Altered intra- and inter-network functional connectivity in patients with persistent postural-perceptual dizziness

Li, Kangzhi; Si, Lihong; Cui, Bin; Xia, Ling; Shen, Bo; Yang, Xu

doi:10.1016/j.nicl.2020.102216

Cited by 46 publications

(43 citation statements)

References 29 publications

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“…Functional disorders are considered as a change in the functioning of an organ unrelated to structural or cellular deficits (Dieterich & Staab, 2017). Consecutively, a change in functional connectivity in neuronal networks could recently be demonstrated in patients with PPPD (Li et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Multimodal treatment of persistent postural–perceptual dizziness

et al. 2020

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Section: Introductionmentioning

confidence: 99%

Multimodal treatment of persistent postural–perceptual dizziness

et al. 2020

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“…Six fMRI studies investigated functional alterations in patients diagnosed with PPPD, CSD, PPV, or VID relative to healthy controls using different paradigms, such as sound-evoked vestibular stimulation [ 39 ], various visual motion stimuli [ 48 , 50 ], visually evoked self-motion simulation [ 47 , 49 ], and caloric vestibular stimulation [ 50 ] ( Table 1 ). Four additional fMRI studies were conducted at ‘rest’ [ 36 , 42 , 43 , 44 ]. One study used SPECT to assess the brain metabolic differences between patients with PPPD and healthy controls [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…Illuminating the neural basis of PPPD may have important consequences in terms of developing more objective markers for its diagnosis and more reliable approaches its treatment [ 41 ]. Different neuroimaging studies of patients with PPPD and predecessor syndromes using functional and structural techniques have begun to shed light on its etiopathogenesis [ 36 , 39 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Herein, we review recently published studies of structural and functional correlates of PPPD, PPV, CSD, and VID and suggest new avenues for future neuroimaging research the better understand the specific brain mechanisms underlying PPPD.…”

Section: Introductionmentioning

confidence: 99%

Brain Correlates of Persistent Postural-Perceptual Dizziness: A Review of Neuroimaging Studies

Indovina

Passamonti

Mucci

et al. 2021

JCM

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Persistent postural-perceptual dizziness (PPPD), defined in 2017, is a vestibular disorder characterized by chronic dizziness that is exacerbated by upright posture and exposure to complex visual stimuli. This review focused on recent neuroimaging studies that explored the pathophysiological mechanisms underlying PPPD and three conditions that predated it. The emerging picture is that local activity and functional connectivity in multimodal vestibular cortical areas are decreased in PPPD, which is potentially related to structural abnormalities (e.g., reductions in cortical folding and grey-matter volume). Additionally, connectivity between the prefrontal cortex, which regulates attentional and emotional responses, and primary visual and motor regions appears to be increased in PPPD. These results complement physiological and psychological data identifying hypervigilant postural control and visual dependence in patients with PPPD, supporting the hypothesis that PPPD arises from shifts in interactions among visuo-vestibular, sensorimotor, and emotional networks that overweigh visual over vestibular inputs and increase the effects of anxiety-related mechanisms on locomotor control and spatial orientation.

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“…A recent study [5] suggests that a possible mechanism for PPPD symptomatology is an impairment in spatial navigation in the absence of reliable visual cues. Brain imaging studies identified decreased activity [40] and functional connectivity [41] XXXof the precuneus, an area associated with spatial processing, in people with PPPD. Results from the current study, which examined self-motion under complex visual load conditions (but with limited visual cues for self-motion), suggest that specific characteristics of PPPD are associated with limited ROM.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test

Aharoni

Lubetzky

Arie

et al. 2021

J NeuroEngineering Rehabil

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Background Persistent postural-perceptual dizziness (PPPD) is a condition characterized by chronic subjective dizziness and exacerbated by visual stimuli or upright movement. Typical balance tests do not replicate the environments known to increase symptoms in people with PPPD—crowded places with moving objects. Using a virtual reality system, we quantified dynamic balance in people with PPPD and healthy controls in diverse visual conditions. Methods Twenty-two individuals with PPPD and 29 controls performed a square-shaped fast walking task (Four-Square Step Test Virtual Reality—FSST-VR) using a head-mounted-display (HTC Vive) under 3 visual conditions (empty train platform; people moving; people and trains moving). Head kinematics was used to measure task duration, movement smoothness and anterior–posterior (AP) and medio-lateral (ML) ranges of movement (ROM). Heart rate (HR) was monitored using a chest-band. Participants also completed a functional mobility test (Timed-Up-and-Go; TUG) and questionnaires measuring anxiety (State-Trait Anxiety Inventory; STAI), balance confidence (Activities-Specific Balance Confidence; ABC), perceived disability (Dizziness Handicap Inventory) and simulator sickness (Simulator Sickness Questionnaire). Main effects of visual load and group and associations between performance, functional and self-reported outcomes were examined. Results State anxiety and simulator sickness did not increase following testing. AP-ROM and HR increased with high visual load in both groups (p < 0.05). There were no significant between-group differences in head kinematics. In the high visual load conditions, high trait anxiety and longer TUG duration were moderately associated with reduced AP and ML-ROM in the PPPD group and low ABC and high perceived disability were associated with reduced AP-ROM (|r| = 0.47 to 0.53; p < 0.05). In contrast, in controls high STAI-trait, low ABC and longer TUG duration were associated with increased AP-ROM (|r| = 0.38 to 0.46; p < 0.05) and longer TUG duration was associated with increased ML-ROM (r = 0.53, p < 0.01). Conclusions FSST-VR may shed light on movement strategies in PPPD beyond task duration. While no main effect of group was observed, the distinct associations with self-reported and functional outcomes, identified using spatial head kinematics, suggest that some people with PPPD reduce head degrees of freedom when performing a dynamic balance task. This supports a potential link between spatial perception and PPPD symptomatology.

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Altered intra- and inter-network functional connectivity in patients with persistent postural-perceptual dizziness

Cited by 46 publications

References 29 publications

Multimodal treatment of persistent postural–perceptual dizziness

Multimodal treatment of persistent postural–perceptual dizziness

Brain Correlates of Persistent Postural-Perceptual Dizziness: A Review of Neuroimaging Studies

Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test

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