Tetra-ataxiometric Posturography in Patients with Migrainous Vertigo

Abstract

Background: Migraine is a common disorder characterized by headache attacks frequently accompanied by vestibular symptoms like dizziness, vertigo, and balance disorders. Clinical studies support a strong link between migraine and vertigo rather than between other headache types and vertigo or nonvertiginous dizziness. There is a lack of consensus regarding the pathophysiology of migrainous vertigo. Activation of central vestibular processing during migraine attacks and vasospasm-induced ischemia of the labyrinth are reported as the probable responsible mechanisms. Because vestibular examination alone does not provide enough information for diagnosis of migrainous vertigo, posturography systems which provide objective assessment of somatosensory, vestibular, and visual information would be very helpful to show concomitant involvement of the vestibular and somato-sensorial systems. There are few posturographic studies on patients with migraine but it seems that how balance is affected in patients with migraine and/or migrainous vertigo is still not clear. We want to investigate balance function in migraineurs with and without vertigo with a tetra-ataxiometric posturography system and our study is the first study in which tetra-ataxiometric static posturography was used to evaluate postural abnormalities in a well-defined population of patients with migrainous vertigo. Objective: To investigate balance functions in migraineurs with and without vertigo with a tetra-ataxiometric posturography system. Study Design: Prospective, nonrandomized, controlled study. Setting: Pamukkale University Hospital, Neurology and Physical Therapy and Rehabilitation outpatient clinics. Methods: Sixteen patients with migrainous vertigo, 16 patients with migraine without aura and no vestibular symptoms, and 16 controls were included in the study. Computerized static posturography system was performed and statistical analyses of fall, Fourier, Stability, and Weight distribution indexes were performed. The tetra-ataxiometric posturography device measures vertical pressure fluctuations on 4 independent stable platforms, each placed beneath 2 heels and toe parts of the patient; inputs from these platforms are integrated and processed by a computer digitally. Four separate plates are used and perpendicular pressures of the anterior and posterior feet are measured. Pressure of each force plate is measured and data was analyzed by the software program. Limitations: A very small, non-randomized, and controlled study with the inability to find an answer to the mechanism of involvement of the somatosensorial system and vestibular system in migrainous headaches. Results: The distribution of patients with posturographical abnormalities in the migrainous vertigo group was significantly different than the control group. Distribution of the patients with posturographical abnormalities in the high frequencies of the head-right position was significantly different in the migrainous vertigo group than in the control group and distribution of the patients with posturographical abnormalities in high frequencies of the head-right position was significantly different in the migraine group than in the controls groups. The stability index of the migrainous vertigo group was significantly higher than in the control group when tested on in the neutral-head position with open eyes. Conclusion: In this first study of tetra-ataxiometric static posturography evaluating postural abnormalities in a well-defined population of patients with migrainous vertigo, the central part of the vestibular apparatus would be responsible of postural abnormalities in patients with migraine and migrainous vertigo. Key words: Fall index, migraine, migrainous vertigo, static posturography

Vibration Perception Threshold and Related Factors for Balance Assessment in Patients with Type 2 Diabetes Mellitus

“…The patients stood in the center of four force plates and were instructed to maintain eight different postures, such as head rotation, upward, and downward, with eyes open, eyes closed, and on unstable surfaces. In this study, the postural steadiness was estimated with reference to the fall risk index, ST, and FI for a medium to high frequency of 0.5–1 Hz [ 11 , 34 , 35 , 36 , 37 ].…”

“…Fall risk index: The fall risk index is globally calculated using the data of ST, FI, WDI, and synchronization index, considering the oscillation velocities computed by the Tetrax ® program [ 34 , 36 , 37 ]. It is numerically expressed from 0 to 100.…”

“…A value of 0–36 indicates low risk, 37–58 indicates moderate risk, and 59–100 indicates high risk. A higher fall risk index indicates a greater risk of falling [ 34 , 35 , 36 , 37 ].…”

“…Then, it is divided by the patient’s body weight [ 34 , 35 , 37 ]. A higher index score indicates more postural instability [ 34 , 35 , 36 , 37 ].…”

“…The FI value for medium to high frequency of 0.5–1 Hz (F 5–6) is high when the patients present with somatosensory dysfunction of the lower extremities and spine [ 34 , 38 ]. A higher index score for frequency represents greater postural instability [ 35 , 36 , 37 ].…”