Chronic Dizziness and Anxiety

Staab, Jeffrey P.; Ruckenstein, Michael J.

doi:10.1001/archotol.131.8.675

Cited by 94 publications

(27 citation statements)

References 20 publications

(24 reference statements)

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“…For example, previous studies indicate that SSRIs have parallel effects on dizziness symptoms and anxiety in patients with high Subjective Depression Scale scores and clinical evidence of organic vestibular disease [132], and patients with chronic subjective dizziness [4,128]. It is noteworthy that the three symptom scales showing improvement in the former study [132] include the main components of SMD.…”

Section: Diagnostic and Neurotherapeutic Implicationsmentioning

confidence: 87%

Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications

Balaban¹,

Jacob

Furman

2011

Expert Review of Neurotherapeutics

185

135

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The comorbidity among balance disorders, anxiety disorders and migraine has been studied extensively from clinical and basic research perspectives. From a neurological perspective, the comorbid symptoms are viewed as the product of sensorimotor, interoceptive and cognitive adaptations that are produced by afferent interoceptive information processing, a vestibulo–parabrachial nucleus network, a cerebral cortical network (including the insula, orbitofrontal cortex, prefrontal cortex and anterior cingulate cortex), a raphe nuclear–vestibular network, a coeruleo–vestibular network and a raphe–locus coeruleus loop. As these pathways overlap extensively with pathways implicated in the generation, perception and regulation of emotions and affective states, the comorbid disorders and effective treatment modalities can be viewed within the contexts of neurological and psychopharmacological sites of action of current therapies.

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Section: Diagnostic and Neurotherapeutic Implicationsmentioning

confidence: 87%

Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications

Balaban¹,

Jacob

Furman

2011

Expert Review of Neurotherapeutics

185

135

View full text Add to dashboard Cite

show abstract

“…VID is a chronic disorder, often triggered by an acute vestibular disorder, during which these visual stimuli trigger or aggravate vestibular symptoms (Guerraz et al, 2001, Pavlou et al, 2006). Chronic vestibular symptoms triggered by an acute vestibular disorder can also manifest as chronic subjective dizziness (CSD) (Staab et al, 2004, Staab and Ruckenstein, 2005) or phobic postural vertigo (PPV) (Brandt, 1996, Kapfhammer et al, 1997), of which the former is also characterized by increased sensitivity to visual motion (Staab and Ruckenstein, 2005). When a group of 21 patients with VID were assessed for changes in postural sway and SVV in the presence of a tilted visual frame or a rotating visual disc, they displayed increased sway and poorer accuracy in estimating the gravitational vertical compared to controls - suggesting an influence of (moving) visual surroundings on vestibular processing (Guerraz et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…A separate study using fMRI with vestibular stimulation reported localized hypofunction and decreased connectivity between several brain regions including the superior temporal gyrus, anterior insula/inferior frontal gyrus, middle occipital gyrus and hippocampus in patients with chronic subjective dizziness (CSD) compared to controls (Indovina et al, 2015). The authors suggested that the VID symptoms, often present in CSD patients (Staab and Ruckenstein, 2005), might be related to the decreased connectivity between anterior insula and middle occipital gyrus together with the decreased activity in anterior insula, anterior cingulate cortex and hippocampus.…”

Section: Introductionmentioning

confidence: 99%

Altered functional brain connectivity in patients with visually induced dizziness

Ombergen

Heine²,

Jillings

et al. 2017

NeuroImage: Clinical

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BackgroundVestibular patients occasionally report aggravation or triggering of their symptoms by visual stimuli, which is called visually induced dizziness (VID). These patients therefore experience dizziness, discomfort, disorientation and postural unsteadiness. The underlying pathophysiology of VID is still poorly understood.ObjectiveThe aim of the current explorative study was to gain a first insight in the underlying neural aspects of VID.MethodsWe included 10 VID patients and 10 healthy matched controls, all of which underwent a resting state fMRI scan session. Changes in functional connectivity were explored by means of the intrinsic connectivity contrast (ICC). Seed-based analysis was subsequently performed in visual and vestibular seeds.ResultsWe found a decreased functional connectivity in the right central operculum (superior temporal gyrus), as well as increased functional connectivity in the occipital pole in VID patients as compared to controls in a hypothesis-free analysis. A weaker functional connectivity between the thalamus and most of the right putamen was measured in VID patients in comparison to controls in a seed-based analysis. Furthermore, also by means of a seed-based analysis, a decreased functional connectivity between the visual associative area and the left parahippocampal gyrus was found in VID patients. Additionally, we found increased functional connectivity between thalamus and occipital and cerebellar areas in the VID patients, as well as between the associative visual cortex and both middle frontal gyrus and precuneus.ConclusionsWe found alterations in the visual and vestibular cortical network in VID patients that could underlie the typical VID symptoms such as a worsening of their vestibular symptoms when being exposed to challenging visual stimuli. These preliminary findings provide the first insights into the underlying functional brain connectivity in VID patients. Future studies should extend these findings by employing larger sample sizes, by investigating specific task-based paradigms in these patients and by exploring the implications for treatment.

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“…Studies indicate that these medications are effective in managing CSD. [23][24][25] Approximately 50% of patients given an SSRI had complete remission of symptoms, and 70% demonstrated a positive effect. [23][24][25] Physicians should recognize and counsel patients that with CSD.…”

Section: Report Of Casementioning

confidence: 99%

“…[23][24][25] Approximately 50% of patients given an SSRI had complete remission of symptoms, and 70% demonstrated a positive effect. [23][24][25] Physicians should recognize and counsel patients that with CSD. 10,26,27 Osteopathic Considerations A whole-person approach is emphasized in osteopathic philosophies, through which the union of body, mind, and spirit is recognized.…”

Section: Report Of Casementioning

confidence: 99%

Psychogenic Dizziness: An Important but Overlooked Differential Diagnosis in the Workup of the Dizzy Patient

Kelm¹,

Klapchar²,

Kieliszak³

et al. 2018

Journal of Osteopathic Medicine

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Chronic dizziness can be challenging for both patients and physicians, as a variety of specialists may be consulted and tests ordered before a diagnosis is established. The various potential etiologic processes involved in chronic dizziness require an interdisciplinary approach to care. Common causes include neurologic, vestibular, and cardiac diseases. Psychiatric disorders, however, may be overlooked when establishing a differential diagnosis. This case report illustrates some of the complexities in diagnosing and effectively managing chronic dizziness and serves as a reminder that psychiatric disorders should be considered in the differential diagnosis.

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Chronic Dizziness and Anxiety

Abstract: To investigate the hypothesis that the efficacy of selective serotonin reuptake inhibitors (SSRIs) for chronic subjective dizziness (CSD) and anxiety depends on the longitudinal pattern of the patients' symptoms.

Cited by 94 publications

References 20 publications

Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications

Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications

Altered functional brain connectivity in patients with visually induced dizziness

Psychogenic Dizziness: An Important but Overlooked Differential Diagnosis in the Workup of the Dizzy Patient

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