Bilateral vestibulopathy decreases self-motion perception

Abstract

Objective Current diagnostic criteria for bilateral vestibulopathy (BV) primarily involve measurements of vestibular reflexes. Perceptual self-motion thresholds however, are not routinely measured and their clinical value in this specific population is not yet fully determined. Objectives of this study were (1) to compare perceptual self-motion thresholds between BV patients and control subjects, and (2) to explore patterns of self-motion perception performance and vestibular function in BV patients. Methods Thirty-seven BV patients and 34 control subjects were included in this study. Perceptual self-motion thresholds were measured in both groups using a CAREN platform (Motek Medical BV, Amsterdam, The Netherlands). Vestibular function was evaluated (only in BV patients) by the caloric test, torsion swing test, video head impulse test of all semicircular canals, and cervical- and ocular vestibular-evoked myogenic potentials. Differences in thresholds between both groups were analyzed. Hierarchical cluster analysis was performed to visualize patterns between self-motion perception and vestibular function within the group of BV patients. Results Perceptual self-motion thresholds were significantly higher in BV patients compared to control subjects, regarding nearly all rotations and translations (depending on the age group) (p ≤ 0.001). Cluster analysis showed that within the group of BV patients, higher perceptual self-motion thresholds were generally associated with lower vestibular test results (significant for yaw rotation, caloric test, torsion swing test, and video head impulse test (p ≤ 0.001)). Conclusion Self-motion perception is significantly decreased in BV patients compared to control subjects regarding nearly all rotations and translations. Furthermore, decreased self-motion perception is generally associated with lower residual vestibular function in BV patients. Trial registration Trial registration number NL52768.068.15/METC

DISCOHAT: An Acronym to Describe the Spectrum of Symptoms Related to Bilateral Vestibulopathy

“…This could facilitate uniform documentation of these symptoms within and between clinics world-wide. Such a structured documentation might be valuable during rehabilitation ( 23 ) and when developing therapeutic devices and patient reported outcome measures ( 1 , 20 , 23 , 25 ). The DISCOHAT acronym is complementary to currently used paradigms in history taking of vestibular patients, like focusing on “timing and triggers” ( 26 ) and the “SO STONED” paradigm ( 27 ).…”

“…All patients underwent vestibular testing at the vestibular department of Maastricht University Medical Center+, which was performed by trained laboratory technicians. The testing paradigms were previously described in detail ( 13 , 23 ). To summarize, caloric tests (Variotherm Plus device, Lenzkirch, Germany) were performed with warm (44°C) and cold (30°C) water.…”

“…The prognosis of BVP is poor (16), but vestibular rehabilitation is possible (17) and therapeutic devices like vibrotactile feedback systems (18), and vestibular implants (19)(20)(21)(22) are emerging. A thorough inventory of the spectrum of symptoms related to BVP, might therefore improve the individual rehabilitation process by e.g., facilitating goal setting during rehabilitation (23). Next to this, a good insight in the spectrum of symptoms could improve the development of patient reported outcome measures, necessary to reliably investigate new therapeutic devices (24).…”

Patterns of Vestibular Impairment in Bilateral Vestibulopathy and Its Relation to Etiology

“…An extensive description of caloric testing was described previously ( 44 ). To summarize, in all centers, bithermal caloric testing was performed in both ears whilst patients were in supine position with a forward head inclination of 30°.…”

“…oVEMPs were measured over the inferior oblique muscle after stimulating the contralateral vestibular organ with the same stimulation parameters as for cVEMPs. Details on the procedure have been published previously ( 44 , 48 , 49 ). In brief, for cVEMPS, subjects were in a supine position with their back tilted at an angle of 30° from the horizontal plane and were instructed to turn their head away from the stimulus and to lift their head up slightly.…”