Altered brain function in persistent postural perceptual dizziness: A study on resting state functional connectivity

Abstract

This study used resting state functional magnetic resonance imaging (rsfMRI) to investigate whole brain networks in patients with persistent postural perceptual dizziness (PPPD). We compared rsfMRI data from 38 patients with PPPD and 38 healthy controls using whole brain and region of interest analyses. We examined correlations among connectivity and clinical variables and tested the ability of a machine learning algorithm to classify subjects using rsfMRI results. Patients with PPPD showed: (a) increased connectivity of subcallosal cortex with left superior lateral occipital cortex and left middle frontal gyrus, (b) decreased connectivity of left hippocampus with bilateral central opercular cortices, left posterior opercular cortex, right insular cortex and cerebellum, and (c) decreased connectivity between right nucleus accumbens and anterior left temporal fusiform cortex. After controlling for anxiety and depression as covariates, patients with PPPD still showed decreased connectivity between left hippocampus and right inferior frontal gyrus, bilateral temporal lobes, bilateral insular cortices, bilateral central opercular cortex, left parietal opercular cortex, bilateral occipital lobes and cerebellum (bilateral lobules VI and V, and left I-IV). Dizziness handicap, anxiety, and depression correlated with connectivity in clinically meaningful brain regions. The machine learning algorithm correctly classified patients and controls with a sensitivity of 78.4%, specificity of 76.9%, and area under the curve = 0.88 using 11 connectivity parameters. Patients with PPPD showed reduced connectivity among the areas involved in multisensory vestibular processing and spatial cognition, but increased connectivity in networks linking visual and emotional processing. Connectivity patterns may become an imaging biomarker of PPPD.

Persistent Postural-Perceptual Dizziness

“…Physiological, psychological, and advanced brain imaging studies published since that time have supported this conceptualization. 16,[33][34][35][36][37][38][39][40] As discussed earlier and shown on the left side of ►Fig. 2, PPPD may be triggered by neuro-otologic disorders, other structural or metabolic conditions, and psychological distress that cause vertigo, unsteadiness, or dizziness, or disrupt balance function.…”

“…2 and identified another pathophysiological process, namely, altered activity and connectivity in cortical networks in the brain that subserve spatial orientation and locomotion. [36][37][38][39][40] In a study using resting state functional magnetic resonance imaging (fMRI), patients with PPPD compared with healthy controls had widespread reductions in connectivity from the left hippocampus (responsible for egocentric spatial navigation) to multiple brain regions. In contrast, connectivity between regions of the frontal and occipital cortices was increased in relation to mild state anxiety, consistent with the concept of visual dependence as a key process in PPPD.…”

Persistent postural perceptual dizziness is on a spectrum in the general population

“…Recent neuroimaging studies report that patients with PPPD show differences in brain structure, connectivity, and function in regions related to visual, vestibular, and spatial processing. [19][20][21][22][23] However, such studies are unable to disentangle preexisting differences from adaptive changes following acute vestibular insults.…”

Persistent postural-perceptual dizziness: current approaches to diagnosis and treatment

“…По разным данным, около трети популяции страдает заболеваниями, проявляющимися данными синдромами [1]. На персистирующее постурально-перцептивное головокружение (ПППГ) приходится 12-15% всех случаев посещения врачей по поводу головокружения и неустойчивости [2,3]. Среди причин обращения пациентов с жалобами на головокружение в амбулаторной практике ПППГ занимает 2-е место после заболеваний периферического отдела вес-тибулярной системы [4,5].…”

“…Дезадаптивные когнитивно-поведенческие реакции приводят к вторичным психологическим и функциональным нарушениям, таким как страх падения, тревожные или депрессивные расстройства и функциональные нарушения походки [2]. Эта гипотеза подтверждается данными функциональной магнитно-резонансной томографии у пациентов с ПППГ, у которых по сравнению с группой контроля выявлены снижение связей между областями, вовлеченными в мультисенсорную вестибулярную обработку и пространственную ориентацию, и увеличение активности в сетях, связывающих визуальную и эмоциональную обработку [3]. В клинической картине могут доминировать различные проявления заболевания: в одних случаях это ощущение головокружения, неустойчивости и гиперчувствительность к движению и визуальным стимулам, в другихфобические расстройства, избегание провоцирующих ситуаций и функциональные нарушения походки.…”