Adrian J. Priesol

Vestibular Labyrinth Contributions to Human Whole-Body Motion Discrimination

To assess the contributions of the vestibular system to whole-body motion discrimination in the dark, we measured direction recognition thresholds as a function of frequency for yaw rotation, superior–inferior translation (“z-translation”), interaural translation (“y-translation”), and roll tilt for 14 normal subjects and for 3 patients following total bilateral vestibular ablation. The patients had significantly higher average threshold measurements than normal (p < 0.01) for yaw rotation (depending upon frequency, 5.4× to 15.7× greater), z-translation (8.3× to 56.8× greater), y-translation (1.7× to 4.5× greater), and roll tilt (1.3× to 3.0× greater)—establishing the predominant contributions of the vestibular system for these motions in the dark.

Abnormal motion perception in vestibular migraine

Vertigo caused by migraine, referred to as vestibular migraine (VM), is a frequently diagnosed but poorly understood entity. No specific oculomotor, postural, or perceptual defect has been described in this disorder and its pathophysiology remains uncertain. In this study we used quantitative psychophysical methods to investigate VM because recent work in normal humans suggests that the brain uses different mechanisms to generate percepts of head motion and reflexive vestibular-mediated eye movements. In particular, perception appears to be more dependent on central interactions between semicircular canal cues (which sense head rotation) and otolith cues (which sense gravity and linear acceleration) than eye movements. Given the high incidence of positional vertigo and nystagmus in VM, we hypothesized that canal-otolith integration may be abnormal in these patients and that this abnormality may be reflected in perceptual responses.

Dynamic tilt thresholds are reduced in vestibular migraine

Vestibular symptoms caused by migraine, referred to as vestibular migraine, are a frequently diagnosed but poorly understood entity. Based on recent evidence that normal subjects generate vestibular-mediated percepts of head motion and reflexive eye movements using different mechanisms, we hypothesized that percepts of head motion may be abnormal in vestibular migraine. We therefore measured motion detection thresholds in patients with vestibular migraine, migraine patients with no history of vestibular symptoms, and normal subjects using the following paradigms: roll rotation while supine (dynamically activating the semicircular canals); quasi-static roll tilt (statically activating the otolith organs); and dynamic roll tilt (dynamically activating the canals and otoliths). Thresholds were determined while patients were asymptomatic using a staircase paradigm, whereby the peak acceleration of the motion was decreased or increased based on correct or incorrect reports of movement direction. We found a dramatic reduction in motion thresholds in vestibular migraine compared to normal and migraine subjects in the dynamic roll tilt paradigm, but normal thresholds in the roll rotation and quasi-static roll tilt paradigms. These results suggest that patients with vestibular migraine may have enhanced perceptual sensitivity (e.g. increased signal-to-noise ratio) for head motions that dynamically modulate canal and otolith inputs together.

Motion Perception in Patients with Idiopathic Bilateral Vestibular Hypofunction.

We measured vestibular perceptual thresholds in patients with idiopathic bilateral vestibulopathy to assess the distribution of peripheral vestibular damage in this disorder. Thresholds were measured with standard psychometric techniques in 4 patients and compared with thresholds in normal subjects and patients with completely absent peripheral vestibular function. Motion paradigms included yaw rotation (testing the lateral canals), interaural translation (testing the utricles), superior-inferior translation (testing the saccules), and roll tilt (testing the vertical semicircular canals and the otolith organs). We found that perceptual thresholds were abnormally elevated in the patients with idiopathic bilateral vestibulopathy for yaw rotation at all frequencies and for interaural translation at only the lower frequencies. Thresholds were normal for the other 2 motion paradigms. The results demonstrate that the distribution of vestibular dysfunction in this disorder is not uniform but, rather, can affect lateral canal and utricular thresholds while relatively sparing vertical canal and saccular function.

Potential solutions to several vestibular challenges facing clinicians.

Among other problems, patients with vestibular problems suffer imbalance, spatial disorientation, and blurred vision. These problems lead to varying degrees of disability and can be debilitating. Unfortunately, a large number of patients with vestibular complaints cannot be diagnosed with the clinical tests available today. Nor do we have treatments for all patients that we can diagnose. These clinical problems provide challenges to and opportunities for the field of vestibular research. In this paper, we discuss some new diagnostic and treatment options that could become available for tomorrows patients. As a new diagnostic, we have begun measuring patients perceptual direction-detection thresholds. Preliminary results appear encouraging; patients diagnosed with bilateral loss have yaw rotation thresholds almost ten times greater than normals, while patients diagnosed with migraine associated vertigo have roll tilt thresholds well below normal at 0.1 Hz. As a new treatment, we have performed animal studies looking at responses evoked by electrical stimulation provided by a vestibular prosthesis. Results measuring the VOR demonstrate promise and preliminary studies of balance and perception are also encouraging. While electrical stimulation is a standard means of stimulation, optical stimulation is also being investigated as a way to improve prosthetic stimulation specificity.

Central Integration of Canal and Otolith Signals is Abnormal in Vestibular Migraine

Vestibular migraine (VM), a common cause of vestibular symptoms within the general population, is a disabling and poorly understood form of dizziness. We sought to examine the underlying pathophysiology of VM with three studies, which involved the central synthesis of canal and otolith cues, and present preliminary results from each of these studies: (1) VM patients appear to have reduced motion perception thresholds when canal and otolith signals are modulated in a co-planar manner during roll tilt; (2) percepts of roll tilt appear to develop more slowly in VM patients than in control groups during a centrifugation paradigm that presents conflicting, orthogonal canal and otolith cues; and (3) eye movement responses appear to be different in VM patients when studied with a post-rotational tilt paradigm, which also presents a canal–otolith conflict, as the shift of the eye’s rotational axis was larger in VM and the relationship between the axis shift and tilt suppression of the vestibulo-ocular reflex differed in VM patients relative to control groups. Based on these preliminary perceptual and eye movement results obtained with three different motion paradigms, we present a hypothesis that the integration of canal and otolith signals by the brain is abnormal in VM and that this abnormality could be cerebellar in origin. We provide potential mechanisms that could underlie these observations, and speculate that one of more of these mechanisms contributes to the vestibular symptoms and motion intolerance that are characteristic of the VM syndrome.

Asymmetric responses to rotation at high frequencies in central vestibular neurons of the alert cat

The horizontal rotatory vestibulo-ocular reflex (VOR) stabilizes gaze by moving the eyes at an angular velocity proportional to head velocity, and can accomplish this for a broad range of frequencies and amplitudes of head motion. Rotation at 5 Hz and above may be processed differently than lower frequencies by the VOR network. We recorded discharges and calculated spike densities of a small sample of vestibular neurons in alert cats during low-velocity rotation at frequencies up to 8 Hz. At high frequencies, we found both vestibular-only (V-only) and eye-movement-sensitive (EM) cells that generated asymmetric output signals. Asymmetry was primarily of the cutoff type, i.e., changes in spike density were smallest for rotation in the inhibitory direction. Most cells were identified as secondary neurons. The mean spike density was 23 sp/s, which was lower than previously reported in vestibular neurons of monkeys. A few neurons had very high sensitivities, associated with phase-locking, to rotation at high frequencies. In general, vestibular neurons carried a high-pass-filtered version of rotational signals. When synaptic inputs from the vestibular commissure were quantified, we found that the immediate change in probability of firing due to commissural vestibular input was inversely correlated with the degree of high-pass filtering. At high frequencies, increased asymmetry and phase-locking occurred in some neurons. A small number of neurons responded with increased probability of firing to both directions of rotation. Together, these observations suggest that high frequencies of rotation may be encoded differently than low frequencies by central vestibular neurons in alert animals.

The clinical manifestations of vestibular migraine: A review.

OBJECTIVES To provide an overview of vestibular migraines presentation, pathology, and diagnosis, as well as an update on current diagnostic criteria. METHODS A review of the most recent literature on vestibular migraines was performed. RESULTS Vestibular migraine is a process with significant impact on the quality of life for those afflicted with the disease, with attacks of spontaneous or positional vertigo and migraine symptoms lasting several minutes to 72h. Inner ear disease can co-exist with migraine and the vestibular symptoms occurring with vestibular migraine can mimic inner ear disorders providing a challenge for clinicians in establishing diagnosis. Recent diagnostic criteria for vestibular migraine proposed by a joint committee of the Bárány Society and the International Headache Society provide an important standard for clinical diagnosis and research endeavor. CONCLUSION Vestibular migraine is a challenging disease process to both diagnose and treat. Proper diagnosis and treatment requires a thorough understanding of the current literature.