The vestibular–basal ganglia connection: Balancing motor control

Stiles, Lucy; Smith, Paul F.

doi:10.1016/j.brainres.2014.11.063

Cited by 85 publications

(81 citation statements)

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“…A proposed role of the basal ganglia, and more specifically the putamen, in vestibular processing is that it uses vestibular input to create a motor outcome for posture control (Stiles and Smith, 2015). The connection between the vestibular system and the basal ganglia consists of a disynaptic pathway from the vestibular nuclei to the putamen through the thalamus (Lai et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Altered functional brain connectivity in patients with visually induced dizziness

Ombergen

Heine²,

Jillings

et al. 2017

NeuroImage: Clinical

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BackgroundVestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visually induced dizziness (VID). These patients therefore experience dizziness, discomfort, disorientation and postural unsteadiness. The underlying pathophysiology of VID is still poorly understood.ObjectiveThe aim of the current explorative study was to gain a first insight in the underlying neural aspects of VID.MethodsWe included 10 VID patients and 10 healthy matched controls, all of which underwent a resting state fMRI scan session. Changes in functional connectivity were explored by means of the intrinsic connectivity contrast (ICC). Seed-based analysis was subsequently performed in visual and vestibular seeds.ResultsWe found a decreased functional connectivity in the right central operculum (superior temporal gyrus), as well as increased functional connectivity in the occipital pole in VID patients as compared to controls in a hypothesis-free analysis. A weaker functional connectivity between the thalamus and most of the right putamen was measured in VID patients in comparison to controls in a seed-based analysis. Furthermore, also by means of a seed-based analysis, a decreased functional connectivity between the visual associative area and the left parahippocampal gyrus was found in VID patients. Additionally, we found increased functional connectivity between thalamus and occipital and cerebellar areas in the VID patients, as well as between the associative visual cortex and both middle frontal gyrus and precuneus.ConclusionsWe found alterations in the visual and vestibular cortical network in VID patients that could underlie the typical VID symptoms such as a worsening of their vestibular symptoms when being exposed to challenging visual stimuli. These preliminary findings provide the first insights into the underlying functional brain connectivity in VID patients. Future studies should extend these findings by employing larger sample sizes, by investigating specific task-based paradigms in these patients and by exploring the implications for treatment.

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Section: Discussionmentioning

confidence: 99%

Altered functional brain connectivity in patients with visually induced dizziness

Ombergen

Heine²,

Jillings

et al. 2017

NeuroImage: Clinical

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“…[42] The vestibular sensory input is represented in the part of striatum including NAc. [43] With changes in vestibular signaling, several neurochemical changes, such as of dopamine (DA), GABA, acetylcholine, were found in the striatum. Animals with vestibular deficit showed changed in DA activity or DA receptors and resultant GABAergic responses in the striatum.…”

Section: Discussionmentioning

confidence: 99%

“…Animals with vestibular deficit showed changed in DA activity or DA receptors and resultant GABAergic responses in the striatum. [43] Conversely, administration of glutamate antagonists reduced locomotion and DA agonist injection into the NAc enhanced locomotor activity. [44] DA is important in detecting changes in familiar information.…”

Section: Discussionmentioning

confidence: 99%

“…[41] In addition, striatal DA enhances activation of NMDA receptors [17] and decreased DA or increased cholinergic activities enhance the production of GABA. [43] These findings suggested that dysfunction of the NAc results in the changes of DA activity and subsequent neurochemical changes, which might be related to vestibular or locomotor deficit as well as well-known neurological and psychiatric conditions such as depression, Parkinson's ds, and drug addiction. [41] Also, functional or neurochemical changes resulted from the volume loss of NAc, which has rich connections with neighboring cortex, might be responsible for mood and behavioral changes in AD.…”

Section: Discussionmentioning

confidence: 99%

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Relationship between postural instability and subcortical volume loss in Alzheimer's disease

Lee

Chung

et al. 2017

Medicine

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The relationship between postural instability and subcortical structure in AD has received less attention. The aims of this study were to assess whether there are differences in the ability to control balance between Alzheimer's disease (AD) and controls, and to investigate the association between subcortical gray matter volumes and postural instability in AD.We enrolled 107 consecutive AD patients and 37 controls. All participants underwent detailed neuropsychological evaluations, T1-weighted MRI at 3 T, and posture assessment using computerized dynamic posturography. We segmented the volumes of 6 subcortical structures of the amygdala, thalamus, caudate nucleus, putamen, globus pallidus and nucleus accumbens, and of hippocampus, using the FMRIBs integrated registration and segmentation tool.All subcortical structures, except for the globus pallidus, were smaller in AD compared with controls on adjusting for age and gender. Falling frequencies in unilateral stance test (UST) and composite scores in sensory organization test (SOT) were worse in AD than in controls. The motor control test did not reveal any differences between groups. On subgroup analyses in AD, the groups with poor performance in UST or SOT exhibited significantly reduced nucleus accumbens and putamen volumes, and nucleus accumbens volume, respectively. The smaller volume of the nucleus accumbens was associated with postural instability in AD (OR [95% CI] 17.847 [2.59–122.80] for UST, 42.827[6.06–302.47] for SOT, all P < .05).AD patients exhibited reduced ability to control balance compared with controls, and this postural instability was associated with nucleus accumbens volume loss. Furthermore, cognitive dysfunction was more prominent in the group with severe postural instability.

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“…Additionally, a recent epidemiologic study found that individuals with vestibular vertigo had a three‐fold increased odds of depressive symptoms, anxiety, and panic disorder than the general US population in adjusted analyses 34. An association between vestibular function and dexterity is supported by recent anatomic studies demonstrating vestibular inputs into central motor control centers such as the basal ganglia,35 and epidemiologic studies showing an association between vestibular function and fine motor tasks 36. The association between vestibular function and speech is more elusive, and may reflect the general link with motor control, and/or neural pathways that remain to be elucidated.…”

Section: Discussionmentioning

confidence: 95%

Health‐related quality of life and economic burden of vestibular loss in older adults

Agrawal

Pineault

Semenov

2017

Laryngoscope Investig Oto

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ObjectivesVestibular loss is a debilitating condition, and despite its high prevalence in older adults, the quality of life (QoL) burden of vestibular loss in older individuals has not been well‐studied. This report quantifies the impact on overall QoL and identifies domains of health most affected. We hypothesize vestibular loss will be associated with impairment in diverse domains of health‐related QoL.Study DesignProspective, case‐control study.MethodsA convenience sample of 27 patients age ≥60 years with vestibular physiologic loss was recruited from an academic neurotology clinic. The patients did not have any identifiable cause of their vestibular loss other than aging. The convenience sample was compared to an age‐matched cross‐sectional sample of the general US population (n = 1266). The main outcome was QoL measured by the Ontario Health Utilities Index Mark III (HUI3).ResultsCompared to the general population, patients with vestibular loss had significantly lower overall unadjusted HUI3 scores (−0.32, p < 0.001). Multivariate regression analysis showed vestibular loss was significantly associated with poorer performance in vision (−0.11 p < 0.0001), speech (−0.15, p < 0.0001), dexterity (−0.13, p < 0.0001), and emotion (−0.07, p = 0.0065). Adjusted aggregate HUI3 was also significantly lower for vestibular loss (−0.15, p = 0.0105). These QoL decrements resulted in an average loss of 1.30 Quality‐Adjusted Life Years (QALYs). When using a $50,000/QALY willingness‐to‐pay threshold, vestibular loss was associated with a $64,929 lifetime economic burden per affected older adult, resulting in a total lifetime societal burden of $227 billion for the US population ≥60 years of age.ConclusionsLoss of vestibular function with aging significantly decreases quality of life across multiple domains of well‐being. These QoL reductions are responsible for heavy societal economic burdens of vestibular loss, which reveal potential benefits of prompt diagnosis and treatment of this condition.Level of Evidence3

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The vestibular–basal ganglia connection: Balancing motor control

Cited by 85 publications

References 84 publications

Altered functional brain connectivity in patients with visually induced dizziness

Altered functional brain connectivity in patients with visually induced dizziness

Relationship between postural instability and subcortical volume loss in Alzheimer's disease

Health‐related quality of life and economic burden of vestibular loss in older adults

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