Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis

Strupp, Michael; Arbusow, Viktor; Maag, Klaus; Gall, Carolin; Brandt, Th.

doi:10.1212/wnl.51.3.838

Cited by 249 publications

(149 citation statements)

References 14 publications

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“…Part of this improvement might be due to vestibular exercises and balance training, which all of our patients had for at least 3 months. The usefulness of vestibular rehabilitation in unilateral vestibular failure 15 and BV 22 23 has been reported previously. The improvement after vestibular rehabilitation with clear locomotor gains has been described in approximately 50% of BV patients who received intensive training over 3-12 months.…”

Section: Discussionmentioning

confidence: 74%

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Follow-up of vestibular function in bilateral vestibulopathy

Zingler

Weintz²,

Jahn³

et al. 2007

Akt Neurol

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Objective: Bilateral vestibulopathy (BV) leads to a bilateral deficit of the vestibulo-ocular reflex and has various aetiologies. The main goal of this study was to determine the frequency and degree of recovery or worsening of vestibular function over time. Methods: 82 patients (59 males, 23 females; mean age at the time of diagnosis 56.3 (SD 17.6) years) were reexamined 51 (36) months after the first examination. All patients underwent a standardised neuro-ophthalmological and neuro-otological examination. Electronystagmography with bithermal caloric irrigation was analysed by measurement of the mean peak slow phase velocity (SPV) of the induced nystagmus. Patients evaluated the course of their disease in terms of balance, gait unsteadiness and health related quality of life. Results: Statistical analysis of the mean peak SPV of caloric induced nystagmus revealed a non-significant worsening over time (initial mean peak SPV 3.0 (3.5)u/s vs 2.1 (2.8)u/s). With respect to subgroups of aetiology, only patients with BV due to meningitis exhibited an increasing, but non-significant SPV (1.0 (1.4)u/s vs 1.9 (1.6)u/s). Vestibular outcome was independent of age, gender, time course of manifestation and severity of BV. Single analysis of all patients showed that a substantial improvement >5u/s occurred in two patients on both sides (idiopathic n = 1, Sjögren's syndrome n = 1) and in eight patients on one side (idiopathic n = 6, meningitis n = 1, Menière's disease n = 1). In 84% of patients there was impairment of their health related quality of life (42% slight, 24% moderate, 18% severe). Forty-three per cent of patients rated the course of their disease as stable, 28% as worsened and 29% as improved. Conclusions: Our data support the view that more than 80% of patients with BV do not improve. Thus the prognosis of BV is less favourable than assumed.

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Section: Discussionmentioning

confidence: 74%

“…14 All patients performed vestibular exercises and balance training using a video or DVD for at least 3 months. 15 …”

Section: Definition Of Aetiologymentioning

confidence: 99%

Follow-up of vestibular function in bilateral vestibulopathy

Zingler

Weintz²,

Jahn³

et al. 2007

Akt Neurol

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“…Interestingly, the overall long-term clinical outcome is independent from the amount and speed of recovery of peripheral vestibular function and age, but rather a consequence of central compensation achieved by vestibular rehabilitation [78].…”

Section: The Impact Of Vc On Recoverymentioning

confidence: 99%

Neurobiological Mechanisms of Acute Vertigo

Tarnutzer

Palla

2013

Future Neurol.

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The vestibular system provides us with reflexive responses of eye movements and balance control, as well as with perceptual estimates of self-motion and gravity direction. Crucial to its proper functioning is a bilaterally balanced vestibular signal originating from the vestibular end organs in the inner ears and projecting via vestibular nerve afferents to the brainstem vestibular nuclei. Disturbances of the bilateral vestibular interplay become evident in cases of acute unilateral peripheral vestibular deafferentation. The resultant sudden imbalance of vestibular afferent tone at the level of the vestibular nuclei leads to pronounced ocular-motor and postural impairment, as well as to intensive vertigo and/or dizziness, accompanied by autonomic symptoms, such as nausea and vomiting. Subsequent compensatory mechanisms efficiently diminish these static symptoms (such as spontaneous nystagmus) within days and allow functional recovery of dynamic symptoms (such as blurred vision during fast head turns) to such a degree that most patients return to their normal daily activities within weeks. This article aims to provide an understanding about the pathophysiological changes after unilateral vestibular deafferentation and the current knowledge on the compensatory mechanisms. SummaryThe vestibular system provides us with reflexive responses of eye movement and

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“…64 There is moderate evidence that vestibular rehabilitation therapy is effective during the acute period of vestibular neuritis. 70 Equilibrium training significantly lessens the time required for vestibulospinal compensation and postural regulation to develop.…”

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confidence: 99%