Postural responses to electrical stimulation of the vestibular end organs in human subjects

Phillips, Christopher M.; DeFrancisci, Christina; Ling, Leow Pei; Nie, Kaibao; Nowack, Amy; Phillips, James O.; Rubinstein, Jay T.

doi:10.1007/s00221-013-3604-3

Cited by 46 publications

(50 citation statements)

References 52 publications

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“…34, 35 Restoring the function of one labyrinth through gene therapy 36 , stem cell interventions 37 or prosthetic interventions 38–46 yield significant benefits. For example, a multi-channel vestibular prosthesis (MVP) currently in development may partly restore unilateral semicircular canal function to BVD patients, thereby improving vestibulo-ocular reflex performance, visual acuity during head movement and postural stability 38, 39, 43–46 . An important consideration in its development is the device’s cost-utility.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Vestibular Deficiency

Sun

Ward

Semenov

et al. 2014

JAMA Otolaryngol Head Neck Surg

112

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Importance Bilateral vestibular deficiency (BVD) causes chronic imbalance, unsteady vision, and greatly increases the risk of falls; however, its effects on quality of life (QOL) and economic impact are not well defined. Objective Quantify disease-specific and health-related quality of life, health care utilization and economic impact suffered by individuals with BVD in comparison to those with unilateral vestibular deficiency (UVD) Design Cross-sectional survey study of BVD, UVD, and healthy individuals Setting Academic medical center Participants Fifteen BVD, 22 UVD and 23 healthy individuals. Vestibular dysfunction was diagnosed by caloric nystagmography Intervention Survey questionnaire Main Outcomes and Measures Health status was measured using the Dizziness Handicap Index (DHI) and Health Utility Index Mark 3 (HUI3). Economic burden was estimated using participant responses to questions on disease-specific health care utilization and lost productivity. Results In comparison to UVD and normal controls, BVD patients had significantly worse DHI and HUI3 scores. Multivariate regression analysis showed UVD, BVD, increasing number of dizziness-related emergency department (ED) visits, and increasing dizziness-related work-place absenteeism were associated with worse HUI3 scores. BVD and UVD patients incurred annual economic burdens of $13,019 and $3,531 per patient, respectively. Conclusions and Relevance BVD significantly decreases quality of life and imposes substantial economic burdens on individuals and society. These results underscore the limits of adaptation and compensation in BVD. Furthermore, they quantify the potential benefits of prosthetic restoration of vestibular function both to these individuals and to society.

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Section: Discussionmentioning

confidence: 99%

Bilateral Vestibular Deficiency

Sun

Ward

Semenov

et al. 2014

JAMA Otolaryngol Head Neck Surg

112

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“…They fulfilled the following inclusion criteria: (1) mean peak slow phase velocity of 5°/s or less in bilateral bithermal (30 and 44°C) caloric irrigations with water, (2) pathologic head-impulse test for horizontal and vertical semicircular canals, and (3) a VOR gain of <0.25 on rotatory chair tests. In addition, since there is a non-negligible risk of inducing a profound hearing loss with the implantation surgery (5, 17, 19, 20), we chose patients who were also profoundly deaf in the implanted ear (i.e., and thus could benefit from a cochlear implant).…”

Section: Methodsmentioning

confidence: 99%

“…They have also conducted preliminary animal studies confirming the possibility to electrically elicit eye movements (and thus effectively activate the vestibular system) with their device, and suggested that it was possible to preserve hearing and pre-existing vestibular function after implantation (18). Unfortunately, this was not verified in humans and both the auditory and vestibular function of implanted patients deteriorated considerably (17, 19). Recently, this group shifted focus to a motion coding device, as mentioned in a recent publication exploring the possibility to induce body sway upon computer-controlled electrical stimulation (19).…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, this was not verified in humans and both the auditory and vestibular function of implanted patients deteriorated considerably (17, 19). Recently, this group shifted focus to a motion coding device, as mentioned in a recent publication exploring the possibility to induce body sway upon computer-controlled electrical stimulation (19). …”

Section: Introductionmentioning

confidence: 99%

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Artificial Balance: Restoration of the Vestibulo-Ocular Reflex in Humans with a Prototype Vestibular Neuroprosthesis

et al. 2014

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The vestibular system plays a crucial role in the multisensory control of balance. When vestibular function is lost, essential tasks such as postural control, gaze stabilization, and spatial orientation are limited and the quality of life of patients is significantly impaired. Currently, there is no effective treatment for bilateral vestibular deficits. Research efforts both in animals and humans during the last decade set a solid background to the concept of using electrical stimulation to restore vestibular function. Still, the potential clinical benefit of a vestibular neuroprosthesis has to be demonstrated to pave the way for a translation into clinical trials. An important parameter for the assessment of vestibular function is the vestibulo-ocular reflex (VOR), the primary mechanism responsible for maintaining the perception of a stable visual environment while moving. Here we show that the VOR can be artificially restored in humans using motion-controlled, amplitude modulated electrical stimulation of the ampullary branches of the vestibular nerve. Three patients received a vestibular neuroprosthesis prototype, consisting of a modified cochlear implant providing vestibular electrodes. Significantly higher VOR responses were observed when the prototype was turned ON. Furthermore, VOR responses increased significantly as the intensity of the stimulation increased, reaching on average 79% of those measured in healthy volunteers in the same experimental conditions. These results constitute a fundamental milestone and allow us to envision for the first time clinically useful rehabilitation of patients with bilateral vestibular loss.

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“…Indeed, vestibular neurostimulators have been shown to be capable of producing aVOR-like nystagmus, the slow phase velocity of which can be controlled by modulating the current amplitude or pulse rate of the stimulation train and the direction by varying which canal nerves receive stimulation. Further studies have demonstrated that such a stimulator, combined with a headmounted rotational sensor, constitutes a functional vestibular prosthesis that is capable of partially restoring vestibulo-ocular reflex (VOR) Perez Fornos et al 2014;Golub et al 2014;Guyot et al 2011aGuyot et al , b, 2012Pelizzone et al 2014;Phillips et al 2015a, b;Thompson et al 2012;Wall et al 2007), producing head and postural movements (Mitchell et al 2013;Phillips et al 2013), and eliciting perceptual responses (Lewis et al 2013, Phillips et al 2015a.…”

Section: Introductionmentioning

confidence: 99%

Loss of Afferent Vestibular Input Produces Central Adaptation and Increased Gain of Vestibular Prosthetic Stimulation

Phillips

Shepherd

Nowack

et al. 2015

JARO

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Implanted vestibular neurostimulators are effective in driving slow phase eye movements in monkeys and humans. Furthermore, increases in slow phase velocity and electrically evoked compound action potential (vECAP) amplitudes occur with increasing current amplitude of electrical stimulation. In intact monkeys, protracted intermittent stimulation continues to produce robust behavioral responses and preserved vECAPs. In lesioned monkeys, shorter duration studies show preserved but with somewhat lower or higher velocity behavioral responses. It has been proposed that such changes are due to central adaptive changes in the electrically elicited vestibulo-ocular reflex (VOR). It is equally possible that these differences are due to changes in the vestibular periphery in response to activation of the vestibular efferent system. In order to investigate the site of adaptive change in response to electrical stimulation, we performed transtympanic gentamicin perfusions to induce rapid changes in vestibular input in monkeys with long-standing stably functioning vestibular neurostimulators, disambiguating the effects of implantation from the effects of ototoxic lesion. Gentamicin injection was effective in producing a large reduction in natural VOR only when it was performed in the non-implanted ear, suggesting that the implanted ear contributed little to the natural rotational response before injection. Injection of the implanted ear produced a reduction in the vECAP responses in that ear, suggesting that the intact hair cells in the non-functional ipsilateral ear were successfully lesioned by gentamicin, reducing the efficacy of stimulation in that ear. Despite this, injection of both ears produced central plastic changes that resulted in a dramatically increased slow phase velocity nystagmus elicited by electrical stimulation. These results suggest that loss of vestibular afferent activity, and a concurrent loss of electrically elicited vestibular input, produces an increase in the efficacy of a vestibular neurostimulator by eliciting centrally adapted behavioral responses without concurrent adaptive increase of galvanic afferent activation in the periphery.

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Postural responses to electrical stimulation of the vestibular end organs in human subjects

Cited by 46 publications

References 52 publications

Bilateral Vestibular Deficiency

Bilateral Vestibular Deficiency

Artificial Balance: Restoration of the Vestibulo-Ocular Reflex in Humans with a Prototype Vestibular Neuroprosthesis

Loss of Afferent Vestibular Input Produces Central Adaptation and Increased Gain of Vestibular Prosthetic Stimulation

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