The Association Between Precuneus Function and Residual Dizziness in Patients With Benign Paroxysmal Positional Vertigo

Abstract

ObjectivesThe purpose of this study was to apply the amplitude of the low-frequency fluctuation (ALFF) method to investigate the spontaneous brain activity alterations in patients with residual dizziness (RD) after successful canalith repositioning manoeuvre for benign paroxysmal positional vertigo (BPPV).MethodsAll BPPV patients underwent visual vertigo analog scale (VVAS) evaluations and functional magnetic resonance imaging (fMRI). The ALFF method was used to assess the spontaneous brain activity. Screening of brain regions with significant changes in ALFF values was based on analysis of the whole brain. We further analyze the relationship between ALFF values of the altered regions and VVAS scores in BPPV patients with RD.ResultsFifteen BPPV patients with RD and fifteen without RD were recruited in this study. In contrast to without RD, RD patients exhibited increased scores in VVAS tests (p < 0.001) and RD patients also showed significant ALFF decrease in the bilateral precuneus (left: 251 voxels; x = −10, y = −69, z = 51; peak t-value = −3.25; right: 170 voxels; x = 4, y = −59, z = 42; peak t-value = −3.43). Correlation analysis revealed that the mean ALFF z-values in the left precuneus displayed significant negative correlations with the VVAS scores(r = −0.44, p = 0.01).ConclusionsThis study shows that RD is associated with left precuneus function as revealed by fMRI. It might provide useful information for explaining neural mechanisms in BPPV patients with RD.

Altered parietal operculum cortex 2 functional connectivity in benign paroxysmal positional vertigo patients with residual dizziness: A resting‐state fMRI study

“…It was demonstrated that electrical stimulation of the precuneus evoked symptom of vertigo, suggesting that the precuneus was an important brain region in processing vestibular information 51,52 . In the present study, we observed decreased FC between left OP2 and left precuneus in BPPV patients with RD compared to healthy controls; this result was in agreement with a previous resting‐state fMRI study which reported decreased ALFF in the bilateral precuneus in BPPV patients with RD 33 . Our results of decreased FC between left OP2 and left precuneus in BPPV patients with RD might indicate decreased connectivity within the vestibular network.…”

“…The functional changes in the left AG have been previously observed in patients with chronic unilateral vestibulopathy during rest and in patients with PPPD during stationary emotional stimulation 31,32 . Our study found altered function in AG in BPPV patients with RD, which was consistent with a previous resting‐state fMRI study which reported decreased ALFF in the AG in BPPV patients with RD compared to patients without RD 33 . We also found that the FC between left AG and OP2 was negatively correlated with the duration of BPPV.…”

“… 31 , 32 Our study found altered function in AG in BPPV patients with RD, which was consistent with a previous resting‐state fMRI study which reported decreased ALFF in the AG in BPPV patients with RD compared to patients without RD. 33 We also found that the FC between left AG and OP2 was negatively correlated with the duration of BPPV. Our results indicated impaired spatial cognition in BPPV patients with RD, and the occurrence of RD might be related to the reduced FC between the areas involved in central vestibular processing and spatial cognition.…”

Increased functional connectivity between default mode network and visual network potentially correlates with duration of residual dizziness in patients with benign paroxysmal positional vertigo

“…Functional changes in DMN have been reported in vestibular disorders of VM ( 35 ), VN ( 36 ) and persistent postural perceptual dizziness (PPPD) ( 37 ), indicating that DMN might be involved in vestibular information processing. In BPPV patients with RD, altered functional activities in PCU were observed by a previous resting-state fMRI study, which was consistent with the functional change of IC 1 (PCU) found in this study ( 10 ). The PCU, a key region of pDMN, was reported to be significantly activated during optokinetic stimulation ( 38 ) and visuo-spatial imagery ( 39 ).…”

“…The authors reported increased functional activities in bilateral pons and left posterior cerebellar regions in BPPV patients, these results indicated that the functional changes in pons might be related to RD after CRM ( 9 ). In another rs-fMRI study, Fu et al applied fALFF analysis to observe the differences in brain functional activity between RD patients and non-RD patients after CRM, the authors found decreased functional activity in bilateral precuneus in patients with RD compared to patients without RD ( 10 ). The above two studies preliminarily suggested that the occurrence of RD symptoms in BPPV patients might be related to central integration and compensation.…”