Journal of Vestibular Research - Volume 17, issue 1

Authors: Horii, Arata | Uno, Atsuhiko | Kitahara, Tadashi | Mitani, Kenji | Masumura, Chisako | Kizawa, Kaoru | Kubo, Takeshi

Article Type: Research Article

Abstract: A prospective, open-label clinical trial was conducted for two aims: first, to evaluate the role of fluvoxamine, one of selective serotonin reuptake inhibitors, in the treatment of dizziness for the first time and to investigate its effective mechanisms. Second, to test the hypothesis that dizziness in patients without abnormal neuro-otologic findings would be induced by psychiatric disorders rather than by unnoticed neuro-otologic diseases. Nineteen patients with neuro-otologic diseases (Group I) and 22 patients in whom standard vestibular tests revealed no abnormal findings (Group II) were treated by fluvoxamine (200 mg/day) for eight weeks. Subjective handicaps due to dizziness using a …questionnaire, anxiety and depressive symptoms measured with the Hospital Anxiety and Depression Scale (HADS), and stress hormones (vasopressin and cortisol) were examined before and 8 weeks after treatment. Overall, fluvoxamine decreased subjective handicaps of both Groups I and II. Fluvoxamine decreased HADS of only patients whose subjective handicaps were reduced (=responders) in both groups, suggesting that fluvoxamine was effective for dizziness via psychiatric action rather than a recovery of vestibular function through serotonergic activation. In non-responders of Group II, pre-treatment HADS was higher than in Group I non-responders and it was not decreased by the treatment, suggesting that dizziness of Group II non-responders was due to severe psychiatric disorders rather than unnoticed neuro-otologic diseases. Anxiety and depression components of HADS showed a good correlation at both pre- and post-treatment periods. No post-therapeutic decrease was observed in either vasopressin or cortisol even in responders, suggesting that dizziness was not the sole cause of stress in chronic dizziness patients. In conclusion, patients with or without physical neuro-otologic deficits who report chronic dizziness accompanied by anxiety and depression (as measured by HADS) showed improvements across a full range of subjective handicaps and psychological distress, while patients with physical neuro-otologic defects and minimal anxiety or depression did not benefit. The main causes of dizziness in patients without physical neuro-otologic findings were psychiatric disorders. Show more

Keywords: SSRI, anxiety, depression, dizziness, stress

DOI: 10.3233/VES-2007-17101

Citation: Journal of Vestibular Research, vol. 17, no. 1, pp. 1-8, 2007

Authors: Grandis, Annamaria | Bombardi, Cristiano | Travostini, Beatrice | Gentile, Arcangelo | Joechler, Monica | Pisoni, Luciano | Chiocchetti, Roberto

Article Type: Research Article

Abstract: The topography and the main characteristics of the vestibular nuclear complex (VNC) in cattle have been studied in serially transversally cut Nissl and Gles-stained sections. By using computerized image analysis software, the cell size, the maximum and minimum diameter of the neurons of each vestibular nucleus were obtained. These parameters were statistically analyzed by comparing the cell population from different nuclei and different parts of each nucleus. Furthermore, in order to investigate the lumbo-sacral projections, the fluorescent tracer Fast Blue was injected into the L6-S1 spinal cord of three calves. Among the vestibular nuclei, the superior was the least extensive …rostro-caudally, the medial was the most extensive and contained the smallest cells, the lateral showed the largest neurons, and the descending nucleus contained cells of intermediate size which decreased in a rostrocaudal direction. Concerning the lumbo-sacral projections of the bovine VNC, the present study showed that only the fibers coming from the lateral vestibular nucleus reached the L6-S1 spinal cord. The labelled neurons were most heavily concentrated in the dorsal portion of this nucleus, but scattered neurons were also observed throughout the entire extension of the nucleus. The differences between the descriptions of cattle and other species were described. Show more

Keywords: Vestibular nuclear complex, spinal cord, anatomy, cattle, Fast Blue

DOI: 10.3233/VES-2007-17102

Citation: Journal of Vestibular Research, vol. 17, no. 1, pp. 9-24, 2007

Authors: Basta, Dietmar | Clarke, Andrew | Ernst, Arne | Todt, Ingo

Article Type: Research Article

Abstract: Dynamic posturography with the Equitest® system is helpful to screen patients for balance deficits, but diagnostic specificity, for otolith disorders is unknown until now. It was therefore the aim of our present paper to examine patients with a well-defined otolith disorder on the Equitest® at different test conditions while simultaneously recording trunk sway by means of the Sway Star® system. A total of 22 patients with different types of otolith disorders were included in this study. All test results of the patients were matched with respect to age and gender to controls without history of ENT diseases. The overall sensitivity …of the Equitest® system in our series was only higher than 50% in 2 conditions. The results of the trunk sway recordings were significantly different between patients with a sacculo-utricular disorder and controls in all test conditions. The results suggest that a disorder of the otolith organs seems to affect especially the trunk sway to a large extent. Show more

Keywords: Otolith disorder, trunk sway, postural control

DOI: 10.3233/VES-2007-17103

Citation: Journal of Vestibular Research, vol. 17, no. 1, pp. 25-31, 2007

Authors: Brantberg, Krister | Löfqvist, Lennart

Article Type: Research Article

Abstract: Bilateral vestibulopathy, i.e. decreased peripheral vestibular function affecting both ears, is characterized by unsteadiness of gait, particularly in darkness and by motion-induced oscillopsia. We have recently seen a few patients with severely impaired semicircular canal function albeit with rather normal vestibular evoked myogenic potentials (VEMP) suggesting normal saccular function. The five young patients, mean age 27 years (range 15–45), 4 males and 1 female, had severely impaired balance in darkness and they all reported walking-induced vertical oscillopsia. Hence, these patients with incomplete vestibular lesions had symptoms that were indistinguishable from the typical patient with bilateral vestibulopathy. Further, the findings in …these patients suggest that saccular function probably contributes little to prevent walking-induced vertical oscillopsia. Show more

Keywords: Bilateral vestibulopathy, oscillopsia, VEMP, saccular VOR

DOI: 10.3233/VES-2007-17104

Citation: Journal of Vestibular Research, vol. 17, no. 1, pp. 33-38, 2007

Authors: Versino, Maurizio | Ranza, Laura | Colnaghi, Silvia | Alloni, Roberto | Callieco, Roberto | Romani, Alfredo | Bergamaschi, Roberto | Pichiecchio, Anna | Bastianello, Stefano | Cosi, Vittorio

Article Type: Research Article

Abstract: Both sound (s-) and galvanic (g-) vestibular-evoked myogenic potential (VEMP) enable us to study the saccular pathways. However, the VEMP can be abnormal for non-vestibular factors, such as insufficient activation of the sterno-cleido-mastoid (SCM) muscle or a lesion that involves the accessory nucleus and/or nerve or the SCM muscle. These drawbacks do not affect another technique that evaluates the saccular function: the N3 potential. We recorded both the s- and the g-VEMP and the N3 potential in a group of 31 healthy subjects to establish a reference range. The N3 potential and the s-VEMP were recordable bilaterally from …all the subjects, whereas the g-VEMP was undetectable uni- or bilaterally in 7 subjects. The latency and amplitude values of the s-VEMP did not differ from those of the g-VEMP. For all three techniques, the latency and amplitude values from the right and from the left recording and/or stimulation side were the same. We suggest using normative latency and amplitude values based on the mean and ratio of the right- and left-side values. The s-VEMP, the N3 potential and the auditory evoked response (ABR) were compared in 15 subjects suffering from multiple sclerosis. The three techniques detected a similar number of abnormalities, but these abnormalities were not correlated. This suggests that these different techniques should be regarded as complementary in evaluating saccular function. Show more

Keywords: Vestibulocollic reflex, VEMP, N3 potential, normal subjects, multiple sclerosis

DOI: 10.3233/VES-2007-17105

Citation: Journal of Vestibular Research, vol. 17, no. 1, pp. 39-46, 2007

Authors: Fransson, Per-Anders | Hjerpe, Magnus | Johansson, Rolf

Article Type: Research Article

Abstract: Control of orthograde posture and use of adaptive adjustments constitutes essential topics of human movement control, both in maintenance of static posture and in ensuring body stability during locomotion. The objective was to investigate, in twelve normal subjects, how head, shoulder, hip and knee movements and torques induced towards the support surface were affected by vibratory proprioceptive and galvanic vestibular stimulation, and to investigate whether movement pattern, body posture and movement coordination were changed over time. Our findings suggest that the adaptive process to enhance stability involves both alteration of the multi-segmented movement pattern and alteration of body …posture. The magnitude of the vibratory stimulation intensity had a prominent influence on the evoked multi-segmented movement pattern. The trial conditions also influenced whether the posture were altered and if these posture adjustments were done directly at stimulation onset or gradually over a longer period. Moreover, the correlation values showed that the subjects, primarily during trials with vibratory stimulation alone, significantly increased the body movement coordination at stimulation onset and maintained this movement pattern throughout the stimulation period. Furthermore, when exposed to balance perturbations the test subjects synchronized significantly the head and torso movements in anteroposterior direction during all trial conditions. Show more

Keywords: Adaptation, balance, posturography, movement pattern

DOI: 10.3233/VES-2007-17106

Citation: Journal of Vestibular Research, vol. 17, no. 1, pp. 47-62, 2007

Authors: Jáuregui-Renaud, Kathrine | Villanueva Padrón, Laura Alejandra | Cruz Gómez, Nora Silvia

Article Type: Research Article

Abstract: Objective: To assess the effect of performing vestibular rehabilitation using the Cawthorne & Cooksey exercises supplemented by training of the breathing rhythm or proprioception exercises on self-reported disability and postural control, in patients with chronic, peripheral, vestibular disease. Methods: Fifty one patients with peripheral vestibular disease and abnormal caloric test participated in the study (mean age 43 ± S.D. 9 years). They were assigned to one of 3 treatment groups: I. Cawthorne &} Cooksey exercises with training of the breathing rhythm (n = 17); II. Cawthorne & Cooksey exercises with proprioception exercises (n = 17) …and III. Cawthorne & Cooksey exercises with no additional intervention (n = 17). The Dizziness Handicap Inventory and static posturography were evaluated prior to treatment and at week 8 of follow-up. Results: Prior to treatment, composite scores on the Dizziness Handicap Inventory and static posturography were similar in the 3 groups. After treatment, a decrease of the composite score of at least 18 points was observed more frequently in patients of the respiration group (94%), compared to the proprioception group (53%) and the Cawthorne & Cooksey group (70%) (p = 0.03); while the proprioception group showed a significant decrease of oscillation during all sensory conditions of static posturography (p < 0.05). Conclusion: The results suggest that regulation of the breathing pattern may have an influence on disability related to chronic vestibular disease, while proprioception exercises may improve postural control. However, further studies are needed to evaluate if training of the breathing rhythm could be an additional tool for vestibular rehabilitation. Show more

Keywords: Vestibular disease, vestibular rehabilitation, breathing, proprioception

DOI: 10.3233/VES-2007-17107

Citation: Journal of Vestibular Research, vol. 17, no. 1, pp. 63-72, 2007