explains why right-hemispheric lesions in right-handers more often generally cause hemispatial neglect and the pusher syndrome, both of which involve vestibular function. Vestibular input also contributes to cognition and may determine individual lateralization of brain functions such as handedness. Bilateral organization is a major key to understanding cortical functions and disorders, for example, the visual-vestibular interaction that occurs in spatial orientation. Although the vestibular cortex is represented in both hemispheres, there is only one global percept of body position and motion. The chiefly vestibular aspects of the multiple functions and disorders of the parietal lobe dealt with in this chapter cannot be strictly separated from various multisensory vestibular functions within the entire brain.
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Affiliation(s)
- Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany; German Center for Vertigo and Balance Disorders-IFB, Ludwig-Maximilians-University, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders-IFB, Ludwig-Maximilians-University, Munich, Germany; Clinical Neuroscience, Ludwig-Maximilians-University, Munich, Germany
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Walther LE. Current diagnostic procedures for diagnosing vertigo and dizziness. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2017; 16:Doc02. [PMID: 29279722 PMCID: PMC5738933 DOI: 10.3205/cto000141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vertigo is a multisensory syndrome that otolaryngologists are confronted with every day. With regard to the complex functions of the sense of orientation, vertigo is considered today as a disorder of the sense of direction, a disturbed spatial perception of the body. Beside the frequent classical syndromes for which vertigo is the leading symptom (e.g. positional vertigo, vestibular neuritis, Menière’s disease), vertigo may occur as main or accompanying symptom of a multitude of ENT-related diseases involving the inner ear. It also concerns for example acute and chronic viral or bacterial infections of the ear with serous or bacterial labyrinthitis, disorders due to injury (e.g. barotrauma, fracture of the oto-base, contusion of the labyrinth), chronic-inflammatory bone processes as well as inner ear affections in the perioperative course. In the last years, diagnostics of vertigo have experienced a paradigm shift due to new diagnostic possibilities. In the diagnostics of emergency cases, peripheral and central disorders of vertigo (acute vestibular syndrome) may be differentiated with simple algorithms. The introduction of modern vestibular test procedures (video head impulse test, vestibular evoked myogenic potentials) in the clinical practice led to new diagnostic options that for the first time allow a complex objective assessment of all components of the vestibular organ with relatively low effort. Combined with established methods, a frequency-specific assessment of the function of vestibular reflexes is possible. New classifications allow a clinically better differentiation of vertigo syndromes. Modern radiological procedures such as for example intratympanic gadolinium application for Menière’s disease with visualization of an endolymphatic hydrops also influence current medical standards. Recent methodical developments significantly contributed to the possibilities that nowadays vertigo can be better and more quickly clarified in particular in otolaryngology.
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Demarquay G, Ducros A, Montavont A, Mauguiere F. Migraine with brainstem aura: Why not a cortical origin? Cephalalgia 2017; 38:1687-1695. [PMID: 29073774 DOI: 10.1177/0333102417738251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Migraine with brainstem aura is defined as a migraine with aura including at least two of the following symptoms: dysarthria, vertigo, tinnitus, hypacusis, diplopia, ataxia and/or decreased level of consciousness. Aim The aim of this study is to review data coming from clinical observations and functional mapping that support the role of the cerebral cortex in the initiation of brainstem aura symptoms. Results Vertigo can result from a vestibular cortex dysfunction, while tinnitus and hypacusis can originate within the auditory cortex. Diplopia can reflect a parieto-occipital involvement. Dysarthria can be caused by dysfunctions located in precentral gyri. Ataxia can reflect abnormal processing of vestibular, sensory, or visual inputs by the parietal lobe. Alteration of consciousness can be caused by abnormal neural activation within specific consciousness networks that include prefrontal and posterior parietal cortices. Conclusion Any symptom of so-called brainstem aura can originate within the cortex. Based on these data, we suggest that brainstem aura could have a cortical origin. This hypothesis would explain the co-occurrence of typical and brainstem aura during attacks and would fit with the theory of cortical spreading depression. We propose that migraine with brainstem aura should be classified as a typical migraine aura.
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Affiliation(s)
- Geneviève Demarquay
- 1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.,2 Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Lyon, France
| | - Anne Ducros
- 3 Department of Neurology, Montpellier University Hospital, France.,4 Medical School of Montpellier University (UM), France
| | | | - François Mauguiere
- 1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.,5 Lyon Neuroscience Research Center (CRNL), Neuropain team, INSERM U1028, CNRS UMR5292, Lyon, France.,6 Lyon 1 University, Lyon, France
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39
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Kheradmand A, Winnick A. Perception of Upright: Multisensory Convergence and the Role of Temporo-Parietal Cortex. Front Neurol 2017; 8:552. [PMID: 29118736 PMCID: PMC5660972 DOI: 10.3389/fneur.2017.00552] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/28/2017] [Indexed: 12/18/2022] Open
Abstract
We inherently maintain a stable perception of the world despite frequent changes in the head, eye, and body positions. Such "orientation constancy" is a prerequisite for coherent spatial perception and sensorimotor planning. As a multimodal sensory reference, perception of upright represents neural processes that subserve orientation constancy through integration of sensory information encoding the eye, head, and body positions. Although perception of upright is distinct from perception of body orientation, they share similar neural substrates within the cerebral cortical networks involved in perception of spatial orientation. These cortical networks, mainly within the temporo-parietal junction, are crucial for multisensory processing and integration that generate sensory reference frames for coherent perception of self-position and extrapersonal space transformations. In this review, we focus on these neural mechanisms and discuss (i) neurobehavioral aspects of orientation constancy, (ii) sensory models that address the neurophysiology underlying perception of upright, and (iii) the current evidence for the role of cerebral cortex in perception of upright and orientation constancy, including findings from the neurological disorders that affect cortical function.
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Affiliation(s)
- Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Otolaryngology – Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ariel Winnick
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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40
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Zamergrad MV, Levin OS. [Metavestibular disorders and disorders of higher vestibular function]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:11-15. [PMID: 28980607 DOI: 10.17116/jnevro20171176211-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vertigo, instability, oscillopsia and concomitant autonomic disorders are classical and well-known symptoms of vestibular disorders. At the same time, recent studies suggest that there are more complicated vestibular dysfunctions caused by the cortical projections of the vestibular system. The central vestibular system includes parietal temporal cortex and insular, anterior intraparietal sulcus, posterior parietal and medial parts of the superior temporal gyrus, singular gyrus retrosplenial cortex, hippocampus and parahippocampal area. The central part of the vestibular system closely interacts with other afferent systems forming a multisensory structure of higher brain functions. Dysfunctions of higher vestibular function play an important role in the development of clinical syndromes including pusher syndrome, room tilt illusion, unilateral spatial neglect syndrome, impairment of spatial memory and navigation. These syndromes can develop due to the direct damage of the cortical vestibular system or as a result of disconnection between the vestibular cortex and other parts of the sensory cortex.
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Affiliation(s)
- M V Zamergrad
- Russian Medical Academy of Continued Professional Education, Moscow, Russia; Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continued Professional Education, Moscow, Russia
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41
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Brandt T, Dieterich M. The dizzy patient: don't forget disorders of the central vestibular system. Nat Rev Neurol 2017; 13:352-362. [DOI: 10.1038/nrneurol.2017.58] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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42
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Vestibular and visual cortex activity during room tilt illusion. J Neurol 2017; 264:70-73. [DOI: 10.1007/s00415-017-8457-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/11/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
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43
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Cognition and higher vestibular disorders: developing tools for assessing vection. J Neurol 2017; 264:45-47. [PMID: 28293724 DOI: 10.1007/s00415-017-8449-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Abstract
Visually induced vection is the illusory sensation of self-motion caused by visual stimuli (such as a dot cloud) that emulate what is seen when an agent moves through space. The sufficient stimulus parameters to generate vection are unknown, but elucidating this is of interest in the study of higher (cognitive) neurological disorders where the relationship between visual and vestibular processing is disturbed. Here, we selectively eliminate that radial motion angle from vection displays and show that vection is still present, although weaker than during normal optic flow, and that vection strength was strikingly variable across individuals.
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44
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Boegle R, Ertl M, Stephan T, Dieterich M. Magnetic vestibular stimulation influences resting-state fluctuations and induces visual-vestibular biases. J Neurol 2017; 264:999-1001. [PMID: 28271404 DOI: 10.1007/s00415-017-8447-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
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45
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Ward BK, Bockisch CJ, Caramia N, Bertolini G, Tarnutzer AA. Gravity dependence of the effect of optokinetic stimulation on the subjective visual vertical. J Neurophysiol 2017; 117:1948-1958. [PMID: 28148642 DOI: 10.1152/jn.00303.2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 12/17/2022] Open
Abstract
Accurate and precise estimates of direction of gravity are essential for spatial orientation. According to Bayesian theory, multisensory vestibular, visual, and proprioceptive input is centrally integrated in a weighted fashion based on the reliability of the component sensory signals. For otolithic input, a decreasing signal-to-noise ratio was demonstrated with increasing roll angle. We hypothesized that the weights of vestibular (otolithic) and extravestibular (visual/proprioceptive) sensors are roll-angle dependent and predicted an increased weight of extravestibular cues with increasing roll angle, potentially following the Bayesian hypothesis. To probe this concept, the subjective visual vertical (SVV) was assessed in different roll positions (≤ ± 120°, steps = 30°, n = 10) with/without presenting an optokinetic stimulus (velocity = ± 60°/s). The optokinetic stimulus biased the SVV toward the direction of stimulus rotation for roll angles ≥ ± 30° (P < 0.005). Offsets grew from 3.9 ± 1.8° (upright) to 22.1 ± 11.8° (±120° roll tilt, P < 0.001). Trial-to-trial variability increased with roll angle, demonstrating a nonsignificant increase when providing optokinetic stimulation. Variability and optokinetic bias were correlated (R2 = 0.71, slope = 0.71, 95% confidence interval = 0.57-0.86). An optimal-observer model combining an optokinetic bias with vestibular input reproduced measured errors closely. These findings support the hypothesis of a weighted multisensory integration when estimating direction of gravity with optokinetic stimulation. Visual input was weighted more when vestibular input became less reliable, i.e., at larger roll-tilt angles. However, according to Bayesian theory, the variability of combined cues is always lower than the variability of each source cue. If the observed increase in variability, although nonsignificant, is true, either it must depend on an additional source of variability, added after SVV computation, or it would conflict with the Bayesian hypothesis.NEW & NOTEWORTHY Applying a rotating optokinetic stimulus while recording the subjective visual vertical in different whole body roll angles, we noted the optokinetic-induced bias to correlate with the roll angle. These findings allow the hypothesis that the established optimal weighting of single-sensory cues depending on their reliability to estimate direction of gravity could be extended to a bias caused by visual self-motion stimuli.
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Affiliation(s)
- Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Christopher J Bockisch
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland.,Department of Otorhinolaryngology, University Hospital Zurich and University of Zurich, Switzerland; and.,Department of Ophthalmology, University Hospital Zurich and University of Zurich, Switzerland
| | - Nicoletta Caramia
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Giovanni Bertolini
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
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46
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Micarelli A, Viziano A, Bruno E, Micarelli E, Alessandrini M. Vestibular impairment in Multiple Chemical Sensitivity: Component analysis findings. J Vestib Res 2017; 26:459-468. [DOI: 10.3233/ves-160594] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Neuroscience Unit, Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ernesto Bruno
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Micarelli
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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47
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Gauvin DV, Yoder JD, Tapp RL, Baird TJ. Small Compartment Toxicity: CN VIII and Quality of Life: Hearing Loss, Tinnitus, and Balance Disorders. Int J Toxicol 2017; 36:8-20. [PMID: 27194512 DOI: 10.1177/1091581816648905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Life experiences, industrial/environmental exposures, and administration of Food and Drug Administration (FDA)-approved drugs may have unintended but detrimental effects on peripheral and central auditory pathways. Most relevant to the readership of this journal is the role that drug treatments approved by the FDA as safe and effective appear to interact with 3 independent modes of toxicity within the small compartment of the ear. What may seem to be trivial drug-induced toxicity has the potential to change important measures of quality of life and functional capacity of mid- to late-life patients. Drugs meant to treat can become the source of interference in the activities of daily living, and as a result, treatment compliance may be jeopardized. Ototoxicity has been defined as the tendency of certain therapeutic agents and other chemical substances to cause functional impairments and cellular degeneration of the tissues of the inner ear resulting in hearing loss. However, one of the largest contributors to hospitalizations is fall-related injuries in the elderly patients associated with disorders of vestibular function linked to progressive and drug-induced toxicities. Tinnitus affects 35 to 50 million adults representing approximately 25% of the US population, with 12 million seeking medical care and 2 to 3 million reporting symptoms that were severely debilitating. This review is intended to highlight these targets of neurotoxicity that threaten the usefulness of drug treatments deemed safe and effective prior to access by the general public.
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Affiliation(s)
- David V Gauvin
- Neurobehavioral Sciences, MPI Research Inc, Mattawan, MI, USA
| | - Joshua D Yoder
- Neurobehavioral Sciences, MPI Research Inc, Mattawan, MI, USA
| | - Rachel L Tapp
- Neurobehavioral Sciences, MPI Research Inc, Mattawan, MI, USA
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48
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Lawson BD, Rupert AH, McGrath BJ. The Neurovestibular Challenges of Astronauts and Balance Patients: Some Past Countermeasures and Two Alternative Approaches to Elicitation, Assessment and Mitigation. Front Syst Neurosci 2016; 10:96. [PMID: 27920669 PMCID: PMC5118654 DOI: 10.3389/fnsys.2016.00096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 11/07/2016] [Indexed: 12/02/2022] Open
Abstract
Astronauts and vestibular patients face analogous challenges to orientation function due to adaptive exogenous (weightlessness-induced) or endogenous (pathology-induced) alterations in the processing of acceleration stimuli. Given some neurovestibular similarities between these challenges, both affected groups may benefit from shared research approaches and adaptation measurement/improvement strategies. This article reviews various past strategies and introduces two plausible ground-based approaches, the first of which is a method for eliciting and assessing vestibular adaptation-induced imbalance. Second, we review a strategy for mitigating imbalance associated with vestibular pathology and fostering readaptation. In discussing the first strategy (for imbalance assessment), we review a pilot study wherein imbalance was elicited (among healthy subjects) via an adaptive challenge that caused a temporary/reversible disruption. The surrogate vestibular deficit was caused by a brief period of movement-induced adaptation to an altered (rotating) gravitoinertial frame of reference. This elicited adaptation and caused imbalance when head movements were made after reentry into the normal (non-rotating) frame of reference. We also review a strategy for fall mitigation, viz., a prototype tactile sway feedback device for aiding balance/recovery after disruptions caused by vestibular pathology. We introduce the device and review a preliminary exploration of its effectiveness in aiding clinical balance rehabilitation (discussing the implications for healthy astronauts). Both strategies reviewed in this article represent cross-disciplinary research spin-offs: the ground-based vestibular challenge and tactile cueing display were derived from aeromedical research to benefit military aviators suffering from flight simulator-relevant aftereffects or inflight spatial disorientation, respectively. These strategies merit further evaluation using clinical and astronaut populations.
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Affiliation(s)
- Ben D Lawson
- U.S. Army Aeromedical Research Laboratory (USAARL) Fort Rucker, AL, USA
| | - Angus H Rupert
- U.S. Army Aeromedical Research Laboratory (USAARL) Fort Rucker, AL, USA
| | - Braden J McGrath
- Faculty of Education, Science, Technology and Maths, University of Canberra Canberra, ACT, Australia
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49
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Becker-Bense S, Buchholz HG, Baier B, Schreckenberger M, Bartenstein P, Zwergal A, Brandt T, Dieterich M. Functional Plasticity after Unilateral Vestibular Midbrain Infarction in Human Positron Emission Tomography. PLoS One 2016; 11:e0165935. [PMID: 27824897 PMCID: PMC5100888 DOI: 10.1371/journal.pone.0165935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 10/20/2016] [Indexed: 11/18/2022] Open
Abstract
The aim of the study was to uncover mechanisms of central compensation of vestibular function at brainstem, cerebellar, and cortical levels in patients with acute unilateral midbrain infarctions presenting with an acute vestibular tone imbalance. Eight out of 17 patients with unilateral midbrain infarctions were selected on the basis of signs of a vestibular tone imbalance, e.g., graviceptive (tilts of perceived verticality) and oculomotor dysfunction (skew deviation, ocular torsion) in F18-fluordeoxyglucose (FDG)-PET at two time points: A) in the acute stage, and B) after recovery 6 months later. Lesion-behavior mapping analyses with MRI verified the exact structural lesion sites. Group subtraction analyses and comparisons with healthy controls were performed with Statistic Parametric Mapping for the PET data. A comparison of PET A of acute-stage patients with that of healthy controls showed increases in glucose metabolism in the cerebellum, motion-sensitive visual cortex areas, and inferior temporal lobe, but none in vestibular cortex areas. At the supratentorial level bilateral signal decreases dominated in the thalamus, frontal eye fields, and anterior cingulum. These decreases persisted after clinical recovery in contrast to the increases. The transient activations can be attributed to ocular motor and postural recovery (cerebellum) and sensory substitution of vestibular function for motion perception (visual cortex). The persisting deactivation in the thalamic nuclei and frontal eye fields allows alternative functional interpretations of the thalamic nuclei: either a disconnection of ascending sensory input occurs or there is a functional mismatch between expected and actual vestibular activity. Our data support the view that both thalami operate separately for each hemisphere but receive vestibular input from ipsilateral and contralateral midbrain integration centers. Normally they have gatekeeper functions for multisensory input to the cortex and automatic motor output to subserve balance and locomotion, as well as sensorimotor integration.
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Affiliation(s)
- Sandra Becker-Bense
- Department of Neurology, University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
| | - Hans-Georg Buchholz
- Department of Nuclear Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Bernhard Baier
- Department of Neurology, Johannes Gutenberg-University, Mainz, Germany
| | | | - Peter Bartenstein
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
- Department of Nuclear Medicine, University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), University of Munich, Munich, Germany
| | - Andreas Zwergal
- Department of Neurology, University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
- Institute for Clinical Neuroscience, University of Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), University of Munich, Munich, Germany
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Deranged Dimensionality of Vestibular Re-Weighting in Multiple Chemical Sensitivity. APPLIED SCIENCES-BASEL 2016. [DOI: 10.3390/app6110330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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