Background:Saccades are often observed on video head impulse tests(vHIT)in patients with Meniere's Disease(MD)and Vestibular Migraine(VM).However,their saccadic features are not fully described.Objective:This stud...Background:Saccades are often observed on video head impulse tests(vHIT)in patients with Meniere's Disease(MD)and Vestibular Migraine(VM).However,their saccadic features are not fully described.Objective:This study aims to identify the saccades characteristics of MD and VM.Methods:75 VM patients and 103 definite unilateral MD patients were enrolled in this study.First raw saccades were exported and analyzed.The VM patients were divided into left and right based on their ears,while the MD patients were separated into affected and unaffected subgroups based on their audiograms and symptoms.Results:The MD patients have more saccades on the affected side(85%vs.69%),and saccade velocity is more consistent than the contralateral side(shown by the coefficient of variation).The saccades occurrence rates on both sides are similar in VM(77%vs.76%),as are other saccadic parameters.The MD patients have more significant inter-aural differences than the VM patients,manifested in higher velocity(p-value 0.000),earlier arriving(p-value 0.010),and more time-domain gathered(p-value 0.003)on the affected side.Conclusions:Bilateral saccades are commonly observed in MD and VM.In contrast to MD,saccades on VM are subtle,scattered,and late-arrived.Furthermore,the MD patients showed inconsistent saccadic distribution with more velocity-uniform saccades on the affected side.展开更多
Objectives: Vestibular migraine is one of the most common causes of episodic vertigo in adults and even in children. Traditional;management may have a side effect on the long run. So the aim of this review is to expla...Objectives: Vestibular migraine is one of the most common causes of episodic vertigo in adults and even in children. Traditional;management may have a side effect on the long run. So the aim of this review is to explain the other non-medical lines of management for patients with migraine. Methods: English articles from Medline and Cochrane library were searched and reviewed. Results: Evidence indicates that non-traditional management has a prophylactic and therapeutic effect on migraine patients with all its steps. Conclusion: Due to the possible side effects of pharmacological drugs and drug addictions, the use of non-traditional management alone or in combination with normal cures have been proposed. However, further constructive studies are required.展开更多
Objective:Saccades accompanied by normal gain in video head impulse tests(vHIT)are often observed in patients with vestibular migraine(VM).However,they are not considered as an independent indicator,reducing their uti...Objective:Saccades accompanied by normal gain in video head impulse tests(vHIT)are often observed in patients with vestibular migraine(VM).However,they are not considered as an independent indicator,reducing their utility in diagnosing VM.To better understand clinical features of VM,it is necessary to understand raw saccades data.Methods:Fourteen patients with confirmed VM,45 patients with probable VM(p-VM)and 14 agematched healthy volunteers were included in this study.Clinical findings related to spontaneous nystagmus(SN),positional nystagmus(PN),head-shaking nystagmus(HSN),caloric test and vHIT were recorded.Raw saccades data were exported and numbered by their sequences,and their features analyzed.Results:VM patients showed no SN,PN or HSN,and less than half of them showed unilateral weakness(UW)on caloric test.The first saccades from lateral semicircular canal stimulation were the most predominant for both left and right sides.Neither velocity nor time parameters were significantly different when compared between the two sides.Most VM patients(86%)exhibited small saccades,around 35%of the head peak velocity,with a latency of 200e400 ms.Characteristics of saccades were similar in patients with p-VM.Only four normal subjects showed saccades,all unilateral and seemingly random.Conclusions:Small saccades involving bilateral semicircular canals with a scattered distribution pattern are common in patients with VM and p-VM.展开更多
Objective To study the value of the subjective visual vertical(SVV)in the diagnosis of vestibular migraine(VM).Methods This study recruited 128 VM patients and 64 age-matched normal subjects.We detected the SVV during...Objective To study the value of the subjective visual vertical(SVV)in the diagnosis of vestibular migraine(VM).Methods This study recruited 128 VM patients and 64 age-matched normal subjects.We detected the SVV during the interval between attacks in both groups,in sitting upright,and the head tilted at 45°to the left or right.We then examined the correlation between the SVV results with the vestibular evoked myogenic potential(VEMP)and canal paresis(CP).Results It was found there was a significant difference in SVV at the upright position between VM patients and normal controls(P=0.006)and no significant difference was found at the tilts of 45°to the left or right between the two groups.The SVV results at the upright position were significantly correlated with cervical VEMP(P=0.042)whereas not significantly correlated with CP and VEMP.There existed no significant difference in the conformity to the Müller effect(M effect)between the two groups.ROC analysis exhibited that the sensitivity,specificity of SVVs at the upright were 67.200%and 62.500%respectively.The diagnostic value of SVV at the upright position was significantly higher than that at tilts of 45°to the left and right(P=0.006).Nonetheless the diagnostic accuracy was relatively low.Conclusion Abnormality in SVV possibly stems from the lasting functional disorder of cerebellar or high-level cortical centers in VM patients or is linked to the vestibular compensation.The SVV is of low diagnostic value for VM and the value of SVV in VM warrants further study.展开更多
Objective:It aims to evaluate the diagnostic ability of CGRP and other blood indicators in vestibular migraine(VM)patients,and to explain the potential pathological effects of these biomarkers.The hypothesis of VM bei...Objective:It aims to evaluate the diagnostic ability of CGRP and other blood indicators in vestibular migraine(VM)patients,and to explain the potential pathological effects of these biomarkers.The hypothesis of VM being a variant of migraine was examined.Methods:A total of 32 VM patients,35 migraine patients,and 30 healthy control subjects(HC)were selected for this cross-sectional study.Detailed statistics on demographic data,clinical manifestations,calcitonin gene-related peptide(CGRP)and common clinical laboratory indicators were measured within 24 hours from the onset of the conditions.Receptor operating characteristic(ROC)curve and area under the curve(AUC)were analyzed for biomarkers.The risk factors of VM and migraine were determined through univariate and multivariate analyses.Results:Compared with HC,serum CGRP levels(p(VM)=0.012,p(Migraine)=0.028)increased and Mg^(2+)levels(p(VM)<0.001,p(Migraine)<0.001)deceased in VM patients and migraine patients.In multiple logistic regression,VM was correlated with CGRP[odds ratio(OR)=1.07;95%confidence interval(CI),1.02-1.12;P=0.01]and Mg^(2+)[odds ratio(OR)=0.03;95%CI,0.07-0.15;P<0.001].Migraine was correlated with CGRP[odds ratio(OR)=1.07;95%CI,1.02-1.12;P=0.01]and Mg^(2+)[odd ratio(OR=0.01;95%CI,0-0.02;P<0.001)].Mg^(2+)discriminated good differentiation between VM and migraine groups,with AUC of 0.649(95%CI,0.518 to 0.780).The optimal threshold for Mg^(2+)to diagnose VM was 0.805.Conclusions:This study demonstrated that CGRP and Mg^(2+)may be promising laboratory indicators to discriminate HC from VM/migraine,while Mg^(2+)may be uded as a discriminator between VM and migraine.展开更多
Background:Vestibular migraine(VM)is a common cause of dizziness that is underrecognized,underdiagnosed,and challenging to effectively treat.The prevalence,appropriate diagnostic workup,and therapies for VM in low-and...Background:Vestibular migraine(VM)is a common cause of dizziness that is underrecognized,underdiagnosed,and challenging to effectively treat.The prevalence,appropriate diagnostic workup,and therapies for VM in low-and lower-middle-income countries(LLMICs)remain understudied.The objective of this scoping review is to evaluate the current state of VM research in LLMICs.Methods:PubMed,Embase,and Web of Science databases were searched to execute a scoping review of VM.Keywords“vestibular diseases”and“vertigo”were used in combination with terms referring to LLMICs as defined by the World Bank.Title and abstract screening,full-text review,and data collection were conducted by two authors independently.Results:Twenty-six studies were included in the scoping review.Most studies were cross-sectional(57.7%)or case studies/series(23.1%)and were conducted in urban settings only(92.3%).Geographic distribution of studies was skewed,with 65.4%of articles originating from India.The prevalence of VM among clinic patients ranged from 0.3%to 33.3%.VM most frequently presented as headache,nausea and vomiting,and photophobia.Radiographic imaging,audiometry,and electronystagmography/videonystagmography were the three most commonly utilized diagnostic modalities in the dizziness workup.The most studied pharmacotherapies included calcium channel blockers,followed by beta-blockers and antiepileptics.Case studies and series discussed less common VM pharmacotherapies,such as ayurvedic medicine.Conclusions:There is a need for more VM research in LLMICs,including innovative diagnostic approaches and therapies that can improve VM care globally.Equitable partnerships between LLMIC and highincome country researchers must expand vestibular research capacity and productivity in LLMICs.展开更多
Objective:To measure the static visual vertical and the effect of visual rotation on the perception of visual vertical in migraine and vestibular migraine subjects. By so doing, we may better understand the vestibular...Objective:To measure the static visual vertical and the effect of visual rotation on the perception of visual vertical in migraine and vestibular migraine subjects. By so doing, we may better understand the vestibular contribution to the pathophysiology of migraine, as well as the capacity for visual compensation. Methods:The perception of visual vertical in the presence of static and dynamic visual cues was prospectively studied in 10 subjects with migraine, 6 subjects with vestibular migraines, and 10 controls. Subjects used a dial to rotate a fluorescent green line to the vertical position. Static visual vertical (SVV) was measured with a black background, as well as with a static random-dot visual pattern. This pattern was then rotated at various velocities to measure dy-namic visual vertical (DVV). Results: Migraine subjects had greater deviation from true vertical than controls in SVV (P<0.05). The DVV in migraine subjects was greater than controls when rotated in the coun-terclockwise at ?5?/s (P<0.01), ?20?/s (P<0.01), and ?80?/s (P<0.01), but not when the line was rotated clockwise. Vestibular migraine subjects did not deviate significantly from con-trols in SVV (P<0.37, P<0.22), but did show greater deviation in the DVV tasks at ?80 and ?20?/s (P<0.05, P<0.03). Migraine and vestibular migraine subjects demonstrated a wider range of vertical deviance when compared to controls (P<0.02). Conclusions:This study demonstrates a significant deviation of the perceived static as well as dynamic visual vertical in migraine subjects. Moving stimuli may have a greater influence on migraine and vestibular migraine subjects, which suggests an underlying sensory integration disorder.展开更多
Background Although flunarizine has been widely used for migraine prophylaxis with clear success, the mechanisms of its actions in migraine prophylaxis are not completely understood. The aim of this study was to inves...Background Although flunarizine has been widely used for migraine prophylaxis with clear success, the mechanisms of its actions in migraine prophylaxis are not completely understood. The aim of this study was to investigate the effects of flunarizine on tetrodotoxin-resistant Na＋ channels and high-voltage activated Ca2＋ channels of acutely isolated mouse trigeminal ganglion neurons. Methods Sodium currents and calcium currents in trigeminal ganglion neurons were monitored using whole-cell patch-clamp recordings. Paired Student＇s t test was used as appropriate to evaluate the statistical significance of differences between two group means. Results Both tetrodotoxin-resistant sodium currents and high-voltage activated calcium currents were blocked by flunarizine in a concentration-dependent manner with the concentration producing half-maximal current block values of 2.89 μmol/L and 2.73 μmol/L, respectively. The steady-state inactivation curves of tetrodotoxin-resistant sodium currents and high-voltage activated calcium currents were shifted towards more hyperpolarizing potentials after exposure to flunarizine. Furthermore, the actions of flunarizine in blocking tetrodotoxin-resistant sodium currents and high-voltage activated calcium currents were use-dependent, with effects enhanced at higher rates of channel activation. Conclusion Blockades of these currents might help explain the peripheral mechanism underlying the preventive effect of flunarizine on migraine attacks.展开更多
基金supported by grants from National Key Research and Development Program of China-part3(2020YFC2005203)Capital's Funds for Health Improvement and Research(No.2022-1-2023).
文摘Background:Saccades are often observed on video head impulse tests(vHIT)in patients with Meniere's Disease(MD)and Vestibular Migraine(VM).However,their saccadic features are not fully described.Objective:This study aims to identify the saccades characteristics of MD and VM.Methods:75 VM patients and 103 definite unilateral MD patients were enrolled in this study.First raw saccades were exported and analyzed.The VM patients were divided into left and right based on their ears,while the MD patients were separated into affected and unaffected subgroups based on their audiograms and symptoms.Results:The MD patients have more saccades on the affected side(85%vs.69%),and saccade velocity is more consistent than the contralateral side(shown by the coefficient of variation).The saccades occurrence rates on both sides are similar in VM(77%vs.76%),as are other saccadic parameters.The MD patients have more significant inter-aural differences than the VM patients,manifested in higher velocity(p-value 0.000),earlier arriving(p-value 0.010),and more time-domain gathered(p-value 0.003)on the affected side.Conclusions:Bilateral saccades are commonly observed in MD and VM.In contrast to MD,saccades on VM are subtle,scattered,and late-arrived.Furthermore,the MD patients showed inconsistent saccadic distribution with more velocity-uniform saccades on the affected side.
文摘Objectives: Vestibular migraine is one of the most common causes of episodic vertigo in adults and even in children. Traditional;management may have a side effect on the long run. So the aim of this review is to explain the other non-medical lines of management for patients with migraine. Methods: English articles from Medline and Cochrane library were searched and reviewed. Results: Evidence indicates that non-traditional management has a prophylactic and therapeutic effect on migraine patients with all its steps. Conclusion: Due to the possible side effects of pharmacological drugs and drug addictions, the use of non-traditional management alone or in combination with normal cures have been proposed. However, further constructive studies are required.
文摘Objective:Saccades accompanied by normal gain in video head impulse tests(vHIT)are often observed in patients with vestibular migraine(VM).However,they are not considered as an independent indicator,reducing their utility in diagnosing VM.To better understand clinical features of VM,it is necessary to understand raw saccades data.Methods:Fourteen patients with confirmed VM,45 patients with probable VM(p-VM)and 14 agematched healthy volunteers were included in this study.Clinical findings related to spontaneous nystagmus(SN),positional nystagmus(PN),head-shaking nystagmus(HSN),caloric test and vHIT were recorded.Raw saccades data were exported and numbered by their sequences,and their features analyzed.Results:VM patients showed no SN,PN or HSN,and less than half of them showed unilateral weakness(UW)on caloric test.The first saccades from lateral semicircular canal stimulation were the most predominant for both left and right sides.Neither velocity nor time parameters were significantly different when compared between the two sides.Most VM patients(86%)exhibited small saccades,around 35%of the head peak velocity,with a latency of 200e400 ms.Characteristics of saccades were similar in patients with p-VM.Only four normal subjects showed saccades,all unilateral and seemingly random.Conclusions:Small saccades involving bilateral semicircular canals with a scattered distribution pattern are common in patients with VM and p-VM.
基金funded by grants from the Shanghai Science and Technology Commission(No.18ZR1439200)the National Natural Science Foundation of China(No.81873701)+1 种基金the Innovation Items in the Military Service Field of Changzheng Hospital(No.2019CZJS102,No.2020CZWJFW10)the National Twelfth Five-Year Research Program of China(No.2012BAI12B02).
文摘Objective To study the value of the subjective visual vertical(SVV)in the diagnosis of vestibular migraine(VM).Methods This study recruited 128 VM patients and 64 age-matched normal subjects.We detected the SVV during the interval between attacks in both groups,in sitting upright,and the head tilted at 45°to the left or right.We then examined the correlation between the SVV results with the vestibular evoked myogenic potential(VEMP)and canal paresis(CP).Results It was found there was a significant difference in SVV at the upright position between VM patients and normal controls(P=0.006)and no significant difference was found at the tilts of 45°to the left or right between the two groups.The SVV results at the upright position were significantly correlated with cervical VEMP(P=0.042)whereas not significantly correlated with CP and VEMP.There existed no significant difference in the conformity to the Müller effect(M effect)between the two groups.ROC analysis exhibited that the sensitivity,specificity of SVVs at the upright were 67.200%and 62.500%respectively.The diagnostic value of SVV at the upright position was significantly higher than that at tilts of 45°to the left and right(P=0.006).Nonetheless the diagnostic accuracy was relatively low.Conclusion Abnormality in SVV possibly stems from the lasting functional disorder of cerebellar or high-level cortical centers in VM patients or is linked to the vestibular compensation.The SVV is of low diagnostic value for VM and the value of SVV in VM warrants further study.
基金National Natural Science Foundation of China(No.82071549)Key Program of the Natural Science Fund in Heilongjiang Province(No.ZD2019H006)National Key Research&Development Program of China(No.2016YFC1307205).
文摘Objective:It aims to evaluate the diagnostic ability of CGRP and other blood indicators in vestibular migraine(VM)patients,and to explain the potential pathological effects of these biomarkers.The hypothesis of VM being a variant of migraine was examined.Methods:A total of 32 VM patients,35 migraine patients,and 30 healthy control subjects(HC)were selected for this cross-sectional study.Detailed statistics on demographic data,clinical manifestations,calcitonin gene-related peptide(CGRP)and common clinical laboratory indicators were measured within 24 hours from the onset of the conditions.Receptor operating characteristic(ROC)curve and area under the curve(AUC)were analyzed for biomarkers.The risk factors of VM and migraine were determined through univariate and multivariate analyses.Results:Compared with HC,serum CGRP levels(p(VM)=0.012,p(Migraine)=0.028)increased and Mg^(2+)levels(p(VM)<0.001,p(Migraine)<0.001)deceased in VM patients and migraine patients.In multiple logistic regression,VM was correlated with CGRP[odds ratio(OR)=1.07;95%confidence interval(CI),1.02-1.12;P=0.01]and Mg^(2+)[odds ratio(OR)=0.03;95%CI,0.07-0.15;P<0.001].Migraine was correlated with CGRP[odds ratio(OR)=1.07;95%CI,1.02-1.12;P=0.01]and Mg^(2+)[odd ratio(OR=0.01;95%CI,0-0.02;P<0.001)].Mg^(2+)discriminated good differentiation between VM and migraine groups,with AUC of 0.649(95%CI,0.518 to 0.780).The optimal threshold for Mg^(2+)to diagnose VM was 0.805.Conclusions:This study demonstrated that CGRP and Mg^(2+)may be promising laboratory indicators to discriminate HC from VM/migraine,while Mg^(2+)may be uded as a discriminator between VM and migraine.
文摘Background:Vestibular migraine(VM)is a common cause of dizziness that is underrecognized,underdiagnosed,and challenging to effectively treat.The prevalence,appropriate diagnostic workup,and therapies for VM in low-and lower-middle-income countries(LLMICs)remain understudied.The objective of this scoping review is to evaluate the current state of VM research in LLMICs.Methods:PubMed,Embase,and Web of Science databases were searched to execute a scoping review of VM.Keywords“vestibular diseases”and“vertigo”were used in combination with terms referring to LLMICs as defined by the World Bank.Title and abstract screening,full-text review,and data collection were conducted by two authors independently.Results:Twenty-six studies were included in the scoping review.Most studies were cross-sectional(57.7%)or case studies/series(23.1%)and were conducted in urban settings only(92.3%).Geographic distribution of studies was skewed,with 65.4%of articles originating from India.The prevalence of VM among clinic patients ranged from 0.3%to 33.3%.VM most frequently presented as headache,nausea and vomiting,and photophobia.Radiographic imaging,audiometry,and electronystagmography/videonystagmography were the three most commonly utilized diagnostic modalities in the dizziness workup.The most studied pharmacotherapies included calcium channel blockers,followed by beta-blockers and antiepileptics.Case studies and series discussed less common VM pharmacotherapies,such as ayurvedic medicine.Conclusions:There is a need for more VM research in LLMICs,including innovative diagnostic approaches and therapies that can improve VM care globally.Equitable partnerships between LLMIC and highincome country researchers must expand vestibular research capacity and productivity in LLMICs.
文摘Objective:To measure the static visual vertical and the effect of visual rotation on the perception of visual vertical in migraine and vestibular migraine subjects. By so doing, we may better understand the vestibular contribution to the pathophysiology of migraine, as well as the capacity for visual compensation. Methods:The perception of visual vertical in the presence of static and dynamic visual cues was prospectively studied in 10 subjects with migraine, 6 subjects with vestibular migraines, and 10 controls. Subjects used a dial to rotate a fluorescent green line to the vertical position. Static visual vertical (SVV) was measured with a black background, as well as with a static random-dot visual pattern. This pattern was then rotated at various velocities to measure dy-namic visual vertical (DVV). Results: Migraine subjects had greater deviation from true vertical than controls in SVV (P<0.05). The DVV in migraine subjects was greater than controls when rotated in the coun-terclockwise at ?5?/s (P<0.01), ?20?/s (P<0.01), and ?80?/s (P<0.01), but not when the line was rotated clockwise. Vestibular migraine subjects did not deviate significantly from con-trols in SVV (P<0.37, P<0.22), but did show greater deviation in the DVV tasks at ?80 and ?20?/s (P<0.05, P<0.03). Migraine and vestibular migraine subjects demonstrated a wider range of vertical deviance when compared to controls (P<0.02). Conclusions:This study demonstrates a significant deviation of the perceived static as well as dynamic visual vertical in migraine subjects. Moving stimuli may have a greater influence on migraine and vestibular migraine subjects, which suggests an underlying sensory integration disorder.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81070896） and a Yangsen Scienence Grant.
文摘Background Although flunarizine has been widely used for migraine prophylaxis with clear success, the mechanisms of its actions in migraine prophylaxis are not completely understood. The aim of this study was to investigate the effects of flunarizine on tetrodotoxin-resistant Na＋ channels and high-voltage activated Ca2＋ channels of acutely isolated mouse trigeminal ganglion neurons. Methods Sodium currents and calcium currents in trigeminal ganglion neurons were monitored using whole-cell patch-clamp recordings. Paired Student＇s t test was used as appropriate to evaluate the statistical significance of differences between two group means. Results Both tetrodotoxin-resistant sodium currents and high-voltage activated calcium currents were blocked by flunarizine in a concentration-dependent manner with the concentration producing half-maximal current block values of 2.89 μmol/L and 2.73 μmol/L, respectively. The steady-state inactivation curves of tetrodotoxin-resistant sodium currents and high-voltage activated calcium currents were shifted towards more hyperpolarizing potentials after exposure to flunarizine. Furthermore, the actions of flunarizine in blocking tetrodotoxin-resistant sodium currents and high-voltage activated calcium currents were use-dependent, with effects enhanced at higher rates of channel activation. Conclusion Blockades of these currents might help explain the peripheral mechanism underlying the preventive effect of flunarizine on migraine attacks.
