Journal of Vestibular Research-Equilibrium & Orientation最新文献

BackgroundTranscranial magnetic stimulation (TMS) is extensively studied as a neuromodulation tool in neurological disorders. However, its use with the central vestibular disorders is limited.ObjectiveTo evaluate the utility of TMS as an assessment and treatment of chronic vestibular disorders and propose recommendations for future work.MethodsA comprehensive search of four electronic databases (PubMed, CINAHL, PsycINFO, and Rehabilitation and Sports Medicine Source) identified 206 records of which 16 studies were included.ResultsOne study used TMS as a neurophysiological assessment tool and 15 used repetitive TMS (rTMS) as a neuromodulatory intervention. Mal de Debarquement syndrome was the most frequently explored diagnosis. Dorsolateral prefrontal cortex and the cerebellum were the most frequent sites for rTMS application. Statistically significant improvements were noted on the Dizziness Handicap Inventory (3/7 studies) but clinically significant improvements were not observed. Postural control (7/7 studies) showed improvements along with VOR gain (1/1 studies).ConclusionsTMS shows promise as both a neurophysiological assessment tool and a neuromodulatory intervention for chronic vestibular disorders. Methodological limitations of the studies warrant caution while interpreting the results. Larger sample sizes, control groups, optimal neuroanatomical targeting, and dosing along with active rehabilitation are required to determine effectiveness in chronic vestibular disorders.

BackgroundPersistent postural-perceptual dizziness (PPPD) represents a relatively new vestibular diagnosis that has garnered attention within the medical community. Consequently, there is a pressing demand for efficacious management strategies.ObjectiveTo assess the comparative effectiveness of virtual reality (VR) versus vestibular rehabilitation therapy (VRT) in improving PPPD symptoms.MethodsWe randomly assigned a cohort of 42 individuals conclusively diagnosed with PPPD to two distinct groups. The experimental group included 21 participants who received a combination of VR and optokinetic stimulation in addition to VRT, while the control group, also made up of 21 individuals, only received optokinetic stimulation in conjunction with VRT. We administered the intervention sessions twice weekly over a span of 6 weeks, resulting in a total of 10-intervention sessions. Additionally, baseline, post-intervention, and follow-up assessments were conducted.ResultsOur analysis revealed that participants in both groups significantly improved with no significant differences between the groups. Individuals undergoing VR interventions demonstrated marked improvements across all of the assessed parameters including the primary outcome measure that were reduced from 41.55 (11.87) to 23.40 (14.17) (p<0.001). Moreover, participants in the control group also displayed notable enhancements in select outcome measures post-intervention including the primary outcome measure that were reduced from 43.60 (12.75) to 26.10 (16.25) (p = 0.001). All participants in both groups maintained significant improvement in the severity of PPPD after 1 year of the. However, the study cannot determine if this change was definitely from the treatment because there was no non-treatment control group.ConclusionsThe study found that the addition of VR to a well-structured VRT did not significantly improve clinical outcomes, indicating a need for further investigation into more effective approaches to yield meaningful clinical benefits. Moreover, adding a control group with no intervention would help revealing a real effect of the intervention.

BackgroundRamsay Hunt syndrome with dizziness (RHSD), vestibular neuritis (VN), and idiopathic sudden sensorineural hearing loss with vertigo (SHLV) all present with acute vestibular symptoms, and no study has compared the semicircular canal (SCC) deficits among them.ObjectiveThis study aimed to use video head impulse test (vHIT) to compare the SCC injury patterns in RHSD, VN, and SHLV.MethodsTwenty-three RHSD patients, 44 VN patients, and 70 SHLV patients were enrolled. The vestibulo-ocular reflex gain and incidence of corrective saccades of anterior, horizontal, and posterior SCC (ASCC, HSCC, and PSCC) were examined using vHIT. Pathological vHIT results referred to decreased VOR gain and presence of corrective saccades.Results(1) The pathological rate of each SCC in RHSD group was the highest. (2) Impairment pattern of SCCs can be divided into 7 types based on vHIT results. The pattern of ASCC + HSCC + PSCC disability was the most common in RHSD patients (12/23, 52.2%). In the VN group, the HSCC deficit alone was the most common (16/44, 36.4%), followed by HSCC + ASCC impairment (13/44, 29.5%). In SHLV patients, the most common type was the PSCC deficit alone (26/70, 37.1%). (3) The system cluster analysis revealed that the injury of all SCCs in RHSD patients, the deficit of HSCC alone in VN patients, and the impairment of PSCC alone in SHLV patients showed the farthest distance from other injury patterns.ConclusionSCCs deficit showed more severe and extensive vestibular impairment in RHSD compared with VN and SHLV, suggesting these three peripheral acute vestibular disorders may have different pathophysiologic mechanisms.

BackgroundThe International Classification of Vestibular Disorders defines probable vestibular migraine (PVM) as an episodic vestibular disorder with either a history of migraine (criterion B) or migraine features during vestibular episodes (criterion C).ObjectiveThe purpose of this study is to investigate the clinical characteristics of PVM, focusing on items in the diagnostic criteria.MethodsWe retrospectively reviewed the medical records of 30 consecutive PVM patients diagnosed according to the Barany classification. The PVM patients were divided into two groups: those who fulfilled the criterion B (pre-existing migraine group) and those who fulfilled the criterion C (migraine features group).ResultsTwenty-four patients (80%) were in the pre-existing migraine group and the remaining 6 patients (20%) were in the migraine features group. All patients in the migraine features group had headache episodes. There were no significant differences between the two groups with regard to prevalence of migraine features listed in the criterion C and abnormal testing results.ConclusionsThe diagnosis of PVM was based on a history of migraine in most patients and on migraine features during vestibular episodes only in a few. All patients with migraine features during vestibular episodes had also headache episodes.

BackgroundIndividuals with dizziness often face balance issues and anxiety, which can result in reduced physical activity levels and decreased participation in their daily activities. Few studies have evaluated physical activity levels in individuals with chronic dizziness, and none have specifically focused on the two most prevalent types: vestibular migraine (VM) and persistent postural perceptual dizziness (PPPD).ObjectiveEvaluate self-reported physical activity levels in individuals diagnosed with PPPD and VM who are awaiting vestibular rehabilitation.MethodsIn a retrospective cross-sectional study, we extracted data from the electronic healthcare records involving 121 individuals presenting either VM or PPPD, referred for vestibular rehabilitation at National Hospital for Neurology and Neurosurgery, University College London. Data on IPAQ (International Physical Activity Questionnaire) and DHI (dizziness handicap inventory) questionnaires were analysed across groups.ResultsThe total sample consisted of 94 (77.7%) women and 27 (22.3%) men with a median age of 56 years old, ranging from 17 to 81 years (P25 = 41 and P75 = 64). Regarding the total sample, a minority (9.1%) of the individuals scored a high activity level on the IPAQ. We observed a significant difference between VM and PPPD in IPAQ score distribution (p = 0.039, Mann-Whitney). Within the category of high physical activity, a larger proportion of individuals had VM compared to PPPD. An inverse correlation was found between DHI and IPAQ (the lower IPAQ, the higher DHI) in the PPPD group (p<0.003).ConclusionsIn a sample of individuals with PPPD and VM referred for vestibular rehabilitation, only a minority demonstrated high physical activity levels on the IPAQ, with PPPD exhibiting lower activity levels compared to those with VM.

ObjectiveThis study aims to investigate the effect of camera positioning (left-sided vs right-sided) on the vestibulo-ocular reflex (VOR) gain values of normal subjects during the video head impulse test (vHIT), thereby providing valuable reference data for otology clinical practice.MethodsThirty healthy adults (60 ears) were recruited and examined by vHIT for the three pairs of semicircular canals (SCs). During the examination, we meticulously recorded and compared the VOR gain values in the six canal planes-right lateral (RL), left lateral (LL), right anterior-left posterior (RALP), and left anterior-right posterior (LARP)-with the camera positioned on the left side first, followed by repositioning on the right side. We evaluated instantaneous gain (40 ms, 60 ms, and 80 ms), 0-100 ms median gain, and regression gain in 0-100 ms for all SCs.ResultsFor horizontal canals, higher VOR gain values were recorded when the camera was positioned on the same side as the canal being tested. The gain value in LARP was higher when the camera was on the left side than on the right side, while the gain value in RALP was higher when the camera was on the right side than on the left side.ConclusionThis study underscores the importance of camera positioning on VOR gain values for both lateral and vertical canals during vHIT. To mitigate the effects of these variables, standardization of operational procedures and equipment settings is crucial.

In 2007, the Bárány Society embarked on a project to establish definitions of vestibular syndromes and disorders based on best available evidence, referred to as the International Classification of Vestibular Disorders (ICVD). Since then, numerous publications providing consensus-driven diagnostic criteria for vestibular symptoms, syndromes, and disorders have been published. Here, we reflect on the rationale for developing the ICVD as well as its subsequent achievements, challenges, and outlook. In this summary of the work of the ICVD to date, the authors will focus on practical aspects to help improve the utility and applicability of these diagnostic criteria moving forward.

BackgroundGait variability is increased in people with bilateral vestibulopathy (BVP). Since dedicated gait analysis can be resource-intensive, concurrent assessment with another vestibular function test, dynamic visual acuity (DVA), is worth consideration.ObjectiveTo assess comparability of results from a combined gait and DVA assessment with results from a previous dedicated gait analysis.Methods15 participants (4 women) with BVP were analysed. The DVA test assessed visual acuity during stance and during treadmill walking at 2, 4 and 6 km/h. An 8-camera motion capture system measured spatiotemporal gait parameters (step length, step time, step width and double support time; means and coefficients of variation [CoV]). The walking speed effect was assessed by mixed-effects models, and results were visually compared to previous results.ResultsWalking speed affected the means of step length, step time and double support time (p < .0001) but not step width (p = .373) and significantly affected the CoV of all parameters (p < .01). These values, as well as speed-related changes, were comparable between contexts.ConclusionsConcurrent DVA and gait assessment seems promising as an assessment method in people with BVP. Test-retest reliability, clinically feasible motion capture solutions and sensitivity to change following interventions should be further investigated.

ObjectiveThis study aimed to quantitatively analyze the characteristics of saccades in normal subjects during video head impulse test (vHIT), to establish a reference for clinical practice.MethodsA cohort of 20 healthy individuals (40 ears) was recruited and compared with a matched group of 20 patients (20 ears) suffering from vestibular neuritis (VN), utilizing vHIT to evaluate the functionality of all three semicircular canals (SCCs). This study analyzed the quantitative characteristics of saccades observed in healthy individuals and patients with VN.ResultsSignificant differences were observed between both groups in terms of lateral saccade frequency, latency, peak velocity, and duration for both the first and second saccades (all p < 0.05, with age as a covariate). Similarly, significant differences were found in vertical SCCs between groups for the frequency, latency, peak velocity, and duration of the first saccade (all p < 0.05, with age as a covariate). However, no significant differences were found in Perez-Rey (PR) scores either in lateral (p = 0.259) or vertical (p = 0.102) SCCs. Within the healthy group, significant differences were observed in the frequency, peak velocity, and duration of the first saccade in lateral and vertical SCCs (all p < 0.05). However, the latency (p = 0.827) and PR scores (p = 0.552) exhibited no significant variation.ConclusionsMicrosaccades characterized by prolonged latency and reduced amplitude can occur in healthy individuals during vHIT and are distinct from the saccades seen in patients with VN due to vestibular impairment. This highlights the need to carefully identify and interpret relevant saccades during clinical assessments.

BackgroundThe ocular counter roll (OCR) is a component of the vestibulo-ocular reflex (VOR) characterized by torsional eye movements in the opposite direction of the head during head tilt.ObjectiveThis study aimed to determine the test-retest reliability of the video ocular counter-roll (vOCR) test, based on video-oculography (VOG) measurements, in assessing otolith function.MethodsThe study included 40 healthy participants (25 females and 15 males) aged 18-44 years. Each participant underwent the vOCR test twice in 300 lateral head tilt positions 1 week apart. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs), and paired t-tests and Wilcoxon signed-rank tests were used to compare the mean values of the measurements.ResultsThere were no significant differences between the initial and retest measurements (p>0.05). The ICC for left head tilt was 85.2%, and for right head tilt was 79.3%, both indicating excellent reliability (p<0.01). The ICC for vOCR asymmetry was 50.7%, indicating moderate reliability (p<0.05).ConclusionsThe vOCR test demonstrated high reliability for lateral head tilts and was found to be a reliable tool for evaluating otolith function, supporting its use in the diagnosis and treatment of vestibular disorders.