Deficient head motor control in functional dizziness: Experimental evidence of central sensory-motor dysfunction in persistent physical symptoms

Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders

“…Together with the present results, by using the example of functional dizziness patients, we are one step closer in locating an erroneous site of perceptual dysregulation in functional disorders (Edwards et al, 2012;Van den Bergh et al, 2017;Henningsen et al, 2018;Pezzulo et al, 2019). While we could provide evidence for a general central sensorimotor deficit in functional dizziness in a previous paper (Lehnen et al, 2019), we can now demonstrate first experimental evidence for an incorrect internal model use that has the potential to explain symptom experience in functional dizziness patients. The idea of the role of mismatching information in symptom experience is central to the explanation of physiological and clinical vestibular vertigo.…”

“…Head oscillations-and counteracting eye movements-are illustrated in the window with increased y-axis scale (note that the functional dizziness patient display more pronounced head oscillations than the healthy participant, even in the natural condition. Group analysis confirming these differences have been published inLehnen et al, 2019). (A-D right) Shown is eye velocity plotted against head velocity (gray circles) for counter-rotation (CR) and oscillation (OSC) gain computation for one representative gaze shift.…”

“…Moreover, experimentally induced symptoms are more persistent in patients with functional disorders, uncoupled from corresponding sensory input ( Bogaerts et al, 2010 ; Van Den Houte et al, 2018 ). The first evidence for altered sensorimotor processing is provided by our prior study investigating head control in patients with functional dizziness ( Lehnen et al, 2019 ). When using combined eye–head movements to shift gaze to a new visual target, functional dizziness patients showed more pronounced head oscillations, a marker for the incongruency between sensory input and expectations in sensorimotor planning.…”

Complementing Conceptual Models of Persistent Somatic Symptoms With Mathematical Formalization

“…A recent pilot study applied this computational model and experimental set-up to patients with functional dizziness (Lehnen et al, 2019). Findings from this study suggest that patients indeed display head motor control deficits comparable to patients with structural lesions (vestibulopathy, cerebellar disease) pointing at sensory-motor dysfunction in PSS, i.e.…”

Embracing Computational Approaches Can Stimulate Clinical Psychology Research

“…Computational approaches are advocated, for example, to bridge the gap between neural pattern activity and behavioral data (Stephan & Mathys, 2014), to improve (data-driven) phenotyping of patients (Patzelt, Hartley, & Gershman, 2018), and to develop, test and improve theoretical explanatory models through simulation (Lehnen et al, submitted). A recent first attempt at the latter approach, combining mathematical formulization of an existing explanatory model with experiments, has proven useful to deepen our understanding of the complex mechanisms underlying persistent physical symptoms (Lehnen, Schröder, Henningsen, Glasauer, & Ramaioli, 2019).…”