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Özgirgin ON, Kingma H, Manzari L, Lacour M. Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers. Front Neurol 2024; 15:1382196. [PMID: 38854956 PMCID: PMC11157684 DOI: 10.3389/fneur.2024.1382196] [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: 02/05/2024] [Accepted: 04/22/2024] [Indexed: 06/11/2024] Open
Abstract
Despite the high success rate of canalith repositioning maneuvers (CRMs) in the treatment of benign paroxysmal positional vertigo (BPPV), a growing number of patients report residual dizziness symptoms that may last for a significant time. Although the majority of BPPV cases can be explained by canalolithiasis, the etiology is complex. Consideration of the individual patient's history and underlying pathophysiology of BPPV may offer the potential for treatment approaches supplementary to CRMs, as well as a promising alternative for patients in whom CRMs are contraindicated. This article provides a summary of the possible underlying causes of BPPV and residual dizziness, along with suggestions for potential management options that may be considered to relieve the burden of residual symptoms.
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Affiliation(s)
| | - Herman Kingma
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Maastricht University Medical Center, Maastricht, Limburg, Netherlands
| | - Leonardo Manzari
- Vestibology Science, MSA ENT Academy Center, Cassino, Lazio, Italy
| | - Michel Lacour
- Aix-Marseille Université, Neurosciences Department, Marseille, France
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Ren YY, Wang YJ, Li JL, Liu M, Xia F. Low vitamin D and uric acid status in patients with benign paroxysmal positional vertigo. Sci Prog 2023; 106:368504231205397. [PMID: 37807761 PMCID: PMC10563478 DOI: 10.1177/00368504231205397] [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: 10/10/2023]
Abstract
PURPOSE Growing evidence reported that vitamin D and uric acid metabolism played roles in the occurrence of benign paroxysmal positional vertigo, an otoconia-related vestibular disorder. We aimed to investigate the serum 25-hydroxy vitamin D (25(OH)D) and uric acid in patients with benign paroxysmal positional vertigo and to determine the risk factor for benign paroxysmal positional vertigo. METHODS This case-control study comprised 182 patients with benign paroxysmal positional vertigo and 182 age- and gender-matched controls. All subjects' age, body mass index, systolic blood pressure, diastolic blood pressure, 25-hydroxyvitamin D (25(OH)D), uric acid and serum calcium measurements were analyzed. RESULTS We found a female preponderance of benign paroxysmal positional vertigo patients, with a median of 60 (52-66) years old. The results showed low vitamin D status both in benign paroxysmal positional vertigo and controls, with no significant difference of 25(OH)D levels between benign paroxysmal positional vertigo patients and controls (P > 0.05). Compared with the control group, patients with benign paroxysmal positional vertigo had a higher prevalence of vitamin D deficiency and a lower prevalence of vitamin D sufficiency (P < 0.05). Uric acid was significantly lower in the benign paroxysmal positional vertigo groups (P < 0.05). Logistic regression analysis revealed that age and uric acid were considered higher risk predictors for benign paroxysmal positional vertigo. CONCLUSION Our study observed low vitamin D status in patients with benign paroxysmal positional vertigo, with no significant differences of the 25(OH)D level in patients with benign paroxysmal positional vertigo and controls. Elderly, vitamin D deficiency and low uric acid levels may be risk factors for benign paroxysmal positional vertigo occurrence.
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Affiliation(s)
- Yuan-Yuan Ren
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan-Jun Wang
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jin-Lan Li
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mo Liu
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fei Xia
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Oh EH, Lee JO, Kim HS, Park JY, Choi SY, Choi KD, Kim JS, Choi JH. Gene expression analysis in recurrent benign paroxysmal positional vertigo: a preliminary study. Front Neurol 2023; 14:1223996. [PMID: 37475735 PMCID: PMC10354243 DOI: 10.3389/fneur.2023.1223996] [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: 05/17/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
Objectives This study aimed to determine the pathophysiology of recurrent benign paroxysmal positional vertigo (BPPV) in young patients using gene expression profiling combined with bioinformatics analysis. Methods Total RNA was extracted from the whole blood of four young patients with recurrent BPPV and four controls. The differentially expressed genes (DEGs) between the groups were screened using a microarray analysis based on the cutoff criteria of |log2 fold change| > 1 and an adjusted p-value of < 0.05. Functional enrichment analysis of DEGs was performed using Gene Ontology analysis, and the protein-protein interaction (PPI) network was constructed using the Search Tool for the Retrieval of the Interacting Genes database. Results A total of 39 DEGs were detected between the BPPV and control samples, comprising 33 upregulated DEGs and six downregulated DEGs in the BPPV group. Functional enrichment analysis indicated that the upregulated DEGs were significantly enriched in terms related to metabolic processes and the immune system. Two main pathways were extracted from the PPI network: one was associated with oxidative phosphorylation and stress and the other with the adaptive immune system and extracellular matrix degradation. Conclusion The findings of our bioinformatics analysis indicated that oxidative stress or extracellular matrix degradation due to immune-mediated inflammatory responses may contribute to the development of recurrent BPPV in young patients.
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Affiliation(s)
- 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, Republic of Korea
| | - Jin-Ok Lee
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Hyun Sung Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji-Yun Park
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Research Institute, Busan, Republic of Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Biomedical Research Institute, Busan, Republic of Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of 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, Republic of Korea
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Günizi H, Savaş HB. An evaluation of trace elements and oxidative stress in patients with benign paroxysmal positional vertigo. PLoS One 2023; 18:e0277960. [PMID: 36812180 PMCID: PMC9946263 DOI: 10.1371/journal.pone.0277960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/07/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES Vertigo and Dizziness are a common complaint among the reasons for applying to the ear nose throat clinic. Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of perpheric vertigo. Oxidative stress is caused by the formation of hydroxyl radicals, superoxide anions and hydrogen peroxide, which are reactive oxygen derivatives (ROS). The aim of this study is to investigate the relationship between complaints and serum trace element and oxidative stress levels in patients with BPPV. METHODS This study was conducted with 66 adult patients who presented to the ENT policlinic with the complaint of vertigo and were diagnosed with BPPV between May 2020 and September 2020. Blood samples were taken from patients diagnosed with BPPV to measure serum Zn and Cu levels and oxidative stress levels during an attack. RESULTS The mean ages of the study patients and healthy controls were 45.7 ± 15.1 and 44.7±13.2. Female / Male ratio were 28(42.5%)/38(57.5%) and 32(48.5%)/34(51.5%) in study and control group. We found serum Cu levels were lower in the patient group (p <0.05). Serum Total Thiol and Native Thiol values were lower in patients with BPPV. Total Thiol results were statistically significant.(p<0.05) Disulfide values were significantly higher in the disease group. (P <0.05). Thiol Oxidized / Thiol Reduced ratio (2243.6±6.7/343.8±125.3) was higher in control group. (p<0.05). CONCLUSION Serum oxidative stress and trace elements play a role in the pathophysiology of BPPV. We present the cut-off values for Cu and Zn in vertigo patients for the first time in the literature. We think that these cut-off values of the trace elements and thiol/disulfide hemostasis can be used clinically by physicians in the etiology, diagnosis and treatment of vertigo.
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Affiliation(s)
- Hüseyin Günizi
- Department of Otolaryngology, Alkü Alanya Alaaddin Keykubat University Medical School, Alanya, Antalya, Turkey
- * E-mail:
| | - Hasan Basri Savaş
- Department of Clinical Biochemistry, Alkü Alanya Alaaddin Keykubat University Medical School, Alanya, Antalya, Turkey
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Nakata T, Okada M, Nishihara E, Ikedo A, Asoh S, Takagi T, Tokunaga N, Hato N, Imai Y. Effect of hormonal therapy on the otoconial changes caused by estrogen deficiency. Sci Rep 2022; 12:22596. [PMID: 36585504 PMCID: PMC9803649 DOI: 10.1038/s41598-022-27240-5] [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: 10/18/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is associated with menopause and/or osteopenia. Morphological changes in the otoconial layer have been reported after ovariectomy (OVX). Moreover, hormone replacement therapy decreases BPPV risk. However, knowledge concerning the effect of hormonal therapy on the otoconial changes caused by estrogen deficiency is limited. We aimed to examine the effect of hormonal therapy on otoconial changes caused by estrogen deficiency. We hypothesized that hormonal therapy could reduce otoconial changes caused by OVX. Eight-week-old C57BL/6 mice were divided into four groups: sham operation with implantation of vehicle (sham + v), OVX with implantation of vehicle (OVX + v), OVX with implantation of estradiol (E2) (OVX + E2), and OVX with implantation of raloxifene (RAL) (OVX + RAL) groups. Otoconial layer volume was measured by micro-CT at 4 weeks after OVX or the sham operation. The otic bullae were removed; immunohistochemistry was performed for estrogen receptor alpha and 4-hydroxynonenal. Otoconial layer volume was significantly higher in the OVX + v than in the sham + v group. E2 and RAL significantly reduced these changes in the endometrial layer. The staining of estrogen receptor alpha and 4-hydroxynonenal were stronger in the OVX + v than in the sham + v group but equal in the sham + v, OVX + E2, and OVX + RAL groups. These results indicate that E2 and RAL are effective against morphological changes of the otoconial layer caused by estrogen deficiency via oxidative stress reduction.
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Affiliation(s)
- Takahiro Nakata
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan ,Department of Otolaryngology, Ehime Prefectural Niihama Hospital, Niihama, Japan
| | - Masahiro Okada
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Eriko Nishihara
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Aoi Ikedo
- grid.255464.40000 0001 1011 3808Division of Integrative Pathophysiology, Proteo-Science Center, Ehime University, Toon, Japan
| | - Sawa Asoh
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Taro Takagi
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Naohito Tokunaga
- grid.255464.40000 0001 1011 3808Division of Medical Research Support the Advanced Research Support Center, Ehime University, Toon, Japan
| | - Naohito Hato
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Yuuki Imai
- grid.255464.40000 0001 1011 3808Division of Integrative Pathophysiology, Proteo-Science Center, Ehime University, Toon, Japan ,grid.255464.40000 0001 1011 3808Department of Pathophysiology, Ehime University Graduate School of Medicine, Toon, Japan ,grid.255464.40000 0001 1011 3808Division of Laboratory Animal Research, Advanced Research Support Center, Ehime University, Toon, Japan
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Prevention of Recurrent Benign Paroxysmal Positional Vertigo: The Role of Combined Supplementation with Vitamin D and Antioxidants. Audiol Res 2022; 12:445-456. [PMID: 36004953 PMCID: PMC9404917 DOI: 10.3390/audiolres12040045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA® (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with “insufficient” or “deficient” vitamin D blood levels, treated with daily oral supplementation of LICA®, vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with “sufficient” vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a “sufficient” serum concentration of vitamin D who received supplementation with a compound of LICA® and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (−2.32, 95% CI: 3.41−1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV.
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Melatonin Exerts Anti-Inflammatory, Antioxidant, and Neuromodulatory Effects That Could Potentially Be Useful in the Treatment of Vertigo. Int J Otolaryngol 2021; 2021:6641055. [PMID: 33859698 PMCID: PMC8009714 DOI: 10.1155/2021/6641055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
The acute phase of vertigo involves multiple neurotransmitters, inflammatory mediators, and products of oxidative stress. The vestibular pathway has multiple melatonin receptors distributed along its path, both centrally and peripherally. In addition, melatonin has been shown to be a powerful antioxidant and anti-inflammatory agent against factors related to vertigo, such as Bax/caspases, interleukins, and chemokines. Likewise, it exerts central GABAergic, antidopaminergic, and anti-migraine functions and regulates sympathetic activity in a similar way to the drugs classically used in acute vestibular crisis. In this review, the role of melatonin as a potential treatment of the acute phase of vertigo is discussed.
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Erel Ö, Erdoğan S. Thiol-disulfide homeostasis: an integrated approach with biochemical and clinical aspects. Turk J Med Sci 2020; 50:1728-1738. [PMID: 32233181 PMCID: PMC7672356 DOI: 10.3906/sag-2003-64] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Dynamic thiol-disulfide homeostasis (TDH) is a new area has begun to attract more scrutiny. Dynamic TDH is reversal of thiol oxidation in proteins and represents the status of thiols (-SH) and disulfides (-S-S-). Organic compounds containing the sulfhydryl group is called thiol, composed of sulfur and hydrogen atoms. Disulfides are the most important class of dynamic, redox responsive covalent bonds build in between two thiol groups. For many years, thiol levels were analyzed by several methods. During last years, measurements of disulfide levels have been analyzed by a novel automated method, developed by Erel and Neselioglu. In this method, addition to thiol (termed as native thiol) levels, disulfide levels were also measured and sum of native thiol and disulfide levels were termed as total thiol. Therefore, TDH was begun to be understood in organism. In healthy humans, TDH is maintained within a certain range. Dysregulated dynamic TDH has been implicated several disorders with unknown etiology. A growing body of evidence has demonstrated that the thiol-disulfide homeostasis is involved in variety diseases, such as diabetes mellitus, hypertension, nonsmall cell lung cancer, familial Mediterranean fever (FMF), inflammatory bowel diseases, occupational diseases, gestational diabetes mellitus and preeclampsia. These results may elucidate some pathogenic mechanism or may be a predictor indicating diagnostic clue, prognostic marker or therapeutic sign. In conclusion, protection of the thiol-disulfide homeostasis is of great importance for the human being. Evidence achieved so far has proposed that thiol-disulfide homeostasis is an important issue needs to elucidate wholly.
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Affiliation(s)
- Özcan Erel
- Department of Medical Biochemistry, Faculty of Medicine, Ankara Yıldırım Beyazıt Universty, Ankara , Turkey,Department of Medical Biochemistry, Ankara City Hospital , Ankara, Turkey
| | - Serpil Erdoğan
- Department of Medical Biochemistry, Faculty of Medicine, Ankara Yıldırım Beyazıt Universty, Ankara , Turkey
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Serum levels of superoxide dismutases in patients with benign paroxysmal positional vertigo. Biosci Rep 2020; 40:224098. [PMID: 32391546 PMCID: PMC7240196 DOI: 10.1042/bsr20193917] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the possible role of superoxide dismutases (SODs) in the development of benign paroxysmal positional vertigo (BPPV) and recurrence events in a 1-year follow-up study. Methods: This was a prospective one-center study. A total of 204 patients with BPPV and 120 age-and sex matched healthy subjects were included. The levels of SOD between patients and control cases were compared. The levels of SOD between posterior semicircular canal (PSC) and horizontal semicircular canal (HSC) were also compared. In the 1-year follow-up, recurrence events were confirmed. The influence of SOD levels on BPPV and recurrent BPPV were performed by binary logistic regression analysis. Results: The serum levels of SOD in patients with BPPV were lower than in those control cases (P<0.001). Levels of SOD did not differ in patients with PSC and HSC (P=0.42). As a categorical variable, for per interquartile range (IQR) increment of serum level of SOD, the unadjusted and adjusted risks of BPPV would be decreased by 72% (with the odds ratio [OR] of 0.28 [95% confidence interval (CI): 0.21–0.37], P<0.001) and 43% (0.57 [0.42–0.69], P<0.001), respectively. Recurrent attacks of BPPV were reported in 50 patients (24.5%). Patients with recurrent BPPV had lower levels of SOD than in patients without (P<0.001). For per IQR increment of serum level of SOD, the unadjusted and adjusted risks of BPPV would be decreased by 51% (with the OR of 0.49 [95% CI: 0.36–0.68], P<0.001) and 24% (0.76 [0.60–0.83], P<0.001), respectively. Conclusion: Reduced serum levels of SOD were associated with higher risk of BPPV and BPPV recurrence events.
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Biomarkers of Oxidative Stress and Endogenous Antioxidants for Patients with Chronic Subjective Dizziness. Sci Rep 2020; 10:1478. [PMID: 32001745 PMCID: PMC6992639 DOI: 10.1038/s41598-020-58218-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 01/08/2020] [Indexed: 12/18/2022] Open
Abstract
As a neurotologic disorder of persistent non-vertiginous dizziness, chronic subjective dizziness (CSD) arises unsteadily by psychological and physiological imbalance. The CSD is hypersensitivity reaction due to exposure to complex motions visual stimuli. However, the pathophysiological features and mechanism of the CSD still remains unclearly. The present study was purposed to establish possible endogenous contributors of the CSD using serum samples from patients with the CSD. A total 199 participants were gathered and divided into two groups; healthy (n = 152, male for 61, and female for 91) and CSD (n = 47, male for 5, female for 42), respectively. Oxidative stress parameters such as, hydrogen peroxide and reactive substances were significantly elevated (p < 0.01 or p < 0.001), whereas endogenous antioxidant components including total glutathione contents, and activities of catalase and superoxide dismutase were significantly deteriorated in the CSD group (p < 0.01 or p < 0.001) as comparing to the healthy group, respectively. Serum levels of tumor necrosis factor -α and interferon-γ were significantly increased in the CSD participants (p < 0.001). Additionally, emotional stress related hormones including cortisol, adrenaline, and serotonin were abnormally observed in the serum levels of the CSD group (p < 0.01 or p < 0.001). Our results confirmed that oxidative stress and antioxidants are a critical contributor of pathophysiology of the CSD, and that is first explored to establish features of redox system in the CSD subjects compared to a healthy population.
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Elevated serum macrophage migration inhibitory factor levels correlate with benign paroxysmal positional vertigo and recurrence events. Biosci Rep 2019; 39:BSR20191831. [PMID: 31406010 PMCID: PMC6706593 DOI: 10.1042/bsr20191831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/22/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022] Open
Abstract
Objective: We aimed to assess the possible relations between serum levels of macrophage migration inhibitory factor (MIF), a central cytokine of the innate immunity and inflammatory response, and benign paroxysmal positional vertigo (BPPV) risk and BPPV recurrence events. Methods: In the present study, 154 patients with BPPV, and 100 age-and sex-matched control subjects were enrolled in the study. All the patients and controls underwent a complete audio‐vestibular test battery including the Dix–Hallpike maneuver and supine roll test. In the BPPV group, measurements of MIF levels were repeated 1 month after the vertigo attack. The patients were also divided into the recurrence group and the nonrecurrence group in the 1-year follow-up. Results: The serum levels of MIF in patients with BPPV were higher than in those controls (13.9[interquartile range {IQR}, 8.9–18.4] ng/ml vs. 9.8[7.8–11.8]; P<0.001). As a continuous variable, MIF was associated with increased risk of BPPV (odds ratio [OR] 1.21, 95% confidence interval [CI]: 1.11–1.39; P=0.004) in multiple regression analyses. Recurrent attacks of BPPV were reported in 35 patients, and those patients had higher levels of MIF than those patients were not recurrence (18.0[IQR, 13.6–22.2] ng/ml vs. 12.6[9.3–16.8] ng/ml). In multivariate models comparing the second (Q2), third (Q3) and fourth(Q4) quartiles against the first (Q1) quartile of MIF, levels of MIF in Q4 were associated with recurrent BPPV, and the odds were increased by approximately 305% (OR = 4.05; 95%CI: 1.65–15.44; P=0.009). Conclusions: Elevated MIF is positively correlated with BPPV risk and BPPV recurrence events, requiring further efforts to clarify the exact mechanism.
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Yang X, Yang B, Wu M, Wang F, Huang X, Li K, Mao Z, Xu Z, Ren H. Association Between Serum Uric Acid Levels and Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis of Observational Studies. Front Neurol 2019; 10:91. [PMID: 30828314 PMCID: PMC6385523 DOI: 10.3389/fneur.2019.00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/23/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: The objective of the present study was to meta-analyze relevant literature to gain a comprehensive understanding of the potential relationship between serum uric acid levels and risk of benign paroxysmal positional vertigo (BPPV). Methods: The databases of PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed were systematically searched for observational case-control studies of the association between BPPV and serum uric acid levels published up to October 2018. Data from eligible studies were meta-analyzed using Stata 12.0. Results: A total of 12 studies were included in the analysis. There was a strong tendency for serum uric acid levels to be associated with risk of BPPV among studies conducted in China (OR 0.69, 95%CI 0.01–1.40, p = 0.053), but not among studies outside China (OR 1.07, 95%CI 1.08–3.22, p = 0.33). Across all studies, serum uric acid level was significantly higher among individuals with BPPV than among controls (OR 0.78, 95%CI 0.15–1.41, p = 0.015), yet it did not independently predict risk of the disorder (OR 1.003, 95%CI 0.995–1.012, p = 0.471). Conclusion: The available evidence suggests that BPPV is associated with elevated levels of serum uric acid, but these levels may not be an independent risk factor of BPPV.
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Affiliation(s)
- Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Baiyuan Yang
- Department of Neurology, Seventh People's Hospital of Chengdu, Chengdu, China
| | - Mengjun Wu
- Department of Anesthesiology, Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Fang Wang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaodong Huang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kelu Li
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiwei Mao
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhong Xu
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hui Ren
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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