Postural control during galvanic vestibular stimulation in patients with persistent perceptual–postural dizziness

Woll, Josephin; Sprenger, Andreas; Helmchen, Christoph

doi:10.1007/s00415-019-09255-7

Cited by 22 publications

(28 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When combined with the results of Indovina et al, 20 which showed widespread reductions in connectivity of cortical networks linking threat assessment with space-motion information processing, the current findings support the hypothesis that higher-level mechanisms may insufficiently check reflexive actions, such as stiffened postural control and visual dependence, causing these to persist rather than reset back to normal in patients who develop PPPD. 8 20 50 The hypotheses of Brandt and Dieterich 4 48 and Staab 8 are complementary, as space constancy may be one of the higher-level processes that is functionally impaired in patients with PPPD. 3 …”

Section: Discussionmentioning

confidence: 99%

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Lins

Bittar

Bazán

et al. 2020

Int Arch Otorhinolaryngol

View full text Add to dashboard Cite

Introduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception. Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects. Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires. Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex). Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli.

show abstract

Section: Discussionmentioning

confidence: 99%

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Lins

Bittar

Bazán

et al. 2020

Int Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…Bilateral bipolar GVS was applied by a current stimulator (DS5 model, Digitimer Ltd., UK) at both mastoid bones using contact electrodes (E224N‐MR‐HSR‐500, EasyCap GmbH, Herrsching, Germany) as described before (Helmchen et al, ; Woll, Sprenger, & Helmchen, ). This stimulator has also been used and approved in other centers and studies (Cai et al, ; Cyran et al, ).…”

Section: Methodsmentioning

confidence: 99%

Effects of galvanic vestibular stimulation on resting state brain activity in patients with bilateral vestibulopathy

Helmchen

Machner

Rother

et al. 2020

Human Brain Mapping

Self Cite

View full text Add to dashboard Cite

We examined the effect of galvanic vestibular stimulation (GVS) on resting state brain activity using fMRI (rs-fMRI) in patients with bilateral vestibulopathy. Based on our previous findings, we hypothesized that GVS, which excites the vestibular nerve fibers, (a) increases functional connectivity in temporoparietal regions processing vestibular signals, and (b) alleviates abnormal visual-vestibular interaction. Rs-fMRI of 26 patients and 26 age-matched healthy control subjects was compared before and after GVS. The stimulation elicited a motion percept in all participants. Using different analyses (degree centrality, DC; fractional amplitude of low frequency fluctuations [fALFF] and seed-based functional connectivity, FC), group comparisons revealed smaller rs-fMRI in the right Rolandic operculum of patients. After GVS, rs-fMRI increased in the right Rolandic operculum in both groups and in the patients' cerebellar Crus 1 which was related to vestibular hypofunction. GVS elicited a fALFF increase in the visual cortex of patients that was inversely correlated with the patients' rating of perceived dizziness. After GVS, FC between parietoinsular cortex and higher visual areas increased in healthy controls but not in patients. In conclusion, short-term GVS is able to modulate rs-fMRI in healthy controls and BV patients.GVS elicits an increase of the reduced rs-fMRI in the patients' right Rolandic operculum, which may be an important contribution to restore the disturbed visualvestibular interaction. The GVS-induced changes in the cerebellum and the visual cortex were associated with lower dizziness-related handicaps in patients, possibly reflecting beneficial neural plasticity that might subserve visual-vestibular compensation of deficient self-motion perception. K E Y W O R D S bilateral vestibulopathy, galvanic vestibular stimulation, visual-vestibular interaction, fALFF, degree centrality, functional connectivity, rs-fMRI Abbreviations: DC, degree centrality; DHI, dizziness handicap score; fALFF, fractional amplitude of low frequency fluctuations; FC, seed-based functional connectivity; HC, healthy control; IPL, inferior parietal lobule; OP2, core vestibular area of parietal operculum; PIVC, parietoinsular vestibular cortex; ROI, region of interest; SMA, supplementary motor area; SMG, supramarginal gyrus; STG, superior temporal gyrus; VOR, vestibulo-ocular reflex; VSS, vertigo symptom scale.

show abstract

“…Galvanic vestibular stimulation showed a reduced perception threshold for body motion in PPPD patients, which was attributed to a lowered sensory feedback control [37]. Our data imply reduced motion perception thresholds, which may be attributed to cortical and subcortical overexcitability and may explain the abnormal self-motion awareness.…”

Section: Discussionmentioning

confidence: 52%

Reduced Vestibular Perception Thresholds in Persistent Postural-Perceptual Dizziness- A Cross-Sectional Study

Wurthmann

Holle-Lee

Obermann³

et al. 2021

Preprint

View full text Add to dashboard Cite

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is the most common functional vestibular disorder which is maintained by an interaction of psychological and physiological factors. PPPD patients develop inappropriate postural control strategies characterized by increased self-motion perception. Increased cortical and subcortical excitability may play a role in the pathophysiology of PPPD. We hypothesized that decreased motion perception thresholds reflect one mechanism of the abnormal vestibular responsiveness in this disorder. We investigated the vestibular perception thresholds and the vestibular ocular reflex with a rotatory chair experiment to gain insights in the processing and adaption to vestibular provocation. METHODS: In this cross-sectional study 26 female PPPD patients and 33 healthy female age and matched controls (HC) were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli. The chair was rotated for 20 minutes with slowly increasing velocity to a maximum of 72°/s. We functionally tested motion perception thresholds and vegetative responses to rotation as well as vestibular-ocular reflex thresholds. We additionally investigated several psychological comorbidities (i.e. depression, anxiety, somatosensory amplification) using validated scores. Conventional dizziness scores were obtained to quantify the experienced dizziness and impact on daily life. RESULTS: PPPD patients showed a significant reduced vestibulo-perceptual threshold (PPPD: 10.9°/s vs. HC: 29.5°/s; p<0.001) with increased motion sensitivity and concomitant vegetative response during and after the chair rotation compared to healthy controls. The extent of increased vestibular sensitivity was in correlation with the duration of the disease (p=0.043). No significant difference was measured regarding nystagmus parameters between both groups.CONCLUSION: PPPD patients showed increased vegetative response as well as decreased vestibulo-perceptual thresholds which are related to disease duration. This is of interest as PPPD might be sustained by increased vestibular excitability leading to motion intolerance and induction of dizziness when exposed to movement.

show abstract

Postural control during galvanic vestibular stimulation in patients with persistent perceptual–postural dizziness

Cited by 22 publications

References 78 publications

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Effects of galvanic vestibular stimulation on resting state brain activity in patients with bilateral vestibulopathy

Reduced Vestibular Perception Thresholds in Persistent Postural-Perceptual Dizziness- A Cross-Sectional Study

Contact Info

Product

Resources

About