Primary or secondary chronic functional dizziness: does it make a difference? A DizzyReg study in 356 patients

Strobl, Ralf; Grill, Eva; Dieterich, Marianne; Becker‐Bense, Sandra

doi:10.1007/s00415-020-10150-9

Cited by 49 publications

(55 citation statements)

References 49 publications

(54 reference statements)

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“…Furthermore, symptom provocation by position changes in bed may point to BPPV as another vestibular disorder triggering secondary functional dizziness. This findings agree with previous literature ( 8 ). Interestingly, patients with primary functional dizziness had higher fear and depression scales, which may indicate a more intense psychological symptom burden.…”

Section: Discussionsupporting

confidence: 94%

“…In the second classification task, two groups of patients with functional dizziness were compared, who were presumably very similar in their symptomatic presentation, but differed in the evolution of their symptoms: patients with primary functional dizziness, where chronic psychological stress or anxiety is the driving force, and patients with secondary functional dizziness, which develops after a preceding somatic vestibular disorders (e.g., BPPV) due to altered balance perception and strategies of postural control ( 8 ). Accordingly, top 10 features for classification included vestibular function tests (such as vHIT gain left/right and caloric response normal).…”

Section: Discussionmentioning

confidence: 99%

“…The second classification task is, whether patients with primary functional dizziness (based on psychological triggers and stressors) can be separated against patients with secondary functional dizziness following a preceding organic vestibular disorder (such as acute unilateral vestibulopathy, or benign paroxysmal positional vertigo) ( 8 ). This setting is more complex, as patient and symptom characteristics may be similar, but the vestibular function tests may differ.…”

Section: Introductionmentioning

confidence: 99%

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Using Base-ml to Learn Classification of Common Vestibular Disorders on DizzyReg Registry Data

et al. 2021

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Background: Multivariable analyses (MVA) and machine learning (ML) applied on large datasets may have a high potential to provide clinical decision support in neuro-otology and reveal further avenues for vestibular research. To this end, we build base-ml, a comprehensive MVA/ML software tool, and applied it to three increasingly difficult clinical objectives in differentiation of common vestibular disorders, using data from a large prospective clinical patient registry (DizzyReg).Methods: Base-ml features a full MVA/ML pipeline for classification of multimodal patient data, comprising tools for data loading and pre-processing; a stringent scheme for nested and stratified cross-validation including hyper-parameter optimization; a set of 11 classifiers, ranging from commonly used algorithms like logistic regression and random forests, to artificial neural network models, including a graph-based deep learning model which we recently proposed; a multi-faceted evaluation of classification metrics; tools from the domain of “Explainable AI” that illustrate the input distribution and a statistical analysis of the most important features identified by multiple classifiers.Results: In the first clinical task, classification of the bilateral vestibular failure (N = 66) vs. functional dizziness (N = 346) was possible with a classification accuracy ranging up to 92.5% (Random Forest). In the second task, primary functional dizziness (N = 151) vs. secondary functional dizziness (following an organic vestibular syndrome) (N = 204), was classifiable with an accuracy ranging from 56.5 to 64.2% (k-nearest neighbors/logistic regression). The third task compared four episodic disorders, benign paroxysmal positional vertigo (N = 134), vestibular paroxysmia (N = 49), Menière disease (N = 142) and vestibular migraine (N = 215). Classification accuracy ranged between 25.9 and 50.4% (Naïve Bayes/Support Vector Machine). Recent (graph-) deep learning models classified well in all three tasks, but not significantly better than more traditional ML methods. Classifiers reliably identified clinically relevant features as most important toward classification.Conclusion: The three clinical tasks yielded classification results that correlate with the clinical intuition regarding the difficulty of diagnosis. It is favorable to apply an array of MVA/ML algorithms rather than a single one, to avoid under-estimation of classification accuracy. Base-ml provides a systematic benchmarking of classifiers, with a standardized output of MVA/ML performance on clinical tasks. To alleviate re-implementation efforts, we provide base-ml as an open-source tool for the community.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using Base-ml to Learn Classification of Common Vestibular Disorders on DizzyReg Registry Data

et al. 2021

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“…Funktionelle Schwindelsyndrome können entweder primär ohne organisch-vestibuläre Störung oder sekundär bei abgelaufenen oder aktiven Vestibulopathien (z.B. BPPV, Morbus Menière, vestibuläre Migräne) auftreten [73]. In der Bárány-Klassifikation wird als Synonym für den funktionellen Schwindel der persistierende subjektive Schwankschwindel (persistent postural-perceptual dizziness, PPPD) verwendet [74].…”

Section: Funktionelle Schwindelsyndromeunclassified

Aktuelles zu den häufigen Schwindelsyndromen: Diagnostik und Therapie

Zwergal

Dieterich

2021

Fortschr Neurol Psychiatr

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ZusammenfassungDie 8 häufigsten Schwindelsyndrome liegen über 70% aller Schwindelpräsentationen zugrunde. Bei den akuten (meist einzeitigen) Schwindelsyndromen sind die akute unilaterale Vestibulopathie und der vestibuläre Schlaganfall von besonderer Bedeutung, bei den episodischen Schwindelerkrankungen der gutartige Lagerungsschwindel, der Morbus Menière und die vestibuläre Migräne und bei chronischem Schwindel die bilaterale Vestibulopathie/Presbyvestibulopathie, der funktionelle Schwindel und der zerebelläre Schwindel. In der letzten Dekade wurden für die häufigsten Schwindelsyndrome international konsentierte diagnostische Kriterien und Krankheitsbezeichnungen erarbeitet, die einfach im klinischen Alltag angewendet werden können. Die diagnostischen Leitlinien beruhen überwiegend auf einer gezielten Anamnese (Beginn, Dauer, Verlauf, Trigger, Begleitsymptome), klinischen Untersuchung und wenigen apparativen Verfahren zur Diagnosesicherung (vor allem mittels Videookulographie und Audiometrie). Die Therapie der häufigen Schwindelsyndrome basiert in der Regel auf einer Kombination aus physikalischen Verfahren (Lagerungsmanöver, multimodales Gleichgewichtstraining) und pharmakologischen Prinzipien (u.a. Kortikosteroide, Antiepileptika, Antidepressiva, Kaliumkanalblockern, plastizitätsfördernde Medikamente). Allerdings fehlt meist eine hochwertige Evidenz aus prospektiven und kontrollierten Studien. In der klinischen Praxis lassen sich die häufigen Schwindelsyndrome oft effektiv behandeln, sodass eine Chronifizierung oder sekundäre Komorbidität (durch Immobilität, Stürze oder psychiatrische Erkrankungen wie Angst oder Depression) vermieden werden kann.

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“…PPPD affects men and women at all ages. Several clinical epidemiological studies of PPPD have been published worldwide and showed a female predominance [5][6][7]. It is characterized by persisting subjective dizziness, unsteadiness or non-rotational vertigo for at least three months and may be exacerbated by upright posture including the patient's own movement as well as motion of complex visual stimuli [4].…”

Section: Introductionmentioning

confidence: 99%

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

Wurthmann

Holle-Lee

Obermann³

et al. 2021

Preprint

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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.

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Primary or secondary chronic functional dizziness: does it make a difference? A DizzyReg study in 356 patients

Cited by 49 publications

References 49 publications

Using Base-ml to Learn Classification of Common Vestibular Disorders on DizzyReg Registry Data

Using Base-ml to Learn Classification of Common Vestibular Disorders on DizzyReg Registry Data

Aktuelles zu den häufigen Schwindelsyndromen: Diagnostik und Therapie

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

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