No Evidence of a Contribution of the Vestibular System to Frequent Falls in Progressive Supranuclear Palsy

Abstract

Background and Purpose Conflicting results about vestibular function in progressive supranuclear palsy (PSP) prompted a systematic examination of the semicircular canal function, otolith function, and postural stability. Methods Sixteen patients with probable PSP [9 females, age=72±6 years (mean±SD), mean disease duration=3.6 years, and mean PSP Rating Scale score=31] and 17 age-matched controls were examined using the video head impulse test, caloric testing, ocular and cervical vestibular evoked myogenic potentials (o- and cVEMPs), video-oculography, and posturography. Results There was no evidence of impaired function of the angular vestibulo-ocular reflex (gain=1.0±0.1), and caloric testing also produced normal findings. In terms of otolith function, there was no significant difference between PSP patients and controls in the absolute peakto-peak amplitude of the oVEMP (13.5±7.2 µV and 12.5±5.6 µV, respectively; p =0.8) or the corrected peak-to-peak amplitude of the cVEMP (0.6±0.3 µV and 0.5±0.2 µV, p =0.3). The total root-mean-square body sway was significantly increased in patients with PSP compared to controls (eyes open/head straight/hard platform: 9.3±3.7 m/min and 6.9±2.1 m/min, respectively; p =0.032). As expected, the saccade velocities were significantly lower in PSP patients than in controls: horizontal, 234±92°/sec and 442±66°/sec, respectively; downward, 109±105°/sec and 344±72°/sec; and upward, 121±110°/sec and 348±78°/sec (all p <0.01). Conclusions We found no evidence of impairment of either high- or low-frequency semicircular function or otolith organ function in the examined PSP patients. It therefore appears that other causes such as degeneration of supratentorial pathways lead to postural imbalance and falls in patients with PSP.

Ocular Motor Abnormalities in Anti-IgLON5 Disease

“…Our results confirm previous reports underlining reduced saccade peak velocity, saccade amplitude and impaired gain of SPEM in patients suffering from PSP-P and PSP-RS compared to healthy controls (19,20). We could not detect impairment of semicircular-canal function examined at 0.32 Hz sinusoidal rotation in our patients with PSP (21). Square wave jerks have been described to occur in the early stage of PSP which was also observed in our cohort (22).…”

Distinct Vestibular Evoked Myogenic Potentials in Patients With Parkinson Disease and Progressive Supranuclear Palsy

“…It is in line with an earlier study of Liao et al, which reported reduced cVEMP amplitudes in 10 PSP patients compared to 30 controls, and suggested that impaired vestibulo-spinal reflexes contributed to postural instability in PSP (14). While Liao et al also measured reduced oVEMP amplitudes in PSP, other groups failed to confirm VEMP abnormalities in PSP (26,27). Moreover, although cVEMP and oVEMP scores did not differ in PD patients with and without a complaint of imbalance, we found delayed oVEMP latencies in those with imbalance.…”

Video Head Impulse Test and central nervous system diseases: a integrative review

“…In the first selection phase, the titles and abstracts of the identified studies were evaluated, and only 21 of them addressed the study theme of this literature review. These publications were read in full and, after application of the eligibility criteria, 18 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) were selected to compose the final sample of this study. Figure 1 shows the detailed selection process of these publications.…”

“…From the information extracted from the 18 selected articles (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) , a chart was created including data on disease, vestibular symptoms, and results of the vHIT and oculomotor tests (Chart 1).…”