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.

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.

Clinical research progress on acupuncture for the treatment of otogenic vertigo

Otogenic vertigo is a common disorder that affects the vestibular system,which often results in considerable discomfort and impaired daily functioning.Traditional Chinese medicine(TCM),including acupuncture and moxibustion,has been historically utilized to manage the symptoms of vertigo.However,the effectiveness and methodology of these treatments have rarely been investigated in the medical literature.This study reviews the existing literature on the point selection,method,and therapeutic effect of acupuncture and moxibustion to provide a reference for the TCM treatment of otogenic vertigo.A literature search was performed using the PubMed search engine.The terms used included otogenic vertigo,acupuncture treatment,and acupuncture point selection.A total of 34 relevant articles were retrieved from PubMed.These suggest that the clinical treatment of otogenic vertigo should consider the functions of zang-fu organs and meridians and select different acupuncture treatment methods according to syndrome differentiation based on the difference between deficiency and excess.Acupuncture and moxibustion therapy should be based on acupoint selection,considering the syndrome differentiation,supplemented with experience.The treatment of otogenic vertigo with acupuncture and moxibustion refers to the selection of appropriate acupuncture methods under the guidance of TCM theory and following the principles of syndrome,disease,and meridian differentiation.Common acupuncture methods include body acupuncture,auricular acupuncture,scalp acupuncture,acupoint injection,electroacupuncture,and moxibustion.There are many acupuncture and moxibustion acupoints selected for the treatment of otogenic vertigo.Individualized treatment according to the patient’s specific condition is effective and safe,which can help to improve the patient’s vertigo symptoms and cerebral blood perfusion.

ACUPUNCTURE TREATMENT OF DIZZINESS AND VERTIGO

Case HistoryName: Xia; Sex: male, Age: 62; Occu-Pation: worker (retired); Date of first visit:May 27, 1985.Chief ComplaintsDizziness and vertigo with nausea for20 days. Since the afternoon of May 8

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.

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.

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.

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.

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.

Post-stroke dizziness and psycholo gical disturbance

AIM:To study the relationship between post-stroke dizziness and psycho-logical factors.METHODS:To choose 82cases with dizziness after stroke.The patients whose medical treatmen t were invalid were divided into two groups randomly.The experimental g roup of 43cases was treated with an-tipsychotic and the controls group o f 39cases was treated with consola-tion.RESULTS:The total effective rate in experime ntal group was signifi-cantly higher than that in the contro l group(P<0.001).CONCLUSION:It is suggested that though the menta l scales scores might be normal,post-stroke dizziness should be tre ated for a long-term helplessly be ju st a sign of psychological matter.It ought to be discerned and given pertinen t treatments.

The Causes of Dizziness in Parkinson’s Disease

Patients with Parkinson’s disease complain dizziness frequently. Postural hypotension and postural instablity are suggested to be the reasons of dizziness in elderly people with Parkinson’s disease. The aim of this prospective surveillance study was to characterize the etiology of the dizziness in patients with PD. A total of 47 consecutive patients with idiopathic Parkinson’s disease were enrolled in the prospective surveillance study. Of the 47 patients, 32 (68.1%) had dizziness. All patients underwent neurological and otologic examination. Complete blood count, serum electrolytes, glucose, liver function tests, renal function tests and thyroid function tests, cranial computerized tomography, direct cervical region radiography and vertebral artery doppler ultrasonography were obtained from all patients. Patients were screened for blood pressure changes, drug use, cardiovascular diseases, hypertension and diabetes mellitus. The findings of loss of disk height, with subsequent loss of cervical lordosis were higher in patients with dizziness (p = 0.01). The results of this study show that cervical-vertebral degeneration may be a common cause of dizziness in Parkinson’s disease patients.

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.

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.

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.

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.

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

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.

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.

Acute isolated vertigo with vertical up-beating nystagmus: A rare case of nucleus intercalatus of Staderini ischemia

The role of intercalatus nucleus of Staderini(INS),the most caudal of the perihypoglossal nuclei,is much debated.Last research seems to suggest that this nucleus plays a role as a vertical eyes movements integrator.The few clinical reports present in the literature that describe isolated lesions of the INS have described patients presenting in acute with up-beating vertical spontaneous nystagmus.Isolated acute lesion of INS is,in fact,much rare,and,without other neurological signs,is exceptional.We present a case of acute isolated vertigo with no other neurological signs or symptoms,due to INS ischemia provoked by vertebral artery stenosis.The patient presented with spontaneous vertical up-beating nystagmus that showed at videonystagmographic recording,a clear exponential decay of angular slow-phase velocity,that is considered a typical sign of neural integrator impairment.This case seems to represent a further confirm that INS is part,as a vertical-to-position neural integrator,of the neural circuit controlling the vertical eyes movements.

菊钩逍遥散对耳石症手法复位后肝郁型残余头晕患者血浆ET-1、CGRP及NPY水平的影响

目的观察菊钩逍遥散治疗耳石症手法复位后肝郁型残余头晕(RD)的疗效,及对血浆中内皮素-1(ET-1)、降钙素基因相关肽(CGRP)及神经肽Y(NPY)水平的影响并探讨其作用机制。方法90例患者随机分成对照组、中药组和联合组3组各30例。对照组给予甲磺酸倍他司汀片口服,中药组给予菊钩逍遥散口服,联合组给予菊钩逍遥散和甲磺酸倍他司汀片口服。治疗2周后,观察各组的临床疗效、DHI评分、SAS评分和血浆中ET-1、CGRP及NPY的变化。结果联合组总有效率为93.33%,高于中药组的82.76%和对照组的66.67%(P<0.05)。3组治疗前DHI、SAS评分、ET-1、CGRP和NPY含量比较,差别均不大(均P>0.05)。3组治疗后DHI、SAS评分均较治疗前降低(均P<0.01),且中药组、联合组的DHI、SAS评分均低于对照组(均P<0.01),而中药组和联合组DHI、SAS评分比较差别均不大(P>0.05)。3组治疗后ET-1、NPY含量均较治疗前降低(均P<0.01);中药组、联合组ET-1、NPY含量均低于对照组(均P<0.01),中药组和联合组比较,差异无统计学意义(P>0.05)。3组治疗后CGRP含量均较治疗前升高(均P<0.01),且中药组、联合组CGRP含量均高于对照组,联合组CGRP含量高于中药组(均P<0.01)。治疗过程中对照组出现2例便秘,中药组出现1例胃部不适,联合组出现1例便秘,各组均未见其他明显不良反应。结论菊钩逍遥散治疗RD疗效确切,能够缓解焦虑而改善残余头晕,其作用机制可能与调节血浆中ET-1、CGRP及NPY的水平有关。