Short-Term Central Adaptation in Benign Paroxysmal Positional Vertigo

Choi, Seo-Young; Lee, Myung-Jun; Oh, Eun Hye; Choi, Jae‐Hwan; Choi, Kwang-Dong

doi:10.3389/fneur.2020.00260

Cited by 10 publications

(10 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, among 575 consecutive patients with benign paroxysmal positional vertigo, 54 of 575 (9.39%) patients with reversal nystagmus were identified, of which 5.56%(32 of 575) had horizontal semicircular canal BPPV and 3.82% (22 of 575) had posterior semicircular canal BPPV. Compared with previous studies (the incidence of patients with horizontal semicircular canal BPPV reversal nystagmus was 73%) (8,12), the incidence of reversal nystagmus in BPPVobserved in our study was lower (68%). However, a similar result was reported in a study from Japan showing that the incidence of reversal nystagmus in patients with horizontal semicircular canal BPPV was 10% (7).…”

Section: Discussioncontrasting

confidence: 88%

“…In 2015, Ogawa et al (7) proposed that the coexistence of cupulolithiasis and canalolithiasis may be a mechanism that could explain the generation of bilateral reversal nystagmus. In 2020, Choi et al (8) proposed central adaptation mechanism to elucidate the generation of reversal nystagmus. Since the phenomenon of reversal nystagmus in BPPV was discovered, several mechanistic hypotheses have been proposed; however, no theory can explain the occurrence of reversal nystagmus perfectly.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and Possible Mechanisms of Direction-Reversing Nystagmus During Positional Testing in Patients With Benign Paroxysmal Positional Vertigo

Song

et al. 2023

Otol Neurotol

View full text Add to dashboard Cite

Objectives The occurrence of direction-reversing nystagmus during positional testing in patients with benign paroxysmal positional vertigo (BPPV) is not uncommon. Further in-depth analysis of the characteristics and possible mechanisms of direction-reversing nystagmus will help us to diagnose and treat BPPV more precisely. The study aimed to analyze the incidence and characteristics of direction-reversing nystagmus during positional testing in BPPV patients, evaluate the outcomes of canalith repositioning procedure for these patients, and further explore the possible mechanism of reversal nystagmus in BPPV patients. Study design Retrospective study. Setting Single-center study. Patients A total of 575 patients with BPPV who visited the Vertigo Clinic of our hospital between April 2017 and June 2021 were enrolled. Main outcome measures Dix-Hallpike and supine roll tests were performed. The nystagmus was recorded using videonystagmography. The characteristics of direction-reversing nystagmus and the possible underlying mechanism were analyzed. Results Patients with BPPV who showed reversal nystagmus accounted for 9.39% (54 of 575) of all BPPV patients visiting our hospital during the same period, of which 5.57% (32 of 575) had horizontal semicircular canal BPPV (HC-BPPV), and 3.83% (22 of 575) had posterior semicircular canal BPPV (PC-BPPV). The maximum slow-phase velocities (mSPVs) of the first-phase nystagmus were greater in HC-BPPV and PC-BPPV patients with reversal nystagmus than those without (p = 0.04 and p = 0.01, respectively). In all HC-BPPV and PC-BPPV patients with reversal nystagmus, the mSPV of the first-phase nystagmus was greater than that of the second-phase nystagmus (p < 0.01). The duration of the second-phase nystagmus was longer than 60 seconds in 93.75% (30 of 32) of the HC-BPPV patients and 77.27% (17 of 22) of the PC-BPPV patients (p = 0.107, Fisher exact test). HC-BPPV and PC-BPPV patients with reversal nystagmus both required more than one canalith repositioning procedure compared with those without (HC-BPPV: 75 versus 28.13%, p < 0.001; PC-BPPV: 59.09 versus 13.64%, p = 0.002). Conclusions The cause of second-phase nystagmus in BPPV patients with direction-reversing nystagmus may be related to the involvement of central adaptation mechanisms secondary to the overpowering mSPV of the first-phase nystagmus.

show abstract

Section: Discussioncontrasting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Characteristics and Possible Mechanisms of Direction-Reversing Nystagmus During Positional Testing in Patients With Benign Paroxysmal Positional Vertigo

Song

et al. 2023

Otol Neurotol

View full text Add to dashboard Cite

show abstract

“…Four patients showed an evolution of initial positional downbeat into upbeat nystagmus over 4-15 s. This reversal in the direction of induced nystagmus is observed in various conditions including benign paroxysmal positional vertigo (22)(23)(24), head-shaking nystagmus (25), caloric stimulation (26), and vertebral artery occlusion syndrome (21), and may be ascribed to short-term adaption of the vestibular imbalance.…”

Section: Discussionmentioning

confidence: 94%

Positioning Velocity Matters in Central Paroxysmal Positional Vertigo: Implication for the Mechanism

et al. 2020

View full text Add to dashboard Cite

Objectives: To elucidate the mechanism of paroxysmal central positional nystagmus (CPN) by determining the effects of head rotation velocity on the intensity of paroxysmal downbeat nystagmus induced during straight head hanging (SHH). Methods: We recruited 21 patients with paroxysmal downbeat CPN induced during SHH at the Dizziness Center of Seoul National University Bundang Hospital from September 2018 to July 2019. Twenty-one patients had manual SHH at two different lying velocities, the fast (routine) and slow, and they also underwent SHH at different rotation velocities of 10, 20, 30, and 40 • /s using a motorized rotation chair. Induced nystagmus was recorded using video-oculography and the maximum slow phase velocity (SPV) and time constant (TC) of the induced paroxysmal nystagmus were analyzed. Results: During manual SHH, paroxysmal downbeat nystagmus was invariably induced during routine SHH (fast lying down), but absent or minimal during slow positioning. During motorized SHH, the median of maximum intensity of downbeat nystagmus increased from 7.6 • /s (0-16.9) to 14.0 • /s (0-32.5), 16.5 • /s (0-44.6), and 19.1 • /s (0-55.2) as the rotation velocity increased from 10 to 20, 30, and 40 • /s (P < 0.001, P < 0.001, P = 0.004; linear mixed models). In contrast, the TCs of paroxysmal downbeat CPN remained unchanged (P = 0.558, P = 0.881, P = 0.384, linear mixed models). Conclusions: The dependence of nystagmus intensity on head rotation velocity supports a disinhibited and exaggerated inhibitory rebound of the canal signals as the mechanism of paroxysmal CPN.

show abstract

“…Additionally, the incidence of direction-reversing nystagmus was also significantly higher in the CS-BPPV group compared with that in the NCS-BPPV group. A previous study showed that direction-reversing nystagmus during position tests may be caused by short-term central adaptation following the intense first phase nystagmus ( 22 ). This suggests that the high SPV observed in the CS-BPPV group is not accidental.…”

Section: Discussionmentioning

confidence: 99%

Canal switch in benign paroxysmal positional vertigo: Clinical characteristics and possible mechanisms

Song

Xia

et al. 2022

Front. Neurol.

View full text Add to dashboard Cite

BackgroundCanal switch-benign paroxysmal positional vertigo (CS-BPPV) refers to the phenomenon in which otolith particles move from one canal to another (on the ipsilateral side) during or after canalith repositioning procedure (CRP). However, the clinical characteristics of CS-BPPV and the underlying pathological mechanisms remain unclear. In this study, we investigated the incidence of canal switch (CS) for the different semicircular canals in benign paroxysmal positional vertigo (BPPV), examined nystagmus characteristics, and explored the underlying mechanisms.MethodsClinical data for 1,099 patients with single-canal BPPV were collected and retrospectively analyzed. The incidences of CS in the different types of BPPV were analyzed. Patients were divided into CS-BPPV and non-CS (NCS)-BPPV groups according to whether they exhibited CS after CRP. The baseline characteristics and nystagmus characteristics of patients were compared between the two groups.ResultsPatients with BPPV who developed or did not develop CS accounted for 4.6% (51/1,099) and 95.4% (1,048/1,099), respectively, of the patients included in the study. There were no statistically significant differences between the two groups in terms of sex, age, side of the canals involved, hypertension, or diabetes. CS was observed in 3.7% (25/677) of patients with PC-BPPV, including conversion between posterior canal (PC) and horizontal canal (HC) (1.6%, 11/677), and between PC and anterior canal (AC) (2.1%, 14/677). CS was observed in 5.2% (17/327) of patients with HC-BPPV, including from HC to PC (4.3%, 14/327), and from HC to AC (0.9%, 3/327). CS was found in 9.5% (9/95) of patients with AC-BPPV, including from AC to PC (8.4%, 8/95), and from AC to HC (1.1%, 1/95). The intensity of nystagmus was significantly greater in the CS-BPPV group compared with that in the NCS-BPPV group [24.00 (11–39) vs. 12.00 (7–24), P < 0.001]. Furthermore, the incidence of direction-reversing nystagmus was significantly higher in the CS-BPPV group than in the NCS-BPPV group [31.4% (16/51) vs. 4.3% (45/1,048), P < 0.001].ConclusionsCS in BPPV is uncommon. Patients with AC-BPPV are more likely to develop CS, followed by patients with HC-BPPV and PC-BPPV. The occurrence of CS-BPPV may be related to the anatomical structure of the semicircular canals. When the canals contain large/heavy accumulations of otolith particles, CS may be more common during re-examination after CRP.

show abstract

Short-Term Central Adaptation in Benign Paroxysmal Positional Vertigo

Cited by 10 publications

References 18 publications

Characteristics and Possible Mechanisms of Direction-Reversing Nystagmus During Positional Testing in Patients With Benign Paroxysmal Positional Vertigo

Characteristics and Possible Mechanisms of Direction-Reversing Nystagmus During Positional Testing in Patients With Benign Paroxysmal Positional Vertigo

Positioning Velocity Matters in Central Paroxysmal Positional Vertigo: Implication for the Mechanism

Canal switch in benign paroxysmal positional vertigo: Clinical characteristics and possible mechanisms

Contact Info

Product

Resources

About