Advancements in Functional Magnetic Resonance Imaging for Persistent Postural-Perceptual Dizziness

Persistent postural-perceptual dizziness, defined in 2017, is a chronic functional vestibular disorder. Which is characterized by persistent dizziness, unsteadiness, and/or non-spinning vertigo. However, the exact mechanisms remain unclear. In recent years, FMRI studies have provided key insights into the pathogenesis of PPPD. This review summarized functional imaging studies of persistent postural dizziness and its predecessors in recent years and found changes in the activity and functional connectivity of important areas of visual processing, multisensory vestibular and spatial cognition in patients with PPPD. In addition, factors such as stimulation mode, personality traits, mental comorbidities and external vestibular lesions have important effects on brain functional activities and connectivity patterns, and further stratified studies on these factors are needed in the future to further clarify and draw exact conclusions on the pathological mechanism of PPPD.

Effects of Kampo medicine hangebyakujutsutemmato on persistent postural-perceptual dizziness:A retrospective pilot study

BACKGROUND Persistent postural-perceptual dizziness(PPPD)is a functional disorder,typically preceded by acute vestibular disorders.It is characterized by a shift in processing spatial orientation information,to favor visual over vestibular and somatosensory inputs,and a failure of higher cortical mechanisms.To date,no therapies for PPPD have been approved.Kampo medicine hangebyakujutsutemmato(HBT)has been reported to alleviate disturbances of equilibrium.We hypothesized that HBT would be a beneficial treatment for PPPD.AIM To examine the efficacy of HBT for the treatment of PPPD.METHODS Patients with PPPD were enrolled and divided into two groups:The HBT group(n=24)and the non-HBT group(n=14).The participants completed questionnaire surveys[Niigata PPPD questionnaire(NPQ),dizziness handicap inventory,hospital anxiety and depression scale(HADS),orthostatic dysregulation questionnaire,pittsburg sleep quality index(PSQI),and motion sickness scores]before and after HBT treatment.Additionally,to identify HBT responders,multivariate regression analysis was performed using the results of the ques-tionnaire surveys and equilibrium tests;including stabilometry,and caloric,vestibular evoked myogenic response,and head-up tilt tests.RESULTS Thirty-eight outpatients were included in this study,of which 14 patients(3 men,11 women;mean age,63.5±15.9 years)received treatment without HBT,and 24(1 man,23 women;mean age,58.2±18.7 years)received combination treatment with HBT.Following HBT treatment,NPQ scores decreased significantly(baseline 40.1±10.0 vs 2 mo 24.6±17.7,P<0.001).No statistically significant changes were observed in the NPQ scores in the non-HBT group(baseline 38.6±12.2 vs 2 mo 39.4±14.4,P=0.92).Multivariable regression analysis revealed that the results of stabilometry(P=0.02)and the caloric(P=0.03),and head-up tilt tests(P<0.001),HADS(P=0.003),and PSQI(P=0.01)were associated with HBT responsiveness in PPPD patients.CONCLUSION HBT may be an effective adjunct therapy for PPPD.Patients with autonomic dysfunction,unstable balance,semicircular canal paresis,anxiety,and poor sleep quality may be high responders to HBT.

Cervical intervertebral disc degeneration and dizziness

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness.Anterior cervical surgery can eliminate not only chronic neck pain,cervical radiculopathy or myelopathy,but also dizziness.Immunohistochemical studies show that a large number of mechanoreceptors,especially Ruffini corpuscles,are present in degenerated cervical discs.The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease(i.e.cervical discogenic dizziness).Disc degeneration is characterized by an elevation of inflammatory cytokines,which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization.Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system,resulting in sensory mismatches with vestibular and visual information and leads to dizziness.In addition,neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles.Like cervical discogenic pain,the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out.Conservative treatment is effective for the majority of patients.Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.

Clinical evaluation of Xiaoyao Jieyu prescription in the treatment of persistent postural-perceptual dizziness

Objective： The objective of this study is to evaluate the clinical efficacy of Xiaoyao Jieyu prescription （XJP） in the treatment of persistent postural-perceptual dizziness （PPPD）. Methods： A total of 33 PPPD patients were randomly divided into test group and control group. Two groups of patients were given psychological treatment. The test group was given XJP and the control group was given escitalopram. The course of treatment was 12 weeks. Before and after 4 weeks and 8 weeks and 12 weeks, the dizziness handicap inventory （DHI）, Hamilton anxiety scale （HAMA） and Hamilton Depression scale （HAMD） were used to evaluate the treatment effect. Results： The total scores of HAMA, HAMD, DHI and the respective factor scores of DHI significantly decreased in both groups after 4 weeks of treatment compared with those before the treatment （P 〈 0.01）. The DHI scores and the score of function, physiology at 8-week, 12-week, as well as the HAMA and HAMD scores at 4-week, 8-week, 12-week in the test group were significantly lower than those in the control group （P 〈 0.05）. The incidence of adverse reactions in the test group was significantly lower than the control group （P 〈 0.05）. Conclusion： XJP can improve the clinical symptoms of patients with PPPD. It can both improve the physical and functional symptoms of PPPD and reduce anxiety and depression. In the course of treatment, the adverse reaction of the prescription is less and mild. It has the advantages of high efficiency, safety, low price and easy access to materials.

Electromagnetic Waves Collected by a Dental Amalgam Filling Induced Balance Dysregulation and Dizziness over a Period Exceeding 10 Years

This case report describes a woman aged approximately 50 years who has suffered from balance dysregulation and dizziness for more than 10 years. Although the subject underwent several examinations to confirm the etiology of her symptoms, the root cause remained unknown. The symptoms were thought to be caused by electromagnetic wave hypersensitivity because the subject experienced uneasiness and dizziness when a cell phone was held close to her body. A cell phone was used to diagnose the collection of harmful electromagnetic waves, and an amalgam filling was determined to be the cause. The amalgam filling was removed under strict protection, and the subject’s symptoms completely disappeared soon after the filling was removed.

Dental Treatment for Dizziness and Joint Mobility Disorder Caused by Harmful Electromagnetic Waves

With the development of an IT (Information Technology) society, the opportunity to use electronic devices, such as cell phones and personal computers, has increased. These electronic devices pro-vide many benefits to society. However, there have been a number of reports of electromagnetic hypersensitivity (EHS) related to the use of electronic devices. The symptoms of EHS may include headaches, fatigue, tinnitus, dizziness, memory loss, irregular heartbeat, and skin trouble. Since the pathogenic mechanism of such conditions is not yet clear, further research is required. This report shows how a subject’s dizziness and joint mobility disorder, caused by electromagnetic waves emitted by electronic devices, were cured by removing an onlay from the patient’s mouth and replacing it with a gold alloy onlay. The result indicates that the subject’s symptoms were caused by EHS. Although the symptoms were improved after the dental treatment, the underlying mechanism of the symptoms and the reason why this treatment is successful remain unclear. Further research is required to clarify these issues.

Transient ventricular arrhythmia as a rare cause of dizziness during exercise:A case report

BACKGROUND Dizziness is a common symptom in adults and usually due to peripheral causes affecting semicircular canal function or central causes affecting the pons,medulla,or cerebellum.Arrhythmia is a recognized cause of dizziness in people with structural or ischemic heart disease.We report a case of exercise-induced transient ventricular tachycardia and dizziness in a man with no evidence of organic heart disease.CASE SUMMARY A 42-year-old man presented with a 6 mo history of transient exercise-induced dizziness and prodromal palpitations.The patient was otherwise asymptomatic.Physical examination,otoscopy,vestibular tests,cerebellar tests,laboratory investigations,and imaging investigations were all unremarkable.Twenty-four hour Holter monitoring revealed four episodes of transient ventricular tachycardia during exercise.The patient was started on metoprolol and subsequently underwent radiofrequency catheter ablation.The patient reported a full recovery and no dizziness during daily activities.These results were maintained at the 6 mo follow-up.CONCLUSION Ventricular tachycardia is an uncommon but potentially serious cause of dizziness.The outcome of this case illustrates the benefits of careful clinical examination and communication with specialized centers.High clinical suspicion of arrhythmia in a patient with dizziness merits consultation with a cardiologist and referral to a specialized center to ensure timely diagnosis and treatment.

Experience in Acupuncture Treatment of Dizziness and Vertigo——A Report of 3 Cases

Dizziness and vertigo is a commonly encountered disease in clinic. There has been the saying from ancient times that "there would be no dizziness if without wind", " there would be no dizziness if without phlegm", "there would be no dizziness if without deficiency", and " there would be no dizziness if without fire". However, in the author's view, the dizziness and vertigo caused by blood stasis blocking the collaterals is most commonly seen in clinic, which should deserve more attention. The following is an introduction about the author's experience in treating 3 cases of dizziness and vertigo with acupuncture.

Treatment of Dizziness by Massotherapy and Traditional Chinese Drugs——A Report of 110 cases

Note: HLY = hyperactivity of the liver-yang, STPMJ = stagnation of turbid phlegm in middle-Jiao, DQB = deficiency of qi and blood, DKE = deficiency of the kidney-essence, OCBS = obstruction of collaterals by blood

Comparison of Survey Results on Subjective Dizziness,Hearing and Tinnitus and Stabilometry Test Results in Yakumo Inhabitant Examination Study (Comparison of 2005, 2007 and 2015, 2017)

Abstract: The Nagoya University Hospital otolaryngology department is doing the prospective cohort study in Yakumo-cho, Hokkaido, Japan from 2005, because this place is a little transfer of the population. Most of inhabitants of Yakumo-cho engage in fishery and agriculture as work mainly. We perform questionary survey using an interview vote. The item is “having feeling of dizziness or not”,“quality of hearing” and “having tinnitus or not”. Furthermore, we go for the examination of stabilometry, too. We compared 2015, 2017 with 2005, 2007 among Yakumo-cho inhabitant examination data this time. As a result, participant with a feeling of conscious dizziness got a bad reputation of the hearing consciously. In addition, participant with a feeling of conscious dizziness had tinnitus consciously. Furthermore, the participant with a feeling of conscious dizziness had bad stabilometry result. As a result of having compared ten years later, we understood that stabilometry result worsened if 60s became in 70s with or without a feeling of dizziness consciously. When there is a feeling of conscious dizziness, it is necessary to perform an examination of stabilometry as routine work. In addition, it is necessary to inspect stabilometry if participants have the bad hearing or tinnitus with a feeling of dizziness in particularly.

Isolated versus Drug Combined Vestibular Rehabilitation for the Treatment of Metabolic Dizziness

Introduction: Systemic processes and inappropriate use of medications may affect vestibular adaptation. Objectives: To assess the efficacy of isolated and combined drug therapy for treating metabolic dizziness and to determine the effect of multidrug treatment. Methodology: We analyzed 100 questionnaires of patients diagnosed with dizziness of metabolic origin. Results: The group treated with vestibular rehabilitation alone showed improvement with 9 months of therapy (p = 0.01). The group treated with vestibular rehabilitation and medication showed improvement with 45 days of therapy (p = 0.01). The group treated with a single type of drug did not show significant improvement. The group treated with several drugs showed improvement with 45 days of therapy (p = 0.03). Conclusion: Combined vestibular rehabilitation resulted in immediate improvement of symptoms without contributing to long-term compensation. Vestibular rehabilitation alone resulted in improve- ment of symptoms over time. Multidrug treatment was beneficial for immediate relief of dizziness.

Integrating cupping therapy in the management of tinnitus and dizziness:a pilot study

Background:Cupping therapy is one of integrative medicine modalities which is used by several nations.Its mechanism of action is not well known but there are several theories explained how it can play a rule in the treatment of diseases.In recent years,huge advances have taken place in understanding of inner ear pathophysiology causing sensorineural hearing loss,tinnitus,and vertigo.Research articles providing evidence of acupuncture treating dizziness and vertigo but no studies of cupping therapy.The aim of this pilot study was to evaluate the safety and efficacy of integrating wet cupping therapy in the management of tinnitus and dizziness associated with ear pathologies.Methods:This is a prospective interventional pilot study in which pre and post intervention outcomes(tinnitus handicap inventory and dizziness handicap inventory)were assessed and compared.27 patients diagnosed with Ménière's disease and idiopathic tinnitus or tinnitus secondary to inner ear pathology were included in this study and received usual medical treatment and wet cupping therapy.Results:There was a significant improvement after 6 sessions of cupping in tinnitus handicap inventory and dizziness handicap inventory but not in patient’s hearing.No adverse events were reported in this study.Conclusion:Wet cupping therapy demonstrates a promising effectiveness in reducing discomforts of both dizziness and tinnitus.A large scale randomized controlled trial is recommended.

Discussion on the Treatment of Ear Vertigo Based on the Theory of"All Winds and Dizziness Belong to the Liver"

The theory of"all winds and dizziness belong to the liver"provides a basis for 1ater plysicians to study the etiologic and pathogenesis of vertigo diseases.This theory of pathogenesis suggests that vertigo diseases are most closely related to the liver,so the mechanism can be simply understood as liver and spleen damage.Water dampness is unfavourable for transportation and transformation as dampness gathers phlegm,and liver‘wind’carries phlegm to the ear orifice,causing dizziness,or the ear orifice can be attacked due to the deficiency of yin and hyperactivity of yang in liver and kidney,resulting in sudden dizziness.Based on the pathogenesis theory of liver and spleen damage,the treatment principles should be based on strengthening the spleen and dispelling dampness,eliminating phlegm and extinguishing‘wind’.For‘yang-type'hyperactive liver,nourishing yin and suppressing yang,and the clearing of yang in the ears should always be the standard.

Systematic Review and Meta-analysis on the Efficacy and Safety of Tianma Gouteng Granules(天麻钩藤颗粒)in Treatment of Dizziness

Objective:The effectiveness and safety of Tianma Gouteng Granules(天麻钩藤颗粒)in the treatment of dizziness were systematically evaluated.Methods:A randomized controlled trial of Tianma Gouteng Granules for dizziness was screened out by searching CNKI,Wanfang Data,VIP,SinoMed,Cochrane Library,PubMed,Embase,Web of Science in a systematic way and was based on Handbook 5.1 evaluation criteria and tools and RevMan 5.3 software for meta-analysis of the final inclusion of the study.Results:A total of 7 studies were included,6 studies were included in meta-anlysis and 1 other study,with a total sample size of 568 cases,including 328 cases in the experiential group and 240 cases in the control group.The systolic pressure of Tianma Gouteng Granules alone or combined with conventional treatment in the treatment of dizziness is better than conventional treatment alone(MD=-3.38,95%CI[-4.90,-1.86],P<0.00001).The diastolic pressure of Tianma Gouteng Granules alone or combined with conventional treatment in the treatment of dizziness had no difference compared with conventional treatment alone(MD=-1.35,95%CI[-2.36,-0.34],P=0.72).The TCM syndromes score of Tianma Gouteng Granules alone or combined with conventional treatment in the treatment of dizziness was better than conventional treatment(MD=-5.18,95%CI[-6.89,-5.47],P<0.00001).The marked effective rate of Tianma Gouteng Granules combined with conventional treatment in the treatment of dizziness was better than conventional treatment(RR=2.09,95%CI[1.35,3.24],P=0.001).The marked effective rate of Tianma Gouteng Granules in the treatment of dizziness was better than conventional treatment(RR=1.85,95%CI[1.34,2.54],P=0.0002).Adverse actions included stomach discomfort,dry mouth,headache,dizziness,nausea,insomnia,rash,etc.The number of reported cases in both groups was small.Conclusion:The treatment of systolic pressure,TCM syndrome score and marked effective rate of Tianma Gouteng Granules alone or combined with conventional treatment for dizziness was better than conventional treatment.There was no difference between Tianma Gouteng Granules alone or combined with conventional treatment on diastolic pressure.No serial reverse actions were reported,and all reverse actions were reported after drug withdrawal or dose reduction,and the sample size was small,requiring large samples for further verification.However,the quality of the study is not high,and it is necessary to improve the level of evidence quality by using clinical trial schemes with large samples,rational design and compliance with international standards.

Effectiveness and safety of Ginkgo biloba extract(GBE50)in the treatment of dizziness caused by cerebral arteriosclerosis:a multi-center,double-blind,randomized controlled trial

OBJECTIVE:To evaluate the effectiveness and safety of Ginkgo biloba extract(GBE50)in the treatment of dizziness caused by cerebral arteriosclerosis.METHODS:This was a multi-center,double-blind,double-dummy,positive-controlled,parallel randomized controlled clinical trial with 1∶1 allocation.We recruited 404 patients with dizziness caused by cerebral arteriosclerosis(blood stasis symptom pattern)in 10 hospitals in China.GBE50 group received GBE50 and Naoxinqing tablet(NXQ)of mimetic agent,control group received NXQ and GBE50 of mimetic agent.The main outcome was Traditional Chinese Medicine(TCM)symptom pattern score of blood stasis after 6 weeks.The secondary outcomes were changes in the dizziness handicap inventory(DHI)score,vertigo visual analogue scale(VAS)score,the university of California vertigo questionnaire(UCLA-DQ)score and single-item symptom score of TCM from baseline to 2,4 and 6 weeks.Safety indicators included the incidence of adverse events,severe adverse events and laboratory examination including blood routine,liver function,renal function,and so forth.RESULTS:The total effective rate of TCM symptom pattern score in the GBE50 group after 6 weeks of treatment was higher than that in the control group,the difference in rate was statistically significant(92.67%vs 83.07%,P=0.004).Compared with the control group,there was no difference in the incidence of adverse reactions(9.95%vs 14.85%,P=0.136).CONCLUSION:The treatment of dizziness caused by cerebral arteriosclerosis with GBE50 is effective,safe and reliable.

短期针刺治疗良性阵发性位置性眩晕复位后残余头晕的研究

目的观察短期针刺治疗良性阵发性位置性眩晕(BPPV)手法复位成功后残余头晕(residual dizziness,RD)症状的临床疗效。方法对手法复位成功后存在RD症状的BPPV患者80例,随机分为针刺组和对照组,每组40例。治疗组予短期针刺治疗,主穴为晕听区、平衡区等。常规针刺,留针30 min,1次/d,3次为一个疗程。对照组仅予以随访观察。分别于治疗前及治疗后第1、4周对两组患者进行眩晕障碍量表(dizziness handicap inventory,DHI)中文版及视觉模拟尺量表(VAS)评分,比较两组结果。结果治疗后第1周,除对照组中DHI情绪评分项目外,针刺组和对照组治疗后DHI各项评分、总分、VAS评分均较治疗前降低(P<0.05);治疗后第4周,针刺组和对照组治疗后DHI各项评分、总分、VAS评分均较治疗前及治疗后第1周降低(P<0.05);治疗后第1周,治疗组的DHI情绪、DHI功能评分、总分、VAS评分均低于对照组(P<0.05);治疗后第4周,治疗组的DHI功能评分及总分均低于对照组(P<0.05)。结论短期中医针刺治疗能有效减轻BPPV复位成功后的RD症状,尤其在发病后短期内能有效缓解患者头晕症状。

Implementation outcomes of a sensory integration therapy program with computerized dynamic posturography in patients with balance and sensory dysfunction

Objective:We describe the first-year implementation experience of an Instrumented Sensory Integration Therapy Program in Audiological&Balance Center patients.Design:This is a retrospective descriptive study.Participants included Seventy-three adults with diagnoses of acute,episodic,or chronic vestibular syndromes.They were classified into the following two groups:group 1 included 46 individuals treated with ISIT plus VRT,and group 2 included 27 individuals treated only with ISIT.Results:The Sensory Organization Test(SOT)for both groups showed a statistical significance for all three sensory inputs;visual systems(G1:p=0.0003;G2:p=0.0337),vestibular system(G1:p<0.0001;G2:p=0.0003),and balance as demonstrated by compound balance score(G1:p<0.0001;G2:p=0.0035),and balance percentage deficit(G1:p<0.0001;G2:p=0.0078).Conclusions:The severity and complexity of functional neurological disorders in the context of vestibular syndromes seem to require between 10 and 20 therapy sessions,and combined ISIT plus VRT appears to be more effective than ISIT as a monotherapy.

以头晕为首发表现的遗传性尿素循环障碍特点分析

作为一名耳内科医师,经常会听到头晕、头昏及眩晕等众多主诉,患者常常难以明确描述其临床症状。眩晕分为广义和狭义两大类。广义的眩晕(dizziness)指非前庭系统性眩晕或头昏;狭义的眩晕(vertigo)指前庭系统性眩晕,是由于生理或病理性刺激引起患者有外物转动的错觉,是一种空间定位障碍产生的运动错觉,即人体与周围环境之间的相互空间关系在皮层感觉中枢的反应出现失真[1]。尿素循环障碍(urea cycle disorders,UCDs)是一组由于先天酶缺陷引发的以高血氨为特征的代谢性疾病,严重者在新生儿阶段就可以出现拒食、嗜睡、呕吐、抽搐、

Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging

Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso- nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat- ment only. The intervention group received vertebral artery orifice angioplasty and stenting ＋ identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

Applications of dynamic visual acuity test in clinical ophthalmology

Dynamic visual acuity test(DVAT)plays a key role in the assessment of vestibular function,the visual function of athletes,as well as various ocular diseases.As the visual pathways conducting dynamic and static signals are different,DVATs may have potential advantages over the traditional visual acuity tests commonly used,such as static visual acuity,contrast sensitivity,and static perimetry.Here,we provide a review of commonly applied DVATs and their several uses in clinical ophthalmology.These data indicate that the DVAT has its unique clinical significance in the evaluation of several ocular disorders.