Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes

Kitazawa, Meiko; Morita, Yuka; Yagi, Chihiro; Takahashi, Kuniyuki; Ohshima, Shinsuke; Yamagishi, Toshio; Izumi, Shuji; Koizuka, Izumi; Horii, Arata

doi:10.3389/fneur.2021.768718

Cited by 15 publications

(7 citation statements)

References 13 publications

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“…Patients with PPPD had precipitating vestibular conditions, such as an acute attack of peripheral vestibular vertigo, Meniere's disease, and vestibular neuritis; however, CP% was within normal range and remained significantly lower than that of patients with UVH. Nonetheless, the DHI scores and NPQ scores of patients with PPPD were significantly higher than those of patients with UVH, indicating that patients with PPPD had more severe subjective handicaps, even with normal vestibular function; this is consistent with a previous report (Kitazawa et al, 2021). On the NPQ subscale, the PPPD group scored significantly higher than the UVH group on visual stimulation, indicating that visual exacerbation is specifically observed in the PPPD group, as in previous reports (Yagi et al, 2019).…”

Section: Clinical and Demographic Characteristics Of Persistent Postu...supporting

confidence: 90%

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Yagi

Morita²,

Yamagishi³

et al. 2022

Front. Hum. Neurosci.

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IntroductionPersistent postural-perceptual dizziness (PPPD) is a chronic vestibular syndrome lasting more than 3 months. The core vestibular symptoms are dizziness, unsteadiness, and non-spinning vertigo, which are exacerbated by upright posture or walking, active or passive motion, and exposure to moving or complex visual stimuli. Among these, visual exacerbation is a key feature of PPPD for which the neural mechanisms are unknown. We hypothesized that vestibular symptoms may be exacerbated by visual stimuli through gaze behavioral change after exposure to moving or complex visual stimuli. The study aimed to examine gaze stability after exposure to moving visual stimuli in patients with PPPD.MethodsFourteen healthy controls (HCs), 27 patients with PPPD, and 12 patients with unilateral vestibular hypofunction (UVH), showing chronic vestibular symptoms for >3 months, were enrolled in the study. The participants were instructed to fixate on the gazing point at the center of a screen for 30 s before and after 90 s of exposure to moving visual stimuli. Gaze stability, best represented by the bivariate contour ellipse area (BCEA), was compared among three groups, both before and after exposure to the moving visual stimuli. Comparisons between pre- and post-moving visual stimuli in BCEA were also conducted. Correlation between the post/pre ratio of BCEA and vestibular tests, several clinical symptom scales including the Dizziness Handicap Inventory, Niigata PPPD Questionnaire, and Hospital Anxiety and Depression Scale, and the exacerbation of dizziness by exposure to moving visual stimuli was examined in the PPPD group.ResultsBCEA, both before and after exposure to moving visual stimuli in the PPPD group, was not different from that in HC and UVH groups. In the PPPD group, BCEA increased significantly after exposure to moving visual stimuli. The post/pre ratio of BCEA correlated with the occurrence of exacerbation of the dizziness sensation by exposure to moving visual stimuli; however, it did not correlate with vestibular tests or clinical symptom scales.ConclusionPatients with PPPD were more likely to exhibit gaze instability after exposure to moving visual stimuli, which potentially exacerbated vestibular symptoms. This phenomenon may help elucidate the neural mechanisms of visual exacerbation in patients with PPPD.

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Section: Clinical and Demographic Characteristics Of Persistent Postu...supporting

confidence: 90%

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Yagi

Morita²,

Yamagishi³

et al. 2022

Front. Hum. Neurosci.

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“…The reason for this observation could be the punctuation and the composition of the “control” group to compare, since our control group has more cases of migraine and vestibular migraine that have usually presented a high NPQ score and its subscales in a similar way than PPPD subjects. Nonetheless, Kitazawa et al noted that the NPQ is the most useful tool for the diagnosis of PPPD when compared with the video head impulse test, posturography, rotatory chair test, the DHI, bithermal caloric test and cervical and ocular vestibular-evoked myogenic potential assessment [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, since the publication of the scale in 2019, several studies have used the NPQ in the assessment of PPPD in Japanese patients. In addition to the study of Kitazawa [ 30 ] previously mentioned, Yamaguchi et al used the NPQ to assess the effects of a treatment based on virtual reality in participants with PPPD, determining that participants improved their symptoms [ 31 ]. Similarly, Miwa and Kanemaru observed 15.5 points of improvement in the NPQ using traditional medicine in PPPD patients [ 32 ], which is greater than the MDC obtained by our study.…”

Section: Discussionmentioning

confidence: 99%

Validity and reliability of the Niigata PPPD Questionnaire in a Western population

Castillejos-Carrasco-Muñoz¹,

Peinado-Rubia

Lérida-Ortega

et al. 2023

Eur Arch Otorhinolaryngol

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Purpose To analyze the psychometric properties of the Niigata Questionnaire (NPQ) for use in a European population with persistent postural-perceptual dizziness (PPPD). Methods Observational study included 140 patients with different vestibular conditions. Construct validity, internal consistency and concurrent validity were analyzed. Intra-class correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Receiver operating characteristic (ROC) curve was used to test diagnostic values. Results Of the 140 patients, 47 had a diagnosis of PPPD. Factorial analysis showed a single-factor structure and concurrent validity analysis showed strong correlations with other instruments. Cronbach alpha coefficients of 0.938 for the total score, 0.869 for the standing and gait subscale, 0.803 for the subscale of movements and 0.852 for the visual stimulation subscale were obtained. The reproducibility was substantial except for the standing subscale, which could be considered moderate. For the standing, movement and visual stimulation subscales and for the total score, the SEM was 3.27, 2.41, 2.50 and 6.63, respectively, and the MDC was 6.40, 4.72, 4.91 and 12.99, respectively. The NPQ total score showed an area under the curve (AUC) of 0.661, a sensitivity of 72.34 and a specificity of 55.91 for discriminating between PPPD and other vestibular disorders. Conclusions The NPQ is feasible for use in a Western population and presents a uni-factorial structure, high internal consistency and strong correlation with other instruments. The reliability can be considered substantial. The NPQ has low accuracy in discriminating between subjects with or without PPPD.

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“…In this study, we have revealed the association of vestibular function in PPPD with preceding balance disorders. Some previous articles have focused on the vestibular function in PPPD [ 5 , 21 ], including a few which have suggested specific laboratory findings for this disease [ 22 , 23 ]. For example, the functional head impulse test with optokinetic stimulation provoked more reading errors in patients with PPPD than in controls [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Preceding Balance Disorders Affect Vestibular Function in Persistent Postural-Perceptual Dizziness

Oka

Ichijo

Koda

et al. 2023

JCM

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Persistent postural-perceptual dizziness (PPPD) is induced by preceding conditions that cause balance disorders. To investigate the association between vestibular function and preceding balance disorders in PPPD patients, a retrospective chart review was performed. Vestibular function in 55 PPPD patients was measured using the caloric test, cervical vestibular evoked myogenic potential testing to air-conducted sound (ACS cVEMP), ocular vestibular evoked myogenic potential testing to bone-conducted vibration (BCV oVEMP), and video head impulse testing (vHIT). Patients were classified according to the type of preceding balance disorder. The age-stratified Cochran–Mantel–Haenszel (CMH) test and the exact test for the common odds ratio were conducted to evaluate the association between preceding n ≥ 4 balance disorders and present peripheral vestibular dysfunction. PPPD patients with preceding vestibular neuritis presented a significant positive association with abnormal caloric responses (p = 0.013), while those with preceding benign paroxysmal positional vertigo (BPPV) had significantly lower rates of abnormal BCV oVEMP (p = 0.003). Furthermore, patients with preceding vestibular neuritis showed lateral semicircular canal dysfunction, while those with preceding BPPV presented normal utricular functions. These results present the influence of preceding balance disorders on the vestibular function in PPPD.

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Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes

Cited by 15 publications

References 13 publications

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Validity and reliability of the Niigata PPPD Questionnaire in a Western population

Preceding Balance Disorders Affect Vestibular Function in Persistent Postural-Perceptual Dizziness

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