Network changes in patients with phobic postural vertigo

Huber, Judita; Flanagin, Virginia L.; Popp, Pauline; Eulenburg, Peter zu; Dieterich, Marianne

doi:10.1002/brb3.1622

Cited by 17 publications

(10 citation statements)

References 51 publications

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“…Connectivity studies also demonstrated reduced resting-state functional connectivity between visual, vestibular, and spatial cognition areas ( Lee et al, 2018 ; Li et al, 2020 ). Importantly, a special role of the cerebellum is highlighted ( Lee et al, 2018 ; Huber et al, 2020 ): during a visual motion task, for example, cerebellar network activity of functional dizziness patients was reduced, whereas during static visual scenes, it was increased ( Huber et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders

et al. 2021

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Objective: We are still lacking a pathophysiological mechanism for functional disorders explaining the emergence and manifestation of characteristic, severely impairing bodily symptoms like chest pain or dizziness. A recent hypothesis based on the predictive coding theory of brain function suggests that in functional disorders, internal expectations do not match the actual sensory body states, leading to perceptual dysregulation and symptom perception. To test this hypothesis, we investigated the account of internal expectations and sensory input on gaze stabilization, a physiologically relevant parameter of gaze shifts, in functional dizziness.Methods: We assessed gaze stabilization in eight functional dizziness patients and 11 healthy controls during two distinct epochs of large gaze shifts: during a counter-rotation epoch (CR epoch), where the brain can use internal models, motor planning, and resulting internal expectations to achieve internally driven gaze stabilization; and during an oscillation epoch (OSC epoch), where, due to terminated motor planning, no movement expectations are present, and gaze is stabilized by sensory input alone.Results: Gaze stabilization differed between functional patients and healthy controls only when internal movement expectations were involved [F(1,17) = 14.63, p = 0.001, and partial η2 = 0.463]: functional dizziness patients showed reduced gaze stabilization during the CR (p = 0.036) but not OSC epoch (p = 0.26).Conclusion: While sensory-driven gaze stabilization is intact, there are marked, well-measurable deficits in internally-driven gaze stabilization in functional dizziness pointing at internal expectations that do not match actual body states. This experimental evidence supports the perceptual dysregulation hypothesis of functional disorders and is an important step toward understanding the underlying pathophysiology.

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Section: Discussionmentioning

confidence: 99%

Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders

et al. 2021

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“…As physical examination, clinical laboratory testing and vestibular evaluation may be normal in PPPD [21,22], advances in neuroimaging have provided new insights in patients with PPPD illustrating the delicate changes in functional activity and internetwork connectivity involving the vestibular, visual and emotion processing centers [10,12,13,24,26]. However, the functional MRI is not easily available and diagnosis relies heavily on clinical history [21].…”

Section: Introductionmentioning

confidence: 99%

The impact of disease duration in persistent postural-perceptual dizziness (PPPD) on the quality of life, dizziness handicap and mental health

Lin

Prepageran

2022

VES

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BACKGROUND: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional disorder which interferes with the way individuals experience their personal, social and work life. OBJECTIVE: To study the impact of disease duration in PPPD on the quality of life (QOL), dizziness handicap and mental health on the patients. METHODS: A prospective study comparing the EQ-5D for QOL, Dizziness Handicap Inventory (DHI) and DASS-21 between 27 patients with PPPD and 27 of those who have recovered from an acute vestibular event. Similar parameters between PPPD patients with symptoms less than one year and more than a year were compared. RESULTS: The PPPD patients were predominantly females and middle-aged with significantly higher DHI scores (mean 48.3 + 25.7, p = 0.00002), higher total mean scores in the DASS-21 (mean 21.6 + 13.7, p = 0.009) and poorer QOL with mean EQ-5D VAS of 67.9 + 17.3 (p < 0.00001). PPPD patients with symptoms for more than a year had significant increase in physical handicap (p = 0.041) as well as anxiety levels (p = 0.008). CONCLUSIONS: PPPD is predominantly seen in females and middle-aged which significantly reduces the QOL, increases dizziness handicap and increases depression, anxiety and stress levels. The increase in duration of illness further increases the anxiety levels and physical handicap.

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“…The increased in activation was seen when static visual stimulus was given. However, cerebellar activation was reduced when a visual motion stimuli was used and this was accompanied by increase in the sensorimotor network (23). Patients with PPPD also did not show the increased activation motion in the third short insular gyrus and adjacent Rolandic operculum which was seen in the healthy controls during vertical to horizontal (23).…”

Section: Resultsmentioning

confidence: 78%

Neuroimaging Systematic Review in Persistent Postural-Perceptual Dizziness: The Elaborate Alterations in the Delicate Network to Remain Balanced

Teh

Mah

Rahmat

et al. 2021

Otology &Amp; Neurotology

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Objectives: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that may have normal physical examination, clinical laboratory testing and vestibular evaluation. However, advances in neuroimaging have provided new insights in brain functional connectivity and structure in patients with PPPD. This systematic review was aimed at identifying significant structural or alterations in functional connectivity in patients with PPPD. Databases Reviewed: Science Direct, Pubmed, Embase via Ovid databases, and Cochrane library. Methods: This review following the guidelines of PRISMA, systematically and independently examined papers published up to March 2021 which fulfilled the predetermined criteria. PROSPERO Registration (CRD42020222334). Results: A total of 15 studies were included (MRI = 4, SPECT = 1, resting state fMRI = 4, task-based fMRI = 5, task-based fMRI + MRI = 1). Significant changes in the gray matter volume, cortical folding, blood flow, and connectivity were seen at different brain regions involved in vestibular, visual, emotion, and motor processing. Conclusion: There is a multisensory dimension to the impairment resulting in chronic compensatory changes in PPPD that is evident by the significant alterations in multiple networks involved in maintaining balance. These changes observed offer some explanation for the symptoms that a PPPD patient may experience. Systematic Review Registration: This study is registered with PROSPERO (CRD42020222334).

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Network changes in patients with phobic postural vertigo

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 17 publications

References 51 publications

Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders

Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders

The impact of disease duration in persistent postural-perceptual dizziness (PPPD) on the quality of life, dizziness handicap and mental health

Neuroimaging Systematic Review in Persistent Postural-Perceptual Dizziness: The Elaborate Alterations in the Delicate Network to Remain Balanced

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