Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Abstract

IntroductionPersistent postural-perceptual dizziness (PPPD) is a chronic vestibular syndrome lasting more than 3 months. The core vestibular symptoms are dizziness, unsteadiness, and non-spinning vertigo, which are exacerbated by upright posture or walking, active or passive motion, and exposure to moving or complex visual stimuli. Among these, visual exacerbation is a key feature of PPPD for which the neural mechanisms are unknown. We hypothesized that vestibular symptoms may be exacerbated by visual stimuli through gaze behavioral change after exposure to moving or complex visual stimuli. The study aimed to examine gaze stability after exposure to moving visual stimuli in patients with PPPD.MethodsFourteen healthy controls (HCs), 27 patients with PPPD, and 12 patients with unilateral vestibular hypofunction (UVH), showing chronic vestibular symptoms for >3 months, were enrolled in the study. The participants were instructed to fixate on the gazing point at the center of a screen for 30 s before and after 90 s of exposure to moving visual stimuli. Gaze stability, best represented by the bivariate contour ellipse area (BCEA), was compared among three groups, both before and after exposure to the moving visual stimuli. Comparisons between pre- and post-moving visual stimuli in BCEA were also conducted. Correlation between the post/pre ratio of BCEA and vestibular tests, several clinical symptom scales including the Dizziness Handicap Inventory, Niigata PPPD Questionnaire, and Hospital Anxiety and Depression Scale, and the exacerbation of dizziness by exposure to moving visual stimuli was examined in the PPPD group.ResultsBCEA, both before and after exposure to moving visual stimuli in the PPPD group, was not different from that in HC and UVH groups. In the PPPD group, BCEA increased significantly after exposure to moving visual stimuli. The post/pre ratio of BCEA correlated with the occurrence of exacerbation of the dizziness sensation by exposure to moving visual stimuli; however, it did not correlate with vestibular tests or clinical symptom scales.ConclusionPatients with PPPD were more likely to exhibit gaze instability after exposure to moving visual stimuli, which potentially exacerbated vestibular symptoms. This phenomenon may help elucidate the neural mechanisms of visual exacerbation in patients with PPPD.

Validity and reliability of the Niigata PPPD Questionnaire in a Western population

“…Thus, these authors and future authors would benefit from our study, as we calculated the MDC for the NPQ, allowing a better and more precise interpretation of the results of every study that uses the NPQ. The same could be applied to the study of Eldøen et al, who assessed a website with vestibular rehabilitation videos for PPPD patients [ 33 ], and the study of Yagi et al, who considered gaze instability in PPPD [ 34 ]. Other studies used the NPQ to assess the relation between the presence of isolated otolith dysfunction and PPPD [ 35 ] or the presence of exacerbating factors for PPPD patients [ 36 ].…”

Functional Dizziness as a Spatial Cognitive Dysfunction

“…A current model hypothesizes that PPPD may involve functional disruptions at the cortical network level, affecting systems related to motion perception, postural control, locomotion, and spatial orientation [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Such disruptions could potentially contribute to the characteristic dizziness observed in PPPD [5], and may also manifest as heightened attention to motion [9], misperception of movement [25], altered posture [24], increased effort in postural control [26], heightened dependence on visual input [27], and compromised spatial navigation [12], among others [5].…”