Journal of Vestibular Research - Volume 26, issue 5-6

Authors: Strupp, Michael | Lopez-Escamez, Jose A. | Kim, Ji-Soo | Straumann, Dominik | Jen, Joanna C. | Carey, John | Bisdorff, Alexandre | Brandt, Thomas

Article Type: Research Article

Abstract: This paper describes the diagnostic criteria for vestibular paroxysmia (VP) as defined by the Classification Committee of the Bárány Society. The diagnosis of VP is mainly based on the patient history and requires: A) at least ten attacks of spontaneous spinning or non-spinning vertigo; B) duration less than 1 minute; C) stereotyped phenomenology in a particular patient; D) response to a treatment with carbamazepine/oxcarbazepine; and F) not better accounted for by another diagnosis. Probable VP is defined as follows: A) at least five attacks of spinning or non-spinning vertigo; B) duration less than 5 minutes; C) spontaneous occurrence or …provoked by certain head-movements; D) stereotyped phenomenology in a particular patient; E) not better accounted for by another diagnosis. Ephaptic discharges in the proximal part of the 8th cranial nerve, which is covered by oligodendrocytes, are the assumed mechanism. Important differential diagnoses are Menière’s disease, vestibular migraine, benign paroxysmal positional vertigo, epileptic vestibular aura, paroxysmal brainstem attacks (in multiple sclerosis or after brainstem stroke), superior canal dehiscence syndrome, perilymph fistula, transient ischemic attacks and panic attacks. Current areas of uncertainty in the diagnosis of VP are: a) MRI findings of vascular compression which are not diagnostic of the disease or predictive for the affected side because they are also observed in about 30% of healthy asymptomatic subjects; and b) response to treatment with carbamazepine/oxcarbazepine supports the diagnosis but there are so far no randomized controlled trials for treatment of VP. Show more

Keywords: Vertigo, dizziness, attacks, neurovascular compression, ICVD

DOI: 10.3233/VES-160589

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 409-415, 2016

Authors: Cheng, Roger C. | Walker, Mark F.

Article Type: Research Article

Abstract: Dynamic visual acuity is an important clinical tool for assessment of the rotational vestibulo-ocular reflex (rVOR). It is based on the fact that the normal rVOR stabilizes vision and maintains visual acuity during head rotation. The translational VOR (tVOR) generates eye movements during linear head motion. Studies in humans have shown that gaze stabilization during translation is incomplete and that there is a strong effect of the visual environment: eye velocity is much greater in the light than in the dark. In this study, we measured visual acuity during vertical translation in 11 subjects and asked whether a more complex …visual background would enhance the response and improve acuity. During 2 Hz whole-body translation, tumbling-E optotypes (0.0–0.9 logMAR in steps of 0.1 logMAR, six trials of each size randomly ordered) were flashed on a screen that was 30 cm in front of the subject’s eyes. The subject reported the optotype’s orientation with a joystick. Based on a threshold of 75% trials correctly identified, the group dynamic acuity was 0.72 logMAR, compared to a static acuity of 0.0 logMAR. When the background was enhanced with a stationary dot pattern, dynamic acuity improved to 0.42 logMAR. Our findings show that vertical head translation degrades vision more than head rotation. This may limit the use of dynamic acuity as a clinical measure of otolith function. Show more

Keywords: Vestibular, otolith, vestibulo-ocular reflex

DOI: 10.3233/VES-160596

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 417-423, 2016

Authors: Aranda-Moreno, C. | Jáuregui-Renaud, K.

Article Type: Research Article

Abstract: BACKGROUND: Feelings of unreality have been provoked in healthy subjects undergoing stimulation of the semicircular canals, but no studies have assessed the influence of otoliths stimulation on depersonalization/derealization (DD) symptoms. OBJECTIVE: To assess DD symptoms during unilateral centrifugation in healthy adults. METHODS: 100 subjects participated in the study. They completed a standardized questionnaire of symptoms related to balance (Jáuregui-Renaud 2003), the 17-item Hamilton Depression Rating Scale, the Zung Instrument for Anxiety Disorders and the Cox & Swinson 28-item DD inventory. After unilateral centrifugation (300°/s at 3.5 cm), subjects completed the DD inventory again. RESULTS: …Centrifugation provoked symptoms which subjects denied ever experiencing before. The items most frequently reported were “Body feels strange or different in some way” (56%) and “Time seems to pass very slowly” (55%). The DD total score was related to the score of symptoms related to balance and to the depression inventory with no influence from the general characteristics of the subjects or the responses to vestibular tests. The individual scores of symptoms of vestibular function and derealization were related to the report of the other DD symptoms. CONCLUSIONS: In healthy subjects, unilateral centrifugation provokes DD symptoms. The results support that distorted vestibular signals may create a misleading frame of reference which mismatch with the other senses, giving rise to ‘unreal’ perceptions. Show more

Keywords: Depersonalization, derealization, vestibular, utricular macula

DOI: 10.3233/VES-160597

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 425-431, 2016

Authors: Stevens, Madelyn N. | Barbour, Dennis L. | Gronski, Meredith P. | Hullar, Timothy E.

Article Type: Research Article

Abstract: Maintaining balance relies on integration of inputs from the visual, vestibular, and proprioceptive systems. The auditory system has not been credited with a similar contributory role, despite its ability to provide spatial orienting cues with extreme speed and accuracy. Here, we determined the ability of external auditory signals to reduce postural sway, measured as the root-mean-square velocity of center of pressure of a standing subject, in a series of subjects with varying levels of imbalance standing in the dark. The maximum root-mean-square center of pressure among our subjects decreased from 7.0 cm/sec in silence to 4.7 cm/sec.with the addition of external sound. …The addition of sound allowed subjects to decrease sway by 41 percent. The amount of improvement due to sound was 54% of the amount of improvement observed in postural sway when visual cues only were provided to subjects standing in silence. These data support the significant effect of the auditory system in providing balance-related cues and suggest that interventions such as hearing aids or cochlear implants may be useful in improving postural stability and reducing falls. Show more

Keywords: Balance, audition, posturography, sway, stability, vestibular, proprioception, hearing

DOI: 10.3233/VES-160599

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 433-438, 2016

Authors: Alshehri, Mohammed M. | Sparto, Patrick J. | Furman, Joseph M. | Fedor, Sheri | Mucha, Anne | Henry, Luke C. | Whitney, Susan L.

Article Type: Research Article

Abstract: OBJECTIVE: Dizziness after concussion have been reported in both youths and adults. It is not clear if the dizziness experienced post-concussion is from peripheral or central etiology. New technology has been developed to quickly and easily quantify the magnitude of peripheral vestibular disorders that is non-invasive and acceptable to youths and adults. The purpose of this study was to determine if youths and adults’ post-concussion have evidence of decreased horizontal semicircular canal vestibulo-ocular reflex (VOR) gains as measured with the video head impulse test (vHIT), which would indicate a peripheral vestibular disorder. An additional purpose was to determine if …VOR gain scores correlate with functional performance measures. Design: Descriptive cross sectional. SETTING: Large medical center out-patient concussion program. PARTICIPANTS: Fifty-six subjects with concussion. MAIN OUTCOMES/MEASURES: Subjects completed the vHIT testing, the Dizziness Handicap Inventory (DHI), the Vestibular Activities and Participation (VAP) scale, the Pediatric Vestibular Symptom Questionnaire, gait speed assessment, the Dynamic Gait Index (DGI) and a verbal analog scale of symptom provocation before and after the vHIT testing. RESULTS: There were no abnormal vHIT findings in any subject. Headaches, dizziness and nausea were significantly worse post vHIT testing (p  < 0.05). Youths had better DGI and DHI scores than subjects older than 20 (p  < 0.05). CONCLUSION: The vHIT did not detect horizontal semicircular canal weakness in any of the subjects tested. In addition, older adults reported more activity and participation limitations than the younger subjects with concussion. Show more

DOI: 10.3233/VES-160598

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 439-446, 2016

Authors: Furman, Joseph M. | Shirey, Ian | Roxberg, Jillyn | Kiderman, Alexander

Article Type: Research Article

Abstract: Whole-body impulsive rotations were used to overcome several limitations associated with manual head impulse testing. A computer-controlled rotational chair delivered brief, whole-body, earth-vertical axis yaw impulsive rotations while eye movements were measured using video-oculography. Results from an unselected group of 20 patients with dizziness and a group of 22 control subjects indicated that the horizontal computerized rotational head impulse test (crHIT) is well-tolerated and provides an estimate of unidirectional vestibulo-ocular reflex gain comparable to results from caloric testing. This study demonstrates that the horizontal crHIT is a new assessment tool that overcomes many of the limitations of manual head impulse …testing and provides a reliable laboratory-based measure of unilateral horizontal semicircular canal function. Show more

Keywords: Vestibulo-ocular reflex, head impulse testing, semicircular canal

DOI: 10.3233/VES-160595

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 447-457, 2016

Authors: Micarelli, Alessandro | Viziano, Andrea | Bruno, Ernesto | Micarelli, Elisa | Alessandrini, Marco

Article Type: Research Article

Abstract: Multiple chemical sensitivity (MCS) is a common clinical diagnosis in western populations and its symptoms are thought to be mainly related to chemical compounds exposure. Although MCS subjects refer to complain from many central nervous system symptoms, including dizziness, no study to now deepened vestibular detriment nor to what extent such an impairment could worsen MCS. Thus, the purpose of present study was to objectively highlight those clinical/subclinical aspects of vestibular impairment that could be related to MCS symptoms cohorts. A principal component analysis within a wide battery of otoneurological test scores was employed in 18 right-handed MCS patients and …20 sex- and age-matched healthy individuals. A deranged dimensionality in near-optimal re-weighting within otoneurological variables was found in MCS as compared with healthy subjects. These data seem to support the idea that MCS physiopathological underpinnings could lead to a peripheral and higher vestibular decay that could be addressed as a further aspect to better follow MCS patients up along natural history of disease in clinical practice. Show more

Keywords: Multiple chemical sensitivity, vestibular, visual dependency, component analysis, Fourier transform

DOI: 10.3233/VES-160594

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 459-468, 2016

Authors: Mañago, Mark M. | Schenkman, Margaret | Berliner, Jean | Hebert, Jeffrey R.

Article Type: Research Article

Abstract: BACKGROUND: The functional capacity of the vestibulo-ocular reflex (VOR) is not well understood in people with multiple sclerosis (MS). OBJECTIVE: To determine the psychometric properties of computerized Gaze Stabilization Test (GST) and Dynamic Visual Acuity Test (DVAT) in people with MS. METHODS: This cross-sectional study determined discriminant validity of the GST and DVAT between 15 healthy controls and 30 participants with MS, and between participants with MS who had higher versus lower disability. This study also determined same-day and between-session test-retest reliability, and concurrent validity with patient-reported outcomes (PROs) of balance, dizziness, and fatigue. RESULTS: …GST (p  < 0.001) and DVAT (p  = 0.001) scores were lower in participants with MS compared to controls. GST (p  = 0.035) but not DVAT (p  = 0.313) scores were lower in those with higher compared to lower disability. Test-retest reliability intraclass correlation coefficients (ICC (2,1)) were fair-to-good for the GST (0.48 to 0.74) and DVAT (0.47 to 0.60). PROs correlated significantly with GST, but not DVAT scores. CONCLUSIONS: This study provides initial evidence that the functional capacity of the VOR is impaired in people with MS as measured by the GST and DVAT. Further investigation is warranted to determine usefulness of both measures as outcomes for people with MS. Show more

Keywords: Gaze Stabilization Test, Dynamic Visual Acuity Test, vestibulo-ocular reflex, multiple sclerosis, rehabilitation, validity, reliability

DOI: 10.3233/VES-160593

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 469-477, 2016

Authors: Vanspauwen, Robby | Knoop, Allart | Camp, Sophie | van Dinther, Joost | Erwin Offeciers, F. | Somers, Thomas | Zarowski, Andrzej | Blaivie, Cathérine

Article Type: Research Article

Abstract: BACKGROUND: The DHI is a widely used questionnaire for the evaluation of the self-reported disability in patients with dizziness and balance problems. OBJECTIVE: To investigate the relationship between the DHI scores and demographic, symptomatic and diagnostic parameters. METHODS: Retrospective study in 568 patients with balance problems. RESULTS: We observed a total of 61.3% of patients with moderate (DHI total score between 30 and 59) to severe (DHI total score between 60 and 100) disability. Patients with long-standing complaints (lasting longer than 3 months) experience their self-reported disability to a greater extent than patients with new …onset pathology (illness duration of one month and less). Moreover, patients suffering from continuous complaints have a larger DHI score than patients with shorter symptom duration. The first effect (new onset vs. long-standing pathology) is primarily caused by emotional factors, the latter effect (symptom duration) is attributable to functional and physical factors, not to emotional aspects. Patients with daily and weekly complaints have larger DHI scores than patients who reported only one episode. Female patients reported larger DHI scores than males. We found no effect of age, diagnostic group (no diagnosis, episodic, acute or chronic vestibular syndrome) or reported symptoms on the DHI scores. CONCLUSIONS: The information retrieved from the DHI questionnaire is complementary to the information obtained from clinical investigation and diagnostic tests and therefore is an essential tool in a vestibular clinic. Show more

Keywords: Dizziness handicap inventory, vestibular disorders, vestibular symptoms, diagnosis, demographic

DOI: 10.3233/VES-160600

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 479-486, 2016

Article Type: Other

Citation: Journal of Vestibular Research, vol. 26, no. 5-6, pp. 487-489, 2016