1
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Michailidou E, Korda A, Wyss T, Bardins S, Schneider E, Morrison M, Wagner F, Caversaccio MD, Mantokoudis G. The value of saccade metrics and VOR gain in detecting a vestibular stroke. J Vestib Res 2024; 34:49-61. [PMID: 38160379 DOI: 10.3233/ves-230083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE A normal video Head Impulse Test is the gold standard in the emergency department to rule-in patients with an acute vestibular syndrome and a stroke. We aimed to compare the diagnostic accuracy of vHIT metrics regarding the vestibulo-ocular reflex gain and the corrective saccades in detecting vestibular strokes. METHODS Prospective cross-sectional study (convenience sample) of patients presenting with acute vestibular syndrome in the emergency department of a tertiary referral centre between February 2015 and May 2020. We screened 1677 patients and enrolled 76 patients fulfilling the inclusion criteria of acute vestibular syndrome. All patients underwent video head impulse test with automated and manual data analysis. A delayed MRI served as a gold standard for vestibular stroke confirmation. RESULTS Out of 76 patients, 52 were diagnosed with acute unilateral vestibulopathy and 24 with vestibular strokes. The overall accuracy of detecting stroke with an automated vestibulo-ocular reflex gain was 86.8%, compared to 77.6% for cumulative saccade amplitude and automatic saccade mean peak velocity measured by an expert and 71% for cumulative saccade amplitude and saccade mean peak velocity measured automatically. Gain misclassified 13.1% of the patients as false positive or false negative, manual cumulative saccade amplitude and saccade mean peak velocity 22.3%, and automated cumulative saccade amplitude and saccade mean peak velocity 28.9% respectively. CONCLUSIONS We found a better accuracy of video head impulse test for the diagnosis of vestibular strokes when using the vestibulo-ocular reflex gain than using saccade metrics. Nevertheless, saccades provide an additional and important information for video head impulse test evaluation. The automated saccade detection algorithm is not yet perfect compared to expert analysis, but it may become a valuable tool for future non-expert video head impulse test evaluations.
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Affiliation(s)
- Efterpi Michailidou
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Stanislav Bardins
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
| | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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2
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Kremmyda O, Feil K, Bardins S, Strupp M. Acetyl-DL-leucine in combination with memantine improves acquired pendular nystagmus caused by multiple sclerosis: a case report. J Neurol 2023:10.1007/s00415-023-11730-1. [PMID: 37106258 DOI: 10.1007/s00415-023-11730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Affiliation(s)
- O Kremmyda
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.
- Department of Neurology, Helios Klinikum München West, Steinerweg 5, 81241, Munich, Germany.
| | - K Feil
- Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany
| | - S Bardins
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - M Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
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3
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Tsai TI, Dlugaiczyk J, Bardins S, Huppert D, Brandt T, Wuehr M. Physiological oculo-auricular-facial-mandibular synkinesis elicited in humans by gaze deviations. J Neurophysiol 2022; 127:984-994. [PMID: 35235436 DOI: 10.1152/jn.00199.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Integrated motor behaviors involving ocular motion-associated movements of the head, neck, pinna, and parts of the face are commonly seen in animals orienting to a visual target. A number of coordinated movements have also been observed in humans making rapid gaze shifts to horizontal extremes, which may be vestiges of these. Since such integrated mechanisms point to a non-pathological co-activation of several anatomically separate cranial circuits in humans, it is important to see how the different pairs of integrative motor behaviors with a common trigger (i.e., ocular motion) manifest in relation to one another. Here, we systematically examined the pattern of eye movement-induced recruitment of multiple cranial muscles in humans. Simultaneous video-oculography and bilateral surface electromyograms of transverse auricular, temporalis, frontalis, and masseter muscles were recorded in 15 healthy subjects (8 females; 29.3±5.2 years) while they made head-fixed, horizontal saccadic, pursuit and optokinetic eye movements. Potential chin laterotrusion linked to contractions of masticator muscles was captured with a yaw-fixed accelerometer. Our findings objectively show an orchestrated aural-facial-masticatory muscle response to a range of horizontal eye movements (prevalence of 21-93%). These responses were most prominent during eccentric saccades. We further reveal distinctions between the various observed activation patterns in terms of their profile (transient or sustained), laterality (with respect to direction of gaze) and timing (with respect to saccade onset). Possible underlying neural substrates, their atavistic behavioral significance, and potential clinical applications for monitoring sensory attention and designing attention-directed hearing aids in the future are discussed.
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Affiliation(s)
- Tina I Tsai
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Julia Dlugaiczyk
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich 9 (USZ), University of Zurich, Switzerland
| | - Stanislav Bardins
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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4
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Schnabel L, Wuehr M, Huppert A, Bardins S, Brandt T, Huppert D. Age-dependent perturbation of the perceptual and postural vertical by visual roll vection and susceptibility to motion sickness in children. J Neurol 2022; 269:5724-5730. [PMID: 35212790 PMCID: PMC9553811 DOI: 10.1007/s00415-022-11017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
Background The visual contribution to the perceptual and postural vertical is mediated by a multisensory integration process and may relate to children’s susceptibility to motion sickness that is hypothesized to arise from intersensory conflicts. Objective To analyze the maturation of visual contribution to the perceptual and postural vertical in conjunction with the motion sickness susceptibility in childhood. Methods In 81 healthy children (aged 2–17 years; 57 females), adjustments of the subjective visual vertical and posturographically tested mediolateral displacements of body sway were measured during free upright stance and large-field visual motion stimulation in the roll plane (roll vection). Motion sickness susceptibility was assessed by taking the history of parents and children. Results Vection-induced tilts of the visual vertical showed a linear age-dependent decrease with largest tilts in the youngest (2–7 years; median of 20°) and smallest tilts in the oldest age group (13–17 years; median of 9–10°). Analogously, postural tilts as measured by mediolateral body sway were greatest in the youngest and smallest in the oldest age group. In contrast, motion sickness susceptibility was lowest in the youngest and highest in the oldest age group and exhibited an inverse correlation with vection-induced tilts of the visual vertical. Conclusion Roll vection-induced tilts of the visual and postural vertical exhibited a similar age-dependent course with the greatest effects in the youngest and the least effects in the oldest age group, the latter of which exhibited the highest susceptibility to motion sickness.
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Affiliation(s)
- Lutz Schnabel
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany.
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Anna Huppert
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Stanislav Bardins
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
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5
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Donald A, Tan CY, Chakrapani A, Hughes DA, Sharma R, Cole D, Bardins S, Gorges M, Jones SA, Schneider E. Eye movement biomarkers allow for the definition of phenotypes in Gaucher Disease. Orphanet J Rare Dis 2020; 15:349. [PMID: 33334373 PMCID: PMC7745364 DOI: 10.1186/s13023-020-01637-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Neurological forms of Gaucher disease, the inherited disorder of β-Glucosylceramidase caused by bi-allelic variants in GBA1, is a progressive disorder which lacks a disease-modifying therapy. Systemic manifestations of disease are effectively treated with enzyme replacement therapy, however, molecules which cross the blood-brain barrier are still under investigation. Clinical trials of such therapeutics require robust, reproducible clinical endpoints to demonstrate efficacy and clear phenotypic definitions to identify suitable patients for inclusion in trials. The single consistent clinical feature in all patients with neuronopathic disease is the presence of a supranuclear saccadic gaze palsy, in the presence of Gaucher disease this finding serves as diagnostic of 'type 3' Gaucher disease. METHODS We undertook a study to evaluate saccadic eye movements in Gaucher patients and to assess the role of the EyeSeeCam in measuring saccades. The EyeSeeCam is a video-oculography device which was used to run a protocol of saccade measures. We studied 39 patients with non-neurological Gaucher disease (type 1), 21 patients with type 3 (neurological) disease and a series of 35 healthy controls. Mean saccade parameters were compared across disease subgroups. RESULTS We confirmed the saccadic abnormality in patients with type 3 Gaucher disease and identified an unexpected subgroup of patients with type 1 Gaucher disease who demonstrated significant saccade parameter abnormalities. These patients also showed subtle neurological findings and shared a GBA1 variant. CONCLUSIONS This striking novel finding of a potentially attenuated type 3 Gaucher phenotype associated with a specific GBA1 variant and detectable saccadic abnormality prompts review of current disease classification. Further, this finding highlights the broad spectrum of neuronopathic Gaucher phenotypes relevant when designing inclusion criteria for clinical trials.
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Affiliation(s)
- Aimee Donald
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, UK.
| | | | | | | | | | - Duncan Cole
- Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | | | - Martin Gorges
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
| | - Simon A Jones
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, UK
| | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
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6
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Penkava J, Bardins S, Brandt T, Wuehr M, Huppert D. Spontaneous visual exploration during locomotion in patients with phobic postural vertigo. J Neurol 2020; 267:223-230. [PMID: 32852578 PMCID: PMC7718196 DOI: 10.1007/s00415-020-10151-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
Background Earlier studies on stance and gait with posturographic and EMG-recordings and automatic gait analysis in patients with phobic postural vertigo (PPV) or visual height intolerance (vHI) revealed similar patterns of body stiffening with muscle co-contraction and a slow, cautious gait. Visual exploration in vHI patients was characterized by a freezing of gaze-in-space when standing and reduced horizontal eye and head movements during locomotion. Objective Based on the findings in vHI patients, the current study was performed with a focus on visual control of locomotion in patients with PPV while walking along a crowded hospital hallway. Methods Twelve patients with PPV and eleven controls were recruited. Participants wore a mobile infrared video eye-tracking system that continuously measured eye-in-head movements in the horizontal and vertical planes and head orientation and motion in the yaw, pitch, and roll planes. Visual exploration behavior of participants was recorded at the individually preferred speed for a total walking distance of 200 m. Gaze-in-space directions were determined by combining eye-in-head and head-in-space orientation. Walking speeds were calculated based on the trial duration and the total distance traversed. Participants were asked to rate their feelings of discomfort during the walk on a 4-point numeric rating scale. The examiners rated the crowdedness of the hospital hallway on a 4-point numeric rating scale. Results The major results of visual exploration behavior in patients with PPV in comparison to healthy controls were: eye and head positions were directed more downward in the vertical plane towards the ground ahead with increased frequency of large amplitude vertical orientation movements towards the destination, the end of the ground straight ahead. The self-adjusted speed of locomotion was significantly lower in PPV. Particularly those patients that reported high levels of discomfort exhibited a specific visual exploration of their horizontal surroundings. The durations of fixating targets in the visual surroundings were significantly shorter as compared to controls. Conclusion Gaze control of locomotion in patients with PPV is characterized by a preferred deviation of gaze more downward and by horizontal explorations for suitable auxiliary means for potential postural support in order to prevent impending falls. These eye movements have shorter durations of fixation as compared to healthy controls and patients with vHI. Finally, the pathological alterations in eye–head coordination during locomotion correlate with a higher level of discomfort and anxiety about falling.
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Affiliation(s)
- J Penkava
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
| | - S Bardins
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
| | - T Brandt
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, Munich, Germany
| | - M Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
| | - D Huppert
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
- Institute for Clinical Neurosciences, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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7
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Möhwald K, Hadzhikolev H, Bardins S, Becker‐Bense S, Brandt T, Grill E, Jahn K, Dieterich M, Zwergal A. Health‐related quality of life and functional impairment in acute vestibular disorders. Eur J Neurol 2020; 27:2089-2098. [DOI: 10.1111/ene.14318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/05/2020] [Indexed: 01/17/2023]
Affiliation(s)
- K. Möhwald
- Department of Neurology University Hospital, LMU Munich Munich Germany
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
| | - H. Hadzhikolev
- Department of Neurology University Hospital, LMU Munich Munich Germany
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
| | - S. Bardins
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
| | - S. Becker‐Bense
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
| | - T. Brandt
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
- Clinical Neurosciences LMU Munich Munich Germany
| | - E. Grill
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology LMU Munich Munich Germany
| | - K. Jahn
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
- Department of Neurology Schön Klinik Bad Aibling Bad Aibling Germany
| | - M. Dieterich
- Department of Neurology University Hospital, LMU Munich Munich Germany
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
- Munich Cluster of Systems Neurology SyNergy Munich Germany
| | - A. Zwergal
- Department of Neurology University Hospital, LMU Munich Munich Germany
- German Center for Vertigo and Balance Disorders DSGZ, LMU Munich Munich Germany
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8
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Bardins S, Eggert T, Straube A, Kremmyda O. P55 Velocity- and amplitude-related vision changes caused by visual induced downbeat nystagmus in normal subjects. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Tsai T, Dlugaiczyk J, Bardins S, Huppert D, Brandt T, Wühr M. P83 Ocular-mandibular phenomenon. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Zwergal A, Möhwald K, Hadzhikolev H, Bardins S, Brandt T, Dieterich M, Grill E, Jahn K. FV 34 A novel diagnostic index test to detect stroke as a cause of acute vertigo, dizziness and imbalance with high sensitivity and specificity. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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11
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Ahmadi SA, Vivar G, Frei J, Nowoshilow S, Bardins S, Brandt T, Krafczyk S. Towards computerized diagnosis of neurological stance disorders: data mining and machine learning of posturography and sway. J Neurol 2019; 266:108-117. [PMID: 31286203 DOI: 10.1007/s00415-019-09458-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
We perform classification, ranking and mapping of body sway parameters from static posturography data of patients using recent machine-learning and data-mining techniques. Body sway is measured in 293 individuals with the clinical diagnoses of acute unilateral vestibulopathy (AVS, n = 49), distal sensory polyneuropathy (PNP, n = 12), anterior lobe cerebellar atrophy (CA, n = 48), downbeat nystagmus syndrome (DN, n = 16), primary orthostatic tremor (OT, n = 25), Parkinson's disease (PD, n = 27), phobic postural vertigo (PPV n = 59) and healthy controls (HC, n = 57). We classify disorders and rank sway features using supervised machine learning. We compute a continuous, human-interpretable 2D map of stance disorders using t-stochastic neighborhood embedding (t-SNE). Classification of eight diagnoses yielded 82.7% accuracy [95% CI (80.9%, 84.5%)]. Five (CA, PPV, AVS, HC, OT) were classified with a mean sensitivity and specificity of 88.4% and 97.1%, while three (PD, PNP, and DN) achieved a mean sensitivity of 53.7%. The most discriminative stance condition was ranked as "standing on foam-rubber, eyes closed". Mapping of sway path features into 2D space revealed clear clusters among CA, PPV, AVS, HC and OT subjects. We confirm previous claims that machine learning can aid in classification of clinical sway patterns measured with static posturography. Given a standardized, long-term acquisition of quantitative patient databases, modern machine learning and data analysis techniques help in visualizing, understanding and utilizing high-dimensional sensor data from clinical routine.
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Affiliation(s)
- Seyed-Ahmad Ahmadi
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany. .,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany.
| | - Gerome Vivar
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany.,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany
| | - Johann Frei
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany.,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany
| | - Sergej Nowoshilow
- IMP Research Institute of Molecular Pathology, Campus-Vienna-Biocenter 1, 1030, Vienna, Austria
| | - Stanislav Bardins
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Siegbert Krafczyk
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
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12
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Kremmyda O, Kirsch V, Bardins S, Lohr H, Vollmar C, Noachtar S, Dieterich M. Electrical brain stimulation of the parietal lobe impairs the perception of verticality. J Neurol 2019; 266:146-148. [PMID: 31076876 DOI: 10.1007/s00415-019-09355-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 01/10/2023]
Affiliation(s)
- O Kremmyda
- Department of Neurology, Ludwig Maximilian University, Munich, Germany. .,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig Maximilian University, Munich, Germany.
| | - V Kirsch
- Department of Neurology, Ludwig Maximilian University, Munich, Germany.,Graduate School of Systemic Neuroscience, Ludwig Maximilian University, Munich, Germany
| | - S Bardins
- German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig Maximilian University, Munich, Germany
| | - H Lohr
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - C Vollmar
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - S Noachtar
- Department of Neurology, Ludwig Maximilian University, Munich, Germany.,Graduate School of Systemic Neuroscience, Ludwig Maximilian University, Munich, Germany
| | - M Dieterich
- Department of Neurology, Ludwig Maximilian University, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig Maximilian University, Munich, Germany.,Graduate School of Systemic Neuroscience, Ludwig Maximilian University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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13
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Schepermann A, Bardins S, Penkava J, Brandt T, Huppert D, Wuehr M. Approach to an experimental model of Mal de Debarquement Syndrome. J Neurol 2019; 266:74-79. [DOI: 10.1007/s00415-019-09345-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
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14
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Goldschagg N, Bremova-Ertl T, Bardins S, Dinca N, Feil K, Krafczyk S, Lorenzl S, Strupp M. No Evidence of a Contribution of the Vestibular System to Frequent Falls in Progressive Supranuclear Palsy. J Clin Neurol 2019; 15:339-346. [PMID: 31286706 PMCID: PMC6620443 DOI: 10.3988/jcn.2019.15.3.339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/27/2019] [Accepted: 01/31/2019] [Indexed: 12/01/2022] Open
Abstract
Background and Purpose Conflicting results about vestibular function in progressive supranuclear palsy (PSP) prompted a systematic examination of the semicircular canal function, otolith function, and postural stability. Methods Sixteen patients with probable PSP [9 females, age=72±6 years (mean±SD), mean disease duration=3.6 years, and mean PSP Rating Scale score=31] and 17 age-matched controls were examined using the video head impulse test, caloric testing, ocular and cervical vestibular evoked myogenic potentials (o- and cVEMPs), video-oculography, and posturography. Results There was no evidence of impaired function of the angular vestibulo-ocular reflex (gain=1.0±0.1), and caloric testing also produced normal findings. In terms of otolith function, there was no significant difference between PSP patients and controls in the absolute peakto-peak amplitude of the oVEMP (13.5±7.2 µV and 12.5±5.6 µV, respectively; p=0.8) or the corrected peak-to-peak amplitude of the cVEMP (0.6±0.3 µV and 0.5±0.2 µV, p=0.3). The total root-mean-square body sway was significantly increased in patients with PSP compared to controls (eyes open/head straight/hard platform: 9.3±3.7 m/min and 6.9±2.1 m/min, respectively; p=0.032). As expected, the saccade velocities were significantly lower in PSP patients than in controls: horizontal, 234±92°/sec and 442±66°/sec, respectively; downward, 109±105°/sec and 344±72°/sec; and upward, 121±110°/sec and 348±78°/sec (all p<0.01). Conclusions We found no evidence of impairment of either high- or low-frequency semicircular function or otolith organ function in the examined PSP patients. It therefore appears that other causes such as degeneration of supratentorial pathways lead to postural imbalance and falls in patients with PSP.
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Affiliation(s)
- Nicolina Goldschagg
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.
| | - Tatiana Bremova-Ertl
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Stanislav Bardins
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Nora Dinca
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Katharina Feil
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Siegbert Krafczyk
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Stefan Lorenzl
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Michael Strupp
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
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Spiegel R, Claassen J, Teufel J, Bardins S, Schneider E, Lehrer Rettinger N, Jahn K, da Silva FA, Hahn A, Farahmand P, Brandt T, Strupp M, Kalla R. Resting in darkness improves downbeat nystagmus: evidence from an observational study. Ann N Y Acad Sci 2017; 1375:66-73. [PMID: 27447539 DOI: 10.1111/nyas.13172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/01/2016] [Accepted: 06/15/2016] [Indexed: 11/27/2022]
Abstract
Resting in an upright position during daytime decreases downbeat nystagmus (DBN). When measured in brightness only, that is, without intermitting exposure to darkness, it does not make a significant difference whether patients have previously rested in brightness or in darkness. In real-world scenarios, people are often exposed to brightness and darkness intermittently. The aim of this study was to analyze whether resting in brightness or resting in darkness was associated with a lower post-resting DBN after intermitting exposures to brightness and darkness. Eight patients were recorded with three-dimensional video-oculography in brightness and darkness conditions, each following two 2-h resting intervals under either brightness or darkness resting conditions. The dependent variable was DBN intensity, measured in mean slow phase velocity. A repeated measures ANOVA with the factors measurement condition (brightness vs. darkness), resting condition (brightness vs. darkness), and time (after first vs. second resting interval) showed a significant effect for the factor resting condition, where previous resting in darkness was associated with a significantly lower DBN relative to previous resting in brightness (P < 0.01). The clinical relevance is to advise patients with DBN to rest in darkness.
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Affiliation(s)
- Rainer Spiegel
- Division of Internal Medicine, Basel University Hospital, Basel, Switzerland
| | - Jens Claassen
- Department of Neurology, Essen University Hospital, Essen, Germany
| | - Julian Teufel
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Munich, Germany
| | - Stanislav Bardins
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Munich, Germany
| | - Erich Schneider
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Munich, Germany.,Institute of Medical Technology, Brandenburg University of Technology, Cottbus-Senftenberg, Senftenberg, Germany
| | - Nicole Lehrer Rettinger
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Munich, Germany
| | - Klaus Jahn
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Munich, Germany
| | - Fábio Anciães da Silva
- Serviço de Neurologia, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Ales Hahn
- Ear, Nose and Throat Department of the 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Parvis Farahmand
- Department of Medicine, Giessen University Hospital, Giessen, Germany
| | - Thomas Brandt
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Munich, Germany
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Munich, Germany
| | - Roger Kalla
- Department of Neurology, Bern University Hospital, Bern, Switzerland
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Teufel J, Bardins S, Spiegel R, Kremmyda O, Schneider E, Strupp M, Kalla R. Real-time computer-based visual feedback improves visual acuity in downbeat nystagmus - a pilot study. J Neuroeng Rehabil 2016; 13:1. [PMID: 26728632 PMCID: PMC4700576 DOI: 10.1186/s12984-015-0109-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with downbeat nystagmus syndrome suffer from oscillopsia, which leads to an unstable visual perception and therefore impaired visual acuity. The aim of this study was to use real-time computer-based visual feedback to compensate for the destabilizing slow phase eye movements. METHODS The patients were sitting in front of a computer screen with the head fixed on a chin rest. The eye movements were recorded by an eye tracking system (EyeSeeCam®). We tested the visual acuity with a fixed Landolt C (static) and during real-time feedback driven condition (dynamic) in gaze straight ahead and (20°) sideward gaze. In the dynamic condition, the Landolt C moved according to the slow phase eye velocity of the downbeat nystagmus. The Shapiro-Wilk test was used to test for normal distribution and one-way ANOVA for comparison. RESULTS Ten patients with downbeat nystagmus were included in the study. Median age was 76 years and the median duration of symptoms was 6.3 years (SD +/- 3.1y). The mean slow phase velocity was moderate during gaze straight ahead (1.44°/s, SD +/- 1.18°/s) and increased significantly in sideward gaze (mean left 3.36°/s; right 3.58°/s). In gaze straight ahead, we found no difference between the static and feedback driven condition. In sideward gaze, visual acuity improved in five out of ten subjects during the feedback-driven condition (p = 0.043). CONCLUSIONS This study provides proof of concept that non-invasive real-time computer-based visual feedback compensates for the SPV in DBN. Therefore, real-time visual feedback may be a promising aid for patients suffering from oscillopsia and impaired text reading on screen. Recent technological advances in the area of virtual reality displays might soon render this approach feasible in fully mobile settings.
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Affiliation(s)
- Julian Teufel
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilans-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - S Bardins
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilans-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Rainer Spiegel
- Division of Internal Medicine, Basel University Hospital, Am Petersgraben 4, 4031, Basel, Switzerland.
| | - O Kremmyda
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilans-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - E Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Großenhainer Str. 57, 01968, Senftenberg, Germany.
| | - M Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilans-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - R Kalla
- Department of Neurology Inselspital, Bern University Hospital, Freiburgstrasse 4, 3010, Bern, Switzerland.
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Feil K, Claassen J, Bardins S, Teufel J, Krafczyk S, Schneider E, Schniepp R, Jahn K, Kalla R, Strupp M. Effect of chlorzoxazone in patients with downbeat nystagmus: A pilot trial. Neurology 2013; 81:1152-8. [DOI: 10.1212/wnl.0b013e3182a55f6d] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Feil K, Claaßen J, Bardins S, Teufel J, Habs M, Kalla R, Strupp M. Transition from downbeat to upbeat nystagmus caused by 4-aminopyridine. J Neurol 2013; 260:1426-8. [PMID: 23595790 DOI: 10.1007/s00415-013-6907-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 11/27/2022]
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Claassen J, Feil K, Bardins S, Teufel J, Spiegel R, Kalla R, Schneider E, Jahn K, Schniepp R, Strupp M. Dalfampridine in patients with downbeat nystagmus--an observational study. J Neurol 2013; 260:1992-6. [PMID: 23589193 DOI: 10.1007/s00415-013-6911-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/28/2013] [Accepted: 03/30/2013] [Indexed: 10/27/2022]
Abstract
We investigated the effects of dalfampridine, the sustained-release form of 4-aminopyridine, on slow phase velocity (SPV) and visual acuity (VA) in patients with downbeat nystagmus (DBN) and the side effects of the drug. In this proof-of-principle observational study, ten patients received dalfampridine 10 mg bid for 2 weeks. Recordings were conducted at baseline, 180 min after first administration, after 2 weeks of treatment and after 4 weeks of wash-out. Mean SPV decreased from a baseline of 2.12 deg/s ± 1.72 (mean ± SD) to 0.51 deg/s ± 1.00 180 min after first administration of dalfampridine 10 mg and to 0.89 deg/s ± 0.75 after 2 weeks of treatment with dalfampridine (p < 0.05; post hoc both: p < 0.05). After a wash-out period of 1 week, mean SPV increased to 2.30 deg/s ± 1.6 (p < 0.05; post hoc both: p < 0.05). The VA significantly improved during treatment with dalfampridine. Also, 50 % of patients did not report any side effects. The most common reported side effects were abdominal discomfort and dizziness. Dalfampridine is an effective treatment for DBN in terms of SPV. It was well-tolerated in all patients.
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Affiliation(s)
- Jens Claassen
- Department of Neurology and German Center for Vertigo and Balance Disorders (IFBLMU), University of Munich Hospital, Munich, Germany.
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Schneider E, Lehnen N, Bartl K, Bardins S, Kohlbecher S, Glasauer S, Jahn K. Zentral oder peripher? Schwindelursachen auf der Spur mit dem video-basierten Kopfimpulstest. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lehnen N, Bartl K, Bardins S, Kohlbecher S, Glasauer S, Jahn K, Schneider E. Der video-basierte Kopfimpulstest zur Quantifizierung peripher-vestibulärer Funktion bei Kindern und Jugendlichen. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Claaßen J, Bardins S, Schneider E, Kalla R, Spiegel R, Strupp M, Jahn K. The influence of dual task on gait during galvanic vestibular or visual motion stimulation. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Claaßen J, Bardins S, Spiegel R, Schneider E, Kalla R, Strupp M. Body position and direction of a moving object influence visual motion perception. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gramann K, Onton J, Riccobon D, Mueller HJ, Bardins S, Makeig S. Human brain dynamics accompanying use of egocentric and allocentric reference frames during navigation. J Cogn Neurosci 2010; 22:2836-49. [PMID: 19925183 DOI: 10.1162/jocn.2009.21369] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Maintaining spatial orientation while travelling requires integrating spatial information encountered from an egocentric viewpoint with accumulated information represented within egocentric and/or allocentric reference frames. Here, we report changes in high-density EEG activity during a virtual tunnel passage task in which subjects respond to a postnavigation homing challenge in distinctly different ways--either compatible with a continued experience of the virtual environment from a solely egocentric perspective or as if also maintaining their original entrance orientation, indicating use of a parallel allocentric reference frame. By spatially filtering the EEG data using independent component analysis, we found that these two equal subject subgroups exhibited differences in EEG power spectral modulation during tunnel passages in only a few cortical areas. During tunnel turns, stronger alpha blocking occurred only in or near right primary visual cortex of subjects whose homing responses were compatible with continued use of an egocentric reference frame. In contrast, approaching and during tunnel turns, subjects who responded in a way compatible with use of an allocentric reference frame exhibited stronger alpha blocking of occipito-temporal, bilateral inferior parietal, and retrosplenial cortical areas, all areas implicated by hemodynamic imaging and neuropsychological observation in construction and maintenance of an allocentric reference frame. We conclude that in these subjects, stronger activation of retrosplenial and related cortical areas during turns support a continuous translation of egocentrically experienced visual flow into an allocentric model of their virtual position and movement.
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Affiliation(s)
- Klaus Gramann
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA 92093-0961, USA.
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Flanagin V, Guenther A, Bardins S, Brandt T, Glasauer S. Dual task interference during linear distance estimation: an fMRI study. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bartl K, Dera T, Boening G, Bardins S, Wittmann D, Schneider E, Brandt T. Mobiles Video-Okulographiesystem mit hoher Abtastrate und geringer Latenz. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stephan T, Kupferberg A, Stein A, Dera T, Bardins S, Brandt T, Glasauer S. Subjektiver visueller Zenit – funktionelle MRT der Schwerkraftwahrnehmung. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dera T, Schneider E, Böning G, Bardins S, Bartl K, Brandt T. Bestimmung der Listingschen Ebene mittels Videookulographie bei Galvanischer Vestibulärer Stimulation. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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