scholarly journals Vestibular Thresholds: A Review of Advances and Challenges in Clinical Applications

2021 ◽  
Vol 12 ◽  
Author(s):  
Megan J. Kobel ◽  
Andrew R. Wagner ◽  
Daniel M. Merfeld ◽  
Jameson K. Mattingly
Keyword(s):  
Vestibular Function ◽  
Quantitative Measure ◽  
Diagnostic Methods ◽  
Vestibular Disorders ◽  
Bilateral Vestibulopathy ◽  
High Prevalence ◽  
Vestibular Perception ◽  
Vestibular Symptoms ◽  
Potential Use ◽  
Clinical Populations

Vestibular disorders pose a substantial burden on the healthcare system due to a high prevalence and the severity of symptoms. Currently, a large portion of patients experiencing vestibular symptoms receive an ambiguous diagnosis or one that is based solely on history, unconfirmed by any objective measures. As patients primarily experience perceptual symptoms (e.g., dizziness), recent studies have investigated the use of vestibular perceptual thresholds, a quantitative measure of vestibular perception, in clinical populations. This review provides an overview of vestibular perceptual thresholds and the current literature assessing use in clinical populations as a potential diagnostic tool. Patients with peripheral and central vestibular pathologies, including bilateral vestibulopathy and vestibular migraine, show characteristic changes in vestibular thresholds. Vestibular perceptual thresholds have also been found to detect subtle, sub-clinical declines in vestibular function in asymptomatic older adults, suggesting a potential use of vestibular thresholds to augment or complement existing diagnostic methods in multiple populations. Vestibular thresholds are a reliable, sensitive, and specific assay of vestibular precision, however, continued research is needed to better understand the possible applications and limitations, especially with regard to the diagnosis of vestibular disorders.

scholarly journals Proceedings of the GDR Vertige 2019 annual meeting devoted to endolymphatic hydrops

2021 ◽  
pp. 1-3
Author(s):  
Christian Chabbert ◽  
Anne Charpiot
Keyword(s):  
Annual Meeting ◽  
Research Group ◽  
Endolymphatic Hydrops ◽  
Clinical Manifestations ◽  
Vestibular Function ◽  
Therapeutic Strategies ◽  
Vestibular Disorders ◽  
Special Issue ◽  
Clinical Imaging ◽  
New Methods

The GDR Vertige is a federative research group gathering the different components of the French neuro-otology community. The annual meeting of the GDR Vertige is an opportunity for interactive exchanges between scientists, clinicians and industrialists, on basic issues related to vestibular function, as well as translational questions regarding the management of vestibular disorders. For its fifth edition, the annual meeting of the GDR Vertige, which took place in September 2019 in Marseille (France), was devoted to one of the most peculiar phenomena of neuro-otology: endolymphatic hydrops. For two days, international scientists and clinicians presented the most recent advances regarding the biophysical correlates of endolymphatic hydrops, the genetic and endocrine tableaux that favor its manifestation, new methods of clinical imaging, and current and upcoming therapeutic strategies to overcome the associated clinical manifestations. This special issue of the Journal of Vestibular Research aims at providing the proceedings of this meeting.

scholarly journals Supersaturation of VEP in Migraine without Aura Patients Treated with Topiramate: An Anatomo-Functional Biomarker of the Disease

2021 ◽  
Vol 10 (4) ◽  
pp. 769
Author(s):  
Ciro De Luca ◽  
Sara Gori ◽  
Sonia Mazzucchi ◽  
Elisa Dini ◽  
Martina Cafalli ◽  
...  
Keyword(s):  
Visual Cortex ◽  
Cortical Neurons ◽  
Migraine Without Aura ◽  
Inverse Correlation ◽  
Primary Headache ◽  
Contrast Gain ◽  
High Prevalence ◽  
Functional Pathway ◽  
Inhibitory Signaling ◽  
Potential Use

Migraine is a primary headache with high prevalence among the general population, characterized by functional hypersensitivity to both exogenous and endogenous stimuli particularly affecting the nociceptive system. The hyperresponsivity of cortical neurons could be due to a disequilibrium in the excitatory/inhibitory signaling. This study aimed to investigate the anatomo-functional pathway from the retina to the primary visual cortex using visual evoked potentials (VEP). Contrast gain protocol was used in 15 patients diagnosed with migraine without aura (at baseline and after 3 months of topiramate therapy) and 13 controls. A saturation (S) index was assessed to monitor the response of VEP’s amplitude to contrast gain. Non-linear nor monotone growth of VEP (S < 0.95) was defined as supersaturation. A greater percentage of migraine patients (53%) relative to controls (7%) showed this characteristic. A strong inverse correlation was found between the S index and the number of days separating the registration of VEP from the next migraine attack. Moreover, allodynia measured through the Allodynia Symptoms Check-list (ASC-12) correlates with the S index both at baseline and after 3 months of topiramate treatment. Other clinical characteristics were not related to supersaturation. Topiramate therapy, although effective, did not influence electrophysiological parameters suggesting a non-intracortical nor retinal origin of the supersaturation (with possible involvement of relay cells from the lateral geniculate nucleus). In conclusion, the elaboration of visual stimuli and visual cortex activity is different in migraine patients compared to controls. More data are necessary to confirm the potential use of the S index as a biomarker for the migraine cycle (association with the pain-phase) and cortical sensitization (allodynia).

scholarly journals Assessment of cervical and ocular vestibular evoked myogenic potentials in migraine patients

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Doaa Elmoazen ◽  
Hesham Kozou ◽  
Jaidaa Mekky ◽  
Dalia Ghanem
Keyword(s):  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Peak Amplitude ◽  
Vestibular Evoked Myogenic Potentials ◽  
Healthy Controls ◽  
Latency Difference ◽  
Significant Difference ◽  
Cervical Vemp ◽  
Vestibular Symptoms ◽  
Function Assessment

Abstract Background Patients suffering from vestibular migraine (VM) are known to have various vestibular test abnormalities interictally and ictally. Recently, vestibular evoked myogenic potentials (VEMPs) have become accepted as a valid method for otolith function assessment. Many studies have identified various vestibular symptoms and laboratory abnormalities in migraineurs. Since migraineurs with no accompanying vestibular symptoms might exhibit subclinical vestibular dysfunction, we investigated vestibular function using ocular and cervical VEMPs in migraine patients. The aim was to study cervical VEMP and occular VEMP in migraineurs with and without vestibular symptoms interictally. Results Migraine and VM patients showed significantly longer P13 latency of cVEMP compared to controls. A statistically significant cVEMP interaural P13 latency difference was found in VM compared to healthy controls. Cervical VEMP N23 latency, peak-to-peak amplitude, interaural N23 latency, and amplitude asymmetric ratio did not show any significant difference in migraine and VM patients compared to healthy controls as well as no significant difference across the three groups regarding oVEMP parameters. Conclusions Abnormal interictal cVEMP results in migraineurs might indicate subclinical vestibulo-collic pathway dysfunction.

scholarly journals Paving the Way Toward Distinguishing Fallers From Non-fallers in Bilateral Vestibulopathy: A Wide Pilot Observation

2021 ◽  
Vol 12 ◽  
Author(s):  
Nolan Herssens ◽  
Bieke Dobbels ◽  
Julie Moyaert ◽  
Raymond Van de Berg ◽  
Wim Saeys ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Fear Of Falling ◽  
Daily Life ◽  
Contextual Information ◽  
Vestibular Function ◽  
Future Research ◽  
Risk Of Falling ◽  
Bilateral Vestibulopathy ◽  
Activities Of Daily Life ◽  
Increased Risk

Patients with bilateral vestibulopathy (BVP) present with unsteadiness during standing and walking, limiting their activities of daily life and, more importantly, resulting in an increased risk of falling. In BVP patients, falls are considered as one of the major complications, with patients having a 31-fold increased risk of falling compared to healthy subjects. Thus, highlighting objective measures that can easily and accurately assess the risk of falling in BVP patients is an important step in reducing the incidence of falls and the accompanying burdens. Therefore, this study investigated the interrelations between demographic characteristics, vestibular function, questionnaires on self-perceived handicap and balance confidence, clinical balance measures, gait variables, and fall status in 27 BVP patients. Based on the history of falls in the preceding 12 months, the patients were subdivided in a “faller” or “non-faller” group. Results on the different outcome measures were compared between the “faller” and “non-faller” subgroups using Pearson's chi-square test in the case of categorical data; for continuous data, Mann–Whitney U test was used. Performances on the clinical balance measures were comparable between fallers and non-fallers, indicating that, independent from fall status, the BVP patients present with an increased risk of falling. However, fallers tended to report a worse self-perceived handicap and confidence during performing activities of daily life. Spatiotemporal parameters of gait did not differ between fallers and non-fallers during walking at slow, preferred, or fast walking speed. These results may thus imply that, when aiming to distinguish fallers from non-fallers, the BVP patients' beliefs concerning their capabilities may be more important than the moderately or severely affected physical performance within a clinical setting. Outcome measures addressing the self-efficacy and fear of falling in BVP patients should therefore be incorporated in future research to investigate whether these are indeed able to distinguish fallers form non-fallers. Additionally, information regarding physical activity could provide valuable insights on the contextual information influencing behavior and falls in BVP.

scholarly journals Non-invasive diagnostic methods of the liver fibrosis in patients with overweigh and obesity

2021 ◽  
Vol 11 (3) ◽  
pp. 239-245
Author(s):  
Nadiia Gavryliuk ◽  
Ihor Hospodarskyy ◽  
Oksana Prokopchuk ◽  
Olga Namisniak ◽  
Mykhailo Havrylyuk
Keyword(s):  
Liver Fibrosis ◽  
Wide Distribution ◽  
Modern Medicine ◽  
Overweight And Obesity ◽  
Hcv Infection ◽  
Diagnostic Methods ◽  
Non Invasive ◽  
Number Of Patients ◽  
High Prevalence ◽  
Rate Of Progression

One of the biggest problems of modern medicine is the difficulty in early diagnostic and effective treatment of HCV infection due to its wide distribution, latent form and terrible consequences as a formation of liver cirrhosis (CP) and hepatocellular carcinoma (HCC). It is important to mention, that the rate of progression of liver fibrosis. It is an important medical and social problem that the number of patients with NAFLD, overweight and obesity is constantly increases [9]. Due to the high prevalence of NAFLD and CHC, these two pathologies will progress and contribute to the progression of fibrosis, and depending on the genome of the virus and metabolic syndrome. There is a high risk of developing CP and HCC even after achieving a stable virological response.The main aim of our investigation was to assess the stages of fibrosis by using non-invasive methods for patients with overweight and obesity who being treated for HCV infection (with posthepatic fibrosis).

Persistent Postural-Perceptual Dizziness

2020 ◽  
Vol 40 (01) ◽  
pp. 130-137 ◽  
Author(s):  
Jeffrey P. Staab
Keyword(s):  
Diagnostic Testing ◽  
Multimodality Treatment ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Ongoing Research ◽  
Sufficient Detail ◽  
Treatment Plans ◽  
Physical Examinations ◽  
Vestibular Symptoms

AbstractPersistent postural-perceptual dizziness (PPPD) was defined for the International Classification of Vestibular Disorders in 2017. It is a chronic vestibular disorder that manifests with waxing and waning symptoms of dizziness, unsteadiness, or nonspinning vertigo that last for 3 months or more and are exacerbated by upright posture, active or passive motion of self, and exposure to environments with complex or moving visual stimuli. Triggers of PPPD include a wide variety of conditions that may cause vestibular symptoms or disrupt balance functioning, including neuro-otologic and other medical conditions and psychological distress. The diagnosis is made by identifying key symptoms in patients' histories and conducting physical examinations and diagnostic testing of sufficient detail to establish PPPD as opposed to other illnesses. Ongoing research is providing insights into the pathophysiological mechanisms underlying PPPD and support for multimodality treatment plans incorporating specially adapted vestibular rehabilitation, serotonergic medications, and cognitive-behavior therapy.

scholarly journals A recent update of the diagnostic methods for tuberculosis and their applicability in Indonesia: a narrative review

2019 ◽  
Vol 28 (3) ◽  
pp. 284-91
Author(s):  
Tri Nugraha Susilawati ◽  
Riska Larasati
Keyword(s):  
Delayed Diagnosis ◽  
Diagnostic Methods ◽  
World Health ◽  
Current State ◽  
Interferon Gamma Release Assays ◽  
High Prevalence ◽  
The World ◽  
Golden Standard ◽  
Tertiary Hospitals ◽  
Health Organization

Tuberculosis (TB) is a major global problem, especially with the high prevalence of HIV-TB co-infection. Delayed diagnosis and continual transmission contribute to high mortality in Indonesia, which has the third highest incidence of TB in the world, after China and India. Therefore, early diagnosis is needed to reduce the number of cases and to administer therapy to prevent the transmission of bacteria. The diagnosis of TB remains a challenge in clinical practice due to poor sensitivity and the requirement of skilled staff in microscopic tests, the slow growth Mycobacterium in culture, and the low number of bacilli present in extrapulmonary TB. Despite being the golden standard for TB diagnosis, cultures require 2–8 weeks to grow. Other methods for diagnosing TB include interferon-gamma release assays and serologic tests such as the tuberculin skin test. Recently, the World Health Organization recommended the GeneXpert MTB/RIF assay for diagnosing TB. This review presents the current state of TB epidemiology and various methods for TB diagnosis. In particular, the paper provides an in-depth discussion about the GeneXpert MTB/RIF assay that has been made available recently in selected tertiary hospitals in Indonesia.

scholarly journals Vestibular migraine: An update on current understanding and future directions

Cephalalgia ◽  
2019 ◽  
Vol 40 (1) ◽  
pp. 107-121 ◽  
Author(s):  
Tzu-Chou Huang ◽  
Shuu-Jiun Wang ◽  
Amir Kheradmand
Keyword(s):  
Clinical Symptoms ◽  
Vestibular Function ◽  
Vestibular Migraine ◽  
Current Understanding ◽  
Laboratory Findings ◽  
Treatment Regimens ◽  
Migraine Headaches ◽  
Narrative Literature ◽  
Vestibular Symptoms ◽  
Narrative Literature Review

Background Vestibular migraine is among the most common causes of recurrent vertigo in the general population. Despite its prevalence and high impact on healthcare cost and utilization, it has remained an under-recognized condition with largely unknown pathophysiology. In the present article, we aim to provide an overview of the current understanding of vestibular migraine. Methods We undertook a narrative literature review on the epidemiology, presentations, clinical and laboratory findings, pathophysiology, and treatments of vestibular migraine. Results Currently, the diagnosis of vestibular migraine relies solely on clinical symptoms since clinical tests of vestibular function are typically normal, or difficult to interpret based on inconsistent results reported in earlier studies. The challenges related to diagnosis of vestibular migraine lie in its relatively broad spectrum of manifestations, the absence of typical migraine headaches with vestibular symptoms, and its very recent definition as a distinct entity. Here, we highlight these challenges, discuss common vestibular symptoms and clinical presentations in vestibular migraine, and review the current aspects of its clinical diagnosis and evaluation. The concepts related to the pathophysiology and treatment of vestibular migraine are also discussed. Conclusion Vestibular migraine is still underdiagnosed clinically. Future studies are needed to address the pathophysiological mechanisms and investigate effective treatment regimens.

scholarly journals Electrical Vestibular Stimulation in Humans: A Narrative Review

2019 ◽  
Vol 25 (Suppl. 1-2) ◽  
pp. 6-24 ◽  
Author(s):  
Morgana Sluydts ◽  
Ian Curthoys ◽  
Robby Vanspauwen ◽  
Blake Croll Papsin ◽  
Sharon Lynn Cushing ◽  
...  
Keyword(s):  
Treatment Options ◽  
Electrode Array ◽  
Vestibular Function ◽  
Vestibular Stimulation ◽  
Bilateral Vestibulopathy ◽  
Regular Treatment ◽  
Surface Electrodes ◽  
Different Types ◽  
Spread Of Excitation ◽  
Stimulation Method

Background: In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electrical vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular function. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear implant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing. Summary: Vestibular co-stimulation with a CI is based on “spread of excitation,” which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular co-stimulation can be functionally used in patients with bilateral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activation of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implanted electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspecific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to induce a more unspecific stimulation. Although all three applications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicability and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the patient population who serves to gain from such technologies.

Sign in / Sign up

Export Citation Format

Share Document