Betahistine alleviates benign paroxysmal positional vertigo (BPPV) through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway

BACKGROUND: Betahistine is a clinical medication for the treatment of benign paroxysmal positional vertigo (BPPV). Otolin, a secreted glycoprotein with a C-terminal globular domain homologous to the immune complement C1q, has been identified as a biomarker for BPPV. However, the role of complement C1q/TNF-related proteins (CTRPs) with a C-terminal globular domain in BPPV is unclear, so we explored the change of CTRPs in betahistine treated BPPV. METHODS: We treated BPPV patients with Betahistine (12 mg/time, 3 times/day) for 4 weeks and observed the clinical efficacy and the expression of CTRP family members in BPPV patients. Then, we constructed a vertigo mice model of vestibular dysfunction with gentamicin (150 mg/Kg) and a BPPV model of Slc26a4loop/loop mutant mice. Adenoviral vectors for CTRP expression vector and small interfering RNA were injected via the intratympanic injection into mice and detected the expression of CTRP family members, phosphorylation levels of ERK and AKT and the expression of PPARγ. In addition, we treated mice of vestibular dysfunction with Betahistine (10 mg/Kg) and/or ERK inhibitor of SCH772984 (12 mg/Kg) and/or and PPARγ antagonist GW9662 (1 mg/Kg) for 15 days, and evaluated the accuracy of air righting reflex, the time of contact righting reflex and the scores of head tilt and swimming behavior. RESULTS: After treatment with Betahistine, the residual dizziness duration and the score of the evaluation were reduced, and the expression of CTRP1, 3, 6, 9 and 12 were significantly increased in BPPV patients. We also found that Betahistine improved the accuracy of air righting reflex, reduced the time of contact righting reflex and the scores of head tilt and swimming behavior in gentamicin-treated mice and Slc26a4loop/loop mutant mice. The expression levels of CTRP1, 3, 6, 9 and 12, phosphorylation levels of ERK and AKT, and PPARγ expression were significantly increased, and the scores of head tilt and swimming behavior were decreased in vestibular dysfunction mice with overexpression of CTRPs. Silencing CTRPs has the opposite effect. SCH772984 reversed the effect of Betahistine in mice with vestibular dysfunction. CONCLUSION: Betahistine alleviates BPPV through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway.

The assessment of fukuda stepping test results in prognosis of benign paroxysmal postural vertigo / Avaliação dos resultados do teste da marcha de Fukuda no prognóstico da vertigem posicional paroxística benigna

Abstract Introduction Benign paroxysmal postural vertigo originating from the peripheral vestibular system is characterized by brief vertigo spells triggered by the sudden head motion. Usually, vestibular dysfunction in benign paroxysmal postural vertigo is unilateral. Fukuda stepping test which is helpful in the diagnosis of unilateral vestibular dysfunction, may also be valuable in the prediction of prognosis of benign paroxysmal postural vertigo. Objective The purpose of this study is to evaluate the relevance of Fukuda stepping test results with resistant and/or recurrent benign paroxysmal postural vertigo cases. Methods We evaluated 62 patients with unilateral, idiopathic benign paroxysmal postural vertigo of posterior and/or lateral canals. The Fukuda stepping test was performed prior to the Dix-Hallpike and head-roll tests. Two groups were created according to the Fukuda stepping test results. In Group 1 Fukuda stepping test results were positive with a deviation angle >45°, while in Group 2 the results were negative with no apparent deviation. Two groups were compared by the number of canalith repositioning manuevers performed and the frequency of recurrences. Results We found Fukuda stepping test to be invaluable in the diagnosis of benign paroxysmal postural vertigo since the ratio of Fukuda stepping test positivity and negativity were similar in benign paroxysmal postural vertigo patients. However, the need for multiple canalith repositioning manuevers was significantly higher in Group 1 (p= 0.0103). In addition, the recurrence frequency was found significantly lower in the Group 2 (p= 0.0441). Conclusion Although the sensitivity of Fukuda stepping test in detecting mild/moderate unilateral vestibular dysfunction is poor, it may be valuable in prediction of the prognosis of benign paroxysmal postural vertigo. We suggest that positive Fukuda stepping test results in benign paroxysmal postural vertigo patients indicate poor prognosis, the need for multipl canalith repositioning manuevers and the higher possibility of recurrences.

Resumo Introdução A vertigem posicional paroxística benigna com origem no sistema vestibular periférico é caracterizada por breves crises de vertigem desencadeadas pelo movimento súbito da cabeça. Geralmente, a disfunção vestibular na vertigem posicional paroxística benigna é unilateral. O teste da marcha de Fukuda, útil no diagnóstico de disfunção vestibular unilateral, também pode ser valioso para prever o prognóstico da vertigem posicional paroxística benigna. Objetivo Avaliar a relevância dos resultados do teste da marcha de Fukuda em casos de vertigem posicional paroxística benigna resistente e/ou recorrente. Método Avaliamos 62 pacientes com vertigem posicional paroxística benigna unilateral idiopática dos canais posterior e/ou lateral. O teste da marcha de Fukuda foi feito antes dos testes de Dix‐Hallpike e head‐roll (giro da cabeça). Dois grupos foram criados de acordo com os resultados do teste de Fukuda. No Grupo 1, os resultados do teste de Fukuda foram positivos com um ângulo de desvio > 45°, enquanto no Grupo 2 os resultados foram negativos sem desvio aparente. Dois grupos foram comparados pelo número de manobras de reposicionamento canalicular feitas e pela frequência de recorrências. Resultados Observamos que o teste de Fukuda é inestimável no diagnóstico de vertigem posicional paroxística benigna, pois a relação entre a positividade e a negatividade do teste de Fukuda foi semelhante nos pacientes com vertigem posicional paroxística benigna. No entanto, a necessidade de múltiplas manobras de reposicionamento canicular foi significantemente maior no Grupo 1 (p = 0,0103). Além disso, a frequência de recorrência encontrada foi significantemente menor no Grupo 2 (p = 0,0441). Conclusão Embora a sensibilidade do teste de Fukuda para detectar disfunção vestibular unilateral leve/moderada seja baixa, o teste pode ser valioso na previsão do prognóstico de vertigem posicional paroxística benigna. Sugerimos que os resultados positivos do teste da marcha de Fukuda em pacientes com vertigem posicional paroxística benigna indicam mau prognóstico, necessidade de múltiplas manobras de reposicionamento canicular e maior possibilidade de recorrências.

Effect of Gymnastics Exercise on Sensory Integration Disorder in Children Aged Three to Six Years / 中国康复理论与实践

Objective:To explore the effect of gymnastic exercise on sensory integration disorder (SID) in children aged three to six years. Methods:From March to June 2018, 27 children aged three to six years with SID were recruited from Chengdu U-Beller International Children Education Center (Pidu Campus), and were randomly divided into control group (n = 13) and experimental group (n = 14). The experimental group accepted gymnastic exercise, 60 minutes a time, three times a week, for 16 weeks. The control group received no intervention. They were assessed with Assessment Scale for Children Sensory Integration Development, for vestibular dysfunction, tactile defense and proprioception dysfunction. Results:After intervention, the SID improvement was better in the experimental group than in the control group (χ2 > 6.639, P < 0.05), several children with mild disorder returned to normal level, and several with severe disorder returned to mild level. There was no difference in the scores of vestibular dysfunction, tactile defense and proprioception dysfunction before and after intervention in the control group (P > 0.05), and the scores significantly improved in the experimental group (|t| > 7.015, P < 0.01), and was higher in the experimental group than in the control group after intervention (t > 2.193, P < 0.01). Conclusion:Gymnastic exercise can improve vestibular dysfunction, tactile defense and proprioception dysfunction for children with SID aged three to six years.

Advance in Rehabilitation for Vestibular Dysfunction after Mild Traumatic Brain Injury (review) / 中国康复理论与实践

Traumatic brain injury (TBI) would result in structural injury and/or physiological disruption of brain. Mild traumatic brain injury (mTBI) can result in vestibular dysfunctions, such as dizziness, vertigo and imbalance. Vestibular rehabilitation is effective on vestibular dysfunction after mTBI. This paper reviewed the possible mechanisms of vestibular dysfunction caused by mTBI, the common assessments of vestibular function and the new progress in vestibular rehabilitation.

Vestibular Rehabilitation for Children (review) / 中国康复理论与实践

Vestibular rehabilitation has been applied in children with benign paroxysmal positional vertigo, cerebral palsy and central coordination disorder successfully. However, training intensity and methods are various with diseases and therapeutic purposes. This paper reviewed the recovery mechanisms, the assessment and rehabilitation of vestibular dysfunction, and discussed the problems and prospects of vestibular rehabilitation for children.

The relationship between senile hearing loss and vestibular activity / Relação entre perda auditiva senil e atividade vestibular

Abstract Introduction: A considerable high number of SNHL patients also suffer from dizziness and related vestibular symptoms. Objective: To evaluate the association of vestibular dysfunction and sensorineural hearing loss (SNHL) in adult patients. Methods: Prospective, double-blinded, controlled studies composed by 63 adult patients without any vestibular symptoms or diagnosed vestibular diseases. Audiological status was measured with pure tone audiometry and the vestibular system was tested with vestibular evoked myogenic potential (VEMP). Patients were divided into two groups: a study group (patients with SNHL) and a control group (patients without SNHL). VEMP results of the groups were calculated and compared. Results: Mean P1 (23.54) and N1 (30.70) latencies were prolonged in the study group (p < 0.001) and the amplitudes of the study group were significantly reduced (p < 0.001). Both parameters of the VEMP test were abnormal in the study group when compared to the control group. Conclusions: These findings suggest that age-related SNHL may be accompanied by vestibular weakness without any possible predisposing factors for vestibulopathy.

Resumo Introdução: Um número considerável de pacientes com PANS também sofre de tonturas e sintomas vestibulares relacionados. Objetivo: Avaliar a associação entre disfunção vestibular e perda auditiva neurossensorial (PANS) em pacientes adultos. Método: Estudo prospectivo, duplo-cego e controlado com 63 pacientes adultos, sem quaisquer sintomas vestibulares ou doença vestibular diagnosticada. A audição foi avaliada por meio de audiometria tonal e o sistema vestibular, com potenciais evocados miogênicos vestibulares (PEMV). Os pacientes foram divididos em dois grupos: grupo de estudo (pacientes com PANS) e grupo de controle (pacientes sem PANS). Os resultados dos PEMV dos grupos foram calculados e comparados. Resultados: As latências médias de P1 (23,54) e N1 (30,70) encontravam-se prolongadas no grupo de estudo (p < 0,001), e as amplitudes no grupo de estudo estavam significantemente reduzidas (p < 0,001). Ambos os parâmetros do teste de PEMV foram anormais no grupo de estudo quando comparados aos do grupo controle. Conclusões: Nossas achados sugerem que a PANS relacionada à idade pode ser acompanhada por hipofunção vestibular, mesmo na ausência de possíveis fatores predisponentes para vestibulopatia.

Study of audio vestibular dysfunction in type2 diabetes mellitus

Background: Improved quality of life is prime concern of management of diabetes, which is affecting vast population in later years. Audio vestibular function monitoring and care in the diabetics is part of such concern. Materials and methods: A cross sectional investigation was carried out, of type 2 diabetes patients at different stages of disease and therapy to evaluate audio vestibular dysfunction profiles. Results: Hearing loss (HL) was fairly common even in mild early disease while, tinnitus and vertigo too, occurred in all age, gender, disease duration and therapy categories of diabetics. Some 39% of patients bearing tinnitus or vertigo had normal audiograms. Aged males were found to have more exaggerated prevalence of audio vestibular problems than females. Insulin therapy in presumably, patients of long standing disease had lower prevalence of vertigo. Conclusion: Findings imply, more complex relation of audio vestibular complications to diabetes than, to glycemic status or duration of disease. Monitoring of such complications from the earliest, may alone, bring understanding of their pathogenesis and proper prevention and management.

Can Postural Instability Respond to Galvanic Vestibular Stimulation in Patients with Parkinson's Disease?

OBJECTIVE: Galvanic vestibular stimulation (GVS) activates the vestibular afferents, and these changes in vestibular input exert a strong influence on the subject's posture or standing balance. In patients with Parkinson's disease (PD), vestibular dysfunction might contribute to postural instability and gait disorders. METHODS: Current intensity was increased to 0.7 mA, and the current was applied to the patients for 20 minutes. To perform a sham stimulation, the current intensity was increased as described and then decreased to 0 mA over the course of 10 seconds. The patient's status was recorded continuously for 20 minutes with the patient in the supine position. RESULTS: Three out of 5 patients diagnosed with PD with postural instability and/or abnormal axial posture showed a reduction in postural instability after GVS. The score for item 12 of the revised Unified Parkinson's Disease Rating Scale part 3 was decreased in these patients. CONCLUSIONS: The mechanism of postural instability is complex and not completely understood. In 2 out of the 5 patients, postural instability was not changed in response to GVS. Nonetheless, the GVS-induced change in postural instability for 3 patients in our study suggests that GVS might be a therapeutic option for postural instability.

Medio militar y trastornos auditivos inducidos por ruido / The military environment and noise-induced hearing impairments

En el medio militar el personal se ve sometido a los más altos niveles de ruido; se considera que las detonaciones de las armas de fuego superan en intensidad a todos los ruidos industriales. Este trabajo pretende abordar los factores de riesgo y vulnerabilidad asociados a la exposición al ruido en el ambiente militar, los aspectos más actuales relacionados con la lesión auditiva inducida por ruido y su protección. Se realizó una revisión de los artículos más representativos mediante la base de datos Medline e Hinari, se empleó para la búsqueda y creación de la bibliografía el gestor personal de referencias bibliográficas Procite, referencias al tema en revistas, tesis y referencias en Internet mediante el buscador Google. Los resultados reafirman la vulnerabilidad del personal militar a padecer algún tipo de lesión del aparato auditivo inducida por ruido, originado por los niveles de ruido elevado que se producen en el medio militar, la necesidad de enfocar de forma multidisciplinaria este tipo de lesiones y la importancia de implementar sistemas de protección auditiva eficientes, con el fin de elevar la calidad de vida de los expuestos a ruido y evitar que se produzca la discapacidad auditiva, considerando que la mejor opción es su prevención.

Extremely high noise levels are characteristic of the military environment. Firearm detonations are considered to exceed the intensity of any industrial noise. The paper approaches the risk factors and vulnerabilities associated with exposure to noise in the military environment, as well as the most recent notions about noise-induced hearing injury and hearing protection. A review was conducted of the most representative papers on the topic using databases Medline and Hinari. Bibliography lists were searched for and created using Procite personal bibliographic reference manager. Google search engine was used to find references to the topic in journals, theses and Internet references. Results confirm the vulnerability of military personnel to suffer from noise-induced hearing injuries resulting from the high noise levels occurring in the military environment, the need to approach such injuries in a multidisciplinary manner, and the importance of implementing efficient hearing protection systems, with a view to improving the quality of life of persons exposed to noise and preventing hearing impairment, based on the certainty that prevention is always the best option.

Clinical Significance of the Presence of Autonomic and Vestibular Dysfunction in Diabetic Patients with Peripheral Neuropathy

BACKGROUND: We investigated the prevalence of diabetic autonomic neuropathy (DAN) and vestibular dysfunction (VD) in diabetic patients with peripheral neuropathy. METHODS: Thirty-five diabetic patients with peripheral neuropathy were enrolled from August 2008 to July 2009. All subjects underwent autonomic function tests. Nineteen of the patients (54.3%) underwent videonystagmography. RESULTS: Diabetic autonomic neuropathy was observed in 28 patients (80%). A mild degree of autonomic failure was observed in 18 patients (64.3%), and a moderate degree of autonomic failure was observed in ten patients (35.7%). Factors related to DAN included diabetic nephropathy (P=0.032), degree of chronic kidney disease (P=0.003), and duration of diabetes (P=0.044). Vestibular dysfunction was observed in 11 of 19 patients (57.9%). There was no significant association between DAN and VD. CONCLUSION: Diabetic autonomic neuropathy was observed in 28 diabetic patients (80%) with peripheral neuropathy. Vestibular dysfunction was observed in nearly 60% of diabetic patients with peripheral neuropathy who complained of dizziness but showed no significant association with DAN. Diabetic patients who complained of dizziness need to examine both autonomic function and vestibular function.

Electronystagmography findings in spinocerebellar ataxia type 3 (SCA3) and type 2 (SCA2) / Eletronistagmografia em ataxia espinocerebelar do tipo 3 (SCA3) e do tipo 2 (SCA2)

OBJECTIVE: To describe the alterations observed in electronystagmography (ENG) of patients with spinocerebellar ataxia (SCA) types 2 and 3. METHOD: Sixteen patients were studied and the following procedures were carried out: anamnesis, otorhinolaryngological and vestibular evaluations. RESULTS: The clinical findings in the entire group of patients were: gait disturbances (93.75 percent), dysarthria (43.75 percent), headache (43.75 percent), dizziness (37.50 percent) and dysphagia (37.50 percent). In the vestibular exam, the rotatory (62.50 percent) and caloric (75 percent) tests were among those which presented the largest indexes of abnormalities; the presence of alterations in the exams was 87.50 percent, with a predominance of central vestibular disorders in 68.75 percent of the exams. CONCLUSION: Vestibular exams could be an auxiliary tool to investigate SCAs, besides a precise clinical approach and, particularly, molecular genetic tests.

OBJETIVO: Verificar as alterações do exame de eletronistagmografia (ENG) em pacientes com ataxia espinocerebelar (AEC) tipos 2 e 3. MÉTODO: 16 pacientes foram estudados, com a utilização dos seguintes procedimentos: anamnese, avaliação otorrinolaringológica e avaliação vestibular. RESULTADOS: As principais queixas encontradas na anamnese foram, desequilíbrio na marcha (93,75 por cento), dificuldades da fala (43,75 por cento), cefaleia (43,75 por cento), tontura (37,50 por cento) e disfagia (37,50 por cento). No exame vestibular, o teste rotatório e o teste calórico apresentaram os maiores índices de anormalidades, respectivamente, 62,50 por cento e 75 por cento, com a predominância de distúrbio vestibular do tipo central em 68,75 por cento dos casos. CONCLUSÃO: O exame vestibular pode ser um exame auxiliar na investigação das AECs, junto com a avaliação clínica precisa e, particularmente, com os testes de genética molecular.