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Abstract of the Week

October Topic of the month: Neural Correlates of Dizziness

No 490: October 2, 2019

lsalman O, Ost J, Vanspauwen R, Blaivie C, De Ridder D, Vanneste S. The Neural Correlates of Chronic Symptoms of Vertigo Proneness in Humans. PLoS One 2016, Apr 18;11(4):e0152309. doi: 10.1371/journal.pone.0152309. eCollection 2016.
Vestibular signals are of significant importance for variable functions including gaze stabilization, spatial perception, navigation, cognition, and bodily self-consciousness. The vestibular network governs functions that might be impaired in patients affected with vestibular dysfunction. It is currently unclear how different brain regions/networks process vestibular information and integrate the information into a unified spatial percept related to somatosensory awareness and whether people with recurrent balance complaints have a neural signature as a trait affecting their development of chronic symptoms of vertigo. Pivotal evidence points to a vestibular-related brain network in humans that is widely distributed in nature. By using resting state source localized electroencephalography in non-vertiginous state, electrophysiological changes in activity and functional connectivity of 23 patients with balance complaints where chronic symptoms of vertigo and dizziness are among the most common reported complaints are analyzed and compared to healthy subjects. The analyses showed increased alpha2 activity within the posterior cingulate cortex and the precuneues/cuneus and reduced beta3 and gamma activity within the pregenual and subgenual anterior cingulate cortex for the subjects with balance complaints. These electrophysiological variations were correlated with reported chronic symptoms of vertigo intensity. A region of interest analysis found reduced functional connectivity for gamma activity within the vestibular cortex, precuneus, frontal eye field, intra-parietal sulcus, orbitofrontal cortex, and the dorsal anterior cingulate cortex. In addition, there was a positive correlation between chronic symptoms of vertigo intensity and increased alpha-gamma nesting in the left frontal eye field. When compared to healthy subjects, there is evidence of electrophysiological changes in the brain of patients with balance complaints even outside chronic symptoms of vertigo episodes. This suggests that these patients have a neural signature or trait that makes them prone to developing chronic balance problems.
PMID: 27089185

September Topic of the month: Back to Basics

No 488: September 18, 2019

Rodrigues DL, Ledesma ALL, Pires de Oliveira CA, Bahmad F Jr. Effect of Vestibular Exercises Associated With Repositioning Maneuvers in Patients With Benign Paroxysmal Positional Vertigo: A Randomized Controlled Clinical Trial Otol Neurotol. 2019 Sep;40(8):e824-e829. doi: 10.1097/MAO.0000000000002324.
In addition to positional vertigo, it is quite common for patients with benign paroxysmal positional vertigo (BPPV) to present complaints associated with balance problems and a feeling of dizziness even after repositioning maneuvers.

OBJECTIVE: It was to evaluate the additional effects of vestibular rehabilitation exercises as a therapeutic resource in the treatment of BPPV, to improve symptoms and reduce recurrence.

STUDY DESIGN: This was an experimental, prospective, randomized, controlled study.

SETTING: Instituto Brasiliense de Otorrinolaringologia (IBORL) from August 2016 to September 2017.

PATIENTS: Thirty-two individuals, both men and women, over 18 years of age with BPPV.

INTERVENTION: They were randomly assigned to two groups: the control group (n=15) performing only the maneuver technique as treatment and the experimental group (n=17) performing the maneuvers and vestibular rehabilitation exercises. Patients underwent treatment and responded to the dizziness handicap inventory (DHI) and visual analog scale (VAS) questionnaires for comparison between groups. Participants were followed up for 6 months to observe recurrence of symptoms.

MAIN OUTCOME MEASURES: To investigate the additional effects of vestibular exercises in the treatment of BPPV.

RESULTS: The experimental group had a lower level of dizziness in the posttreatment period (p<0.05) and a lower incidence of recurrences (p=0.038) than the control group.

CONCLUSIONS: Vestibular exercises performed after repositioning treatments for BPPV increased the overall efficacy of treatment by improving symptoms with a lower rate of recurrence.

PMID: 31356483

No 487: September 11, 2019

Appiah-Kubi KO, Wright WG. Vestibular training promotes adaptation of multisensory integration in postural control. Gait Posture. 2019 Sep;73:215-220. doi: 10.1016/j.gaitpost.2019.07.197. Epub 2019 Jul 16.
BACKGROUND: Postural stability depends on the integration of the multisensory system to produce motor outputs. When visual and somatosensory input is reliable, this reduces reliance on the vestibular system. Despite this, vestibular loss can still cause severe postural dysfunction. Training one or more of the three sensory systems through vestibular habituation and adaptation can alter sensory weighting and change postural behavior.
AIM: The purpose of this study was to assess sensory reweighting of postural control processing after combined vestibular activation with voluntary weight shift training in healthy adults.
METHODS: Thirty-three healthy individuals (18-35 y.o.) were randomly assigned to one of three groups: No training (control), visual feedback weight shift training (WST) coupled with an active horizontal headshake (HS) activity to elicit a vestibular perturbation, or the same WST without HS (NoHS). Training was performed 2x/day, every other day (M, W, F), totaling six sessions. Pre- and post- assessments on the Sensory Organization Test (SOT) were performed. Separate between- and within- repeated measures ANOVAs were used to analyze the six SOT equilibrium scores, composite scores, sensory ratios and center of pressure (COP) variables by comparing baseline to post-training. Alpha level was set at p<.05. 
RESULTS: There was a significant group x session x condition change (p=.102) in the COP multiscale entropy (MSE) velocity sway in the HS group during SOT conditions 5 and 6. Similarly, COP medio-lateral standard deviation sway (ML Std) showed group x session x visual condition (p=.028), due to HS in condition 6 relative to other two groups.
CONCLUSION: Postural training can alter sensory organization after a visual feedback-vestibular activation training protocol, suggesting a possible sensory reweighting through vestibular adaptation and/or habituation.
SIGNIFICANCE: Translating these findings into a vestibular-impaired population can stimulate the design of a rehabilitation balance protocol.
PMID: 31376748


No 486: September 6, 2019

Verdecchia DH, Monzón AM, Urbina Jaimes V, Oliveira FR, Paiva L da S, Carvalho TD de. Patient-Reported and Performance Outcomes Significantly Improved in Elderly Patients with Vestibular Impairment following Rehabilitation: A Retrospective Study. Journal of Aging Research. August 2018:1-8. doi:10.1155/2018/5093501.
OBJECTIVE: To describe the results of a vestibular rehabilitation (VR) program in the timed up and go (TUG), gait speed (GS), and dizziness handicap inventory (DHI) scores for elderly vestibular patients in a developing country.

METHODS: Descriptive study with retrospective data collected from the clinical records of vestibular patients. The following information was recorded: sex, age, type of vestibular disorder, DHI score, and performance in TUG and GS, before and after participation in a VR program taking place from January 1 to August 30, 2017. The VR program consisted of 10 twice weekly sessions in the clinic and daily exercises at the patient's home. We used Student's t-test for paired and Wilcoxon's test according to the data distribution. The level of significance was 5%.

RESULTS: Data from 57 patients(49 females; 78 ± 5.8 years old) were used. There were statistically significant differences in TUG (12.52 versus 11.56), GS (0.81 versus 0.90 m/s), DHI total handicap (46 versus 24), physical (14 versus 8), emotional (14 versus 6), and functional (18 versus 12) domains.

CONCLUSION: The functional outcome measures reported, including TUG, gait speed, and DHI, reflect statistically significant improvements in elderly patients after vestibular rehabilitation; the DHI improvements are clinically relevant.
PMID: 30225142

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