Vestibular stimulation improves insight into illness in schizophrenia spectrum disorders

Gerretsen, Philip; Pothier, David D.; Falls, Carolyn; Armstrong, Maxine; Balakumar, Thushanthi; Uchida, Hiroyuki; Mamo, David C.; Pollock, Bruce G.; Graff‐Guerrero, Ariel

doi:10.1016/j.psychres.2017.02.020

Cited by 10 publications

(9 citation statements)

References 68 publications

(89 reference statements)

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“…The third study corresponds to a randomized clinical trial published by Gerretzen, where caloric stimulation with water at 4°C was applied sequentially in the right ear and left ear of patients within the spectrum of schizophrenia. This study showed improvement in symptoms and of the insight that lasted approximately 30 minutes after application of the cold water in the left ear [30].…”

Section: Caloric Vestibular Stimulationsupporting

confidence: 55%

Vestibular Stimulation in Neuropsychiatry

Ried¹

2020

ABNE

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Neuropsychiatric disorders involve brain areas of self-awareness, affect voluntary attention to stimuli, and show cognitive processes’ dysfunctions. Functional images demonstrated that the stimulation of the inner ear’s vestibular receptors enhances the activity of the insular cortex, prefrontal cortex, hypothalamus and hippocampus, improving self-perception, attention, reasoning, and memory. Vestibular stimulation techniques (e.g., caloric, galvanic, and rotary) modulates those neuronal centers at the right or the left hemisphere depending on the kind of the stimuli and the side of stimulation, being a potentially useful therapeutic tool for mental disorders. Neuropsychiatric conditions are currently the leading cause of global disability. The present article reviews vestibular stimulation techniques in neuropsychiatry and discusses future directions.

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Section: Caloric Vestibular Stimulationsupporting

confidence: 55%

Vestibular Stimulation in Neuropsychiatry

Ried¹

2020

ABNE

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“…If there is no disease-free baseline to which to return, what does this mean for the applicability of sensory neuromodulation? Gerretsen et al (2017) used irrigation-based CVS with schizophrenia subjects and found evidence of transiently improved insight to illness. The authors concluded that, similar to hemispatial neglect, CVS acted to balance activity in the two hemispheres, making use of the potential of unilateral CVS to preferentially activate one hemisphere.…”

Section: Why It Helps and Doesn't Hurtmentioning

confidence: 99%

Sensory Neuromodulation

Black¹,

Rogers²

2018

Preprint

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We describe a model of neurological disease based on dysfunctional brain oscillators.  This is not a new model, but it is not one that is generally appreciated by clinicians.  The value of this model lies in the predictions it makes and the utility it provides in translational applications, in particular for neuromodulation devices.  We provide a perspective on the difference between neuromodulation devices that enforce an externally administered stimulus with devices that provide input to sensory receptors and thus stimulate endogenous sensory networks.  Current forms of clinically applied neuromodulation are of the former type, including devices such as (implanted) deep brain stimulators (DBS) and various, noninvasive methods such as transcranial magnetic stimulation (TMS) and transcranial current methods (tACS, tDCS).  The challenge with these methods is that they are not sensitive to underlying neuronal dynamics and work by applying an empirically derived electrical current waveform to affect dynamical patterns. Neuromodulation of a sensory organ accesses the same pathways that natural environmental stimuli do and, importantly, the modulatory signal will be transformed as it travels through the brain, allowing the modulation input to be consistent with regional dynamics.  We present specific examples of devices that rely on sensory neuromodulation and evaluate the translational potential of these approaches.  We argue that sensory neuromodulation is well suited to probe and, ideally, repair dysfunctional brain oscillators, thus providing a novel therapeutic approach for neurological diseases.

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“…Compromised white matter integrity in the splenium could represent a marker or therapeutic target to improve illness awareness and treatment adherence in patients with Imp-IA in schizophrenia. 8,40 Evidence suggests that illness awareness in schizophrenia 19,20,41 and other neuropsychiatric conditions (i.e., stroke) 42–44 can be transiently improved with the use of noninvasive neurostimulation techniques, such as transcranial magnetic, direct current, and vestibular stimulation by enhancing interhemispheric function. In particular, three studies found marked improvements in Imp-IA in patients with schizophrenia after the application of fronto-temporoparietal transcranial direct current stimulation, which involved inhibitory cathodal stimulation of the left parietal area.…”

Section: Discussionmentioning

confidence: 99%

Impaired illness awareness in schizophrenia and posterior corpus callosal white matter tract integrity

et al. 2019

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Impaired illness awareness (Imp-IA) in schizophrenia is associated with interhemispheric imbalance, resulting in left hemisphere dominance, primarily within the posterior parietal area (PPA). This may represent an interhemispheric “disconnection syndrome” between PPAs. To test this hypothesis, we aimed to determine if diffusion-based measures of white matter integrity were disrupted in the corpus callosal tracts linking PPAs (i.e., splenium) in patients with Imp-IA in schizophrenia. T1-weighted and diffusion-weighted scans were acquired on a 1.5T GE scanner for 100 participants with a DSM-IV-TR diagnosis of schizophrenia and 134 healthy controls aged 18 to 79 years. The corpus callosal white matter tracts were compared among patients with Imp-IA ( n = 40), intact illness awareness ( n = 60), and healthy controls. White matter disruption was measured with fractional anisotropy (FA) and mean diffusivity (MD). Group differences in FA were found in the splenium, with patients with Imp-IA having the lowest FA, which remained significant after controlling for sex, age, global cognition, and premorbid intelligence. No group differences in MD were observed. Splenial white matter tracts of the corpus callosum appear compromised in patients with Imp-IA. Transcallosal interhemispheric PPA white matter disruption may represent a “disconnection syndrome”, manifesting as Imp-IA in schizophrenia. Future studies are required to investigate the effects of noninvasive brain stimulation interventions, such as transcranial direct current or magnetic stimulation, on Imp-IA in association with white matter changes in patients with schizophrenia.

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Vestibular stimulation improves insight into illness in schizophrenia spectrum disorders

Cited by 10 publications

References 68 publications

Vestibular Stimulation in Neuropsychiatry

Vestibular Stimulation in Neuropsychiatry

Sensory Neuromodulation

Impaired illness awareness in schizophrenia and posterior corpus callosal white matter tract integrity

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