261 results found
Patel M, Agarwal K, Arshad Q, et al., Intratympanic steroids vs. gentamicin in unilateral Ménière's disease: a randomised double-blind comparative effectiveness trial, Lancet, ISSN: 1474-547X
Background: Ménière’s disease (MD) is characterised by severe vertigo attacks and deafness. Intratympanic gentamicin ablates vestibular function, quells vertigo and is the standard treatment for refractory MD - but it can worsen hearing. Intratympanic corticosteroids may reduce vertigo without harming hearing but no RCT comparing steroids versus gentamicin is available.Methods: In this comparative effectiveness trial, refractory unilateral MD patients, defined according to the American Academy of Otolaryngology, were double-blindly randomised (1:1 block-design) to intratympanic methylprednisolone (n=30, 62·5mg/ml) or gentamicin (n=30, 40mg/ml) and followed-up over two years at Charing Cross Hospital (Imperial NHS, London) and Leicester Royal Infirmary, Leicester, UK. Primary outcome was vertigo frequency over the final 6-months (18-24months post-injection) compared to a 6-month pre-injection baseline. Secondary outcomes were vestibular and auditory symptoms (validated questionnaires) and hearing preservation (audiometry). ClinicalTrials.gov:NCT00802529.Findings: For intention-to-treat analysis i.e., all 60 patients, number of vertigo attacks/6months (primary outcome) fell from 19·9 to 2·5 [87%] in the gentamicin arm and 16·4 to 1·6 [90%] in the steroid arm (difference in absolute number of attacks in the final 6months -0·9; 95%CI -3·4 to 1·6). Both drugs reduced the number of vertigo attacks at 2 years (P<0·0001), with equal efficacy (P=0·51). For hearing preservation (secondary outcome), there was no difference (P=0·18) between drugs for hearing thresholds (final difference -2·45decibels, 95%CI -13·4 to 8·5). Both drugs reduced auditory and vestibular symptoms equally. As protocol, patients whose vertigo did not respond post-injection (‘non-responders’) were considered for additional injections by an unblinded physician (8 patients ge
Ahmad H, Roberts RE, Patel M, et al., 2017, Downregulation of early visual cortex excitability mediates oscillopsia suppression., Neurology, Vol: 89, Pages: 1179-1185
OBJECTIVE: To identify in an observational study the neurophysiologic mechanisms that mediate adaptation to oscillopsia in patients with bilateral vestibular failure (BVF). METHODS: We directly probe the hypothesis that adaptive changes that mediate oscillopsia suppression implicate the early visual-cortex (V1/V2). Accordingly, we investigated V1/V2 excitability using transcranial magnetic stimulation (TMS) in 12 avestibular patients and 12 healthy controls. Specifically, we assessed TMS-induced phosphene thresholds at baseline and cortical excitability changes while performing a visual motion adaptation paradigm during the following conditions: baseline measures (i.e., static), during visual motion (i.e., motion before adaptation), and during visual motion after 5 minutes of unidirectional visual motion adaptation (i.e., motion adapted). RESULTS: Patients had significantly higher baseline phosphene thresholds, reflecting an underlying adaptive mechanism. Individual thresholds were correlated with oscillopsia symptom load. During the visual motion adaptation condition, no differences in excitability at baseline were observed, but during both the motion before adaptation and motion adapted conditions, we observed significantly attenuated cortical excitability in patients. Again, this attenuation in excitability was stronger in less symptomatic patients. CONCLUSIONS: Our findings provide neurophysiologic evidence that cortically mediated adaptive mechanisms in V1/V2 play a critical role in suppressing oscillopsia in patients with BVF.
Kaski D, Bronstein AM, 2017, Ocular Tremor in Parkinson's Disease: Discussion, Debate, and Controversy, FRONTIERS IN NEUROLOGY, Vol: 8, ISSN: 1664-2295
Lubeck AJA, Van Ombergen A, Ahmad H, et al., 2017, Differential effect of visual motion adaption upon visual cortical excitability, JOURNAL OF NEUROPHYSIOLOGY, Vol: 117, Pages: 903-909, ISSN: 0022-3077
Panichi R, Faralli M, Bruni R, et al., 2017, Asymmetric vestibular stimulation reveals persistent disruption of motion perception in unilateral vestibular lesions., J Neurophysiol
Self-motion perception was studied in patients with unilateral vestibular lesions (UVL) due to acute vestibular neuritis at 1 week, 4, 8 and 12 months after the acute episode. We assessed vestibularly-mediated self-motion perception by measuring the error in reproducing the position of a remembered visual target at the end of 4 cycles of asymmetric whole-body rotation. The oscillatory stimulus consists of a slow (0.09Hz) and a fast (0.38Hz) half cycle. A large error was present in UVL patients when the slow half cycle was delivered towards the lesion side, but minimal towards the healthy side. This asymmetry diminished over time, but it remained abnormally large at 12 months. In contrast, vestibulo-ocular reflex responses showed a large direction-dependent error only initially, then they normalized. Normalization also occurred for conventional reflex vestibular measures (caloric tests, subjective visual vertical and head shaking nystagmus) and for perceptual function during symmetric rotation. Vestibular-related handicap, measured with the Dizziness Handicap Inventory (DHI) at 12 months, correlated with self-motion perception asymmetry but not with abnormalities in vestibulo-ocular function. We conclude that 1) a persistent self-motion perceptual bias is revealed by asymmetric rotation in UVLs despite vestibulo-ocular function becoming symmetric over time 2) this dissociation is caused by differential perceptual-reflex adaptation to high and low frequency rotations when these are combined as with our asymmetric stimulus 3) the findings imply differential central compensation for vestibulo-perceptual and vestibulo-ocular reflex functions 4) self-motion perception disruption may mediate long-term vestibular-related handicap in UVL patients.
Roberts RE, Ahmad H, Arshad Q, et al., 2017, Functional neuroimaging of visuo-vestibular interaction, BRAIN STRUCTURE & FUNCTION, Vol: 222, Pages: 2329-2343, ISSN: 1863-2653
Arshad Q, Nigmatullina Y, Roberts RE, et al., 2016, Perceived state of self during motion can differentially modulate numerical magnitude allocation, EUROPEAN JOURNAL OF NEUROSCIENCE, Vol: 44, Pages: 2369-2374, ISSN: 0953-816X
Bronstein AM, 2016, Multisensory integration in balance control., Handb Clin Neurol, Vol: 137, Pages: 57-66, ISSN: 0072-9752
This chapter provides an introduction to the topic of multisensory integration in balance control in, both, health and disease. One of the best-studied examples is that of visuo-vestibular interaction, which is the ability of the visual system to enhance or suppress the vestibulo-ocular reflex (VOR suppression). Of clinical relevance, examination of VOR suppression is clinically useful because only central, not peripheral, lesions impair VOR suppression. Visual, somatosensory (proprioceptive), and vestibular inputs interact strongly and continuously in the control of upright balance. Experiments with visual motion stimuli show that the visual system generates visually-evoked postural responses that, at least initially, can override vestibular and proprioceptive signals. This paradigm has been useful for the study of the syndrome of visual vertigo or vision-induced dizziness, which can appear after vestibular disease. These patients typically report dizziness when exposed to optokinetic stimuli or visually charged environments, such as supermarkets. The principles of the rehabilitation treatment of these patients, which use repeated exposure to visual motion, are presented. Finally, we offer a diagnostic algorithm in approaching the patient reporting oscillopsia - the illusion of oscillation of the visual environment, which should not be confused with the syndrome mentioned earlier of visual vertigo.
Kaski D, Bronstein AM, 2016, PATIENTS WITH VESTIBULAR LOSS, TULLIO PHENOMENON, AND PRESSURE-INDUCED NYSTAGMUS: VESTIBULAR ATELECTASIS?, OTOLOGY & NEUROTOLOGY, Vol: 37, Pages: 115-116, ISSN: 1531-7129
Kaski D, Bronstein AM, 2016, Functional (psychogenic) saccadic oscillations and oculogyric crises Reply, LANCET NEUROLOGY, Vol: 15, Pages: 791-792, ISSN: 1474-4422
Kaski D, Bronstein AM, 2016, Functional eye movement disorders., Handb Clin Neurol, Vol: 139, Pages: 343-351, ISSN: 0072-9752
Functional (psychogenic) eye movement disorders are perhaps less established in the medical literature than other types of functional movement disorders. Patients may present with ocular symptoms (e.g., blurred vision or oscillopsia) or functional eye movements may be identified during the formal examination of the eyes in patients with other functional disorders. Convergence spasm is the most common functional eye movement disorder, but functional gaze limitation, functional eye oscillations (also termed "voluntary nystagmus"), and functional convergence paralysis may be underreported. This chapter reviews the different types of functional eye movement abnormalities and provides a practical framework for their diagnosis and management.
Kaski D, Pradhan V, Bronstein A, 2016, THE CLINICAL FEATURES OF FUNCTIONAL (PSYCHOGENIC) EYE MOVEMENTS, Annual Meeting of the Association-of-British-Neurologists (ABN), Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050
Kaski D, Pradhan V, Bronstein AM, 2016, Clinical features of functional (psychogenic) eye movement disorders, JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, Vol: 87, Pages: 1389-+, ISSN: 0022-3050
Kaski D, Quadir S, Nigmatullina Y, et al., 2016, Temporoparietal encoding of space and time during vestibular-guided orientation, BRAIN, Vol: 139, Pages: 392-403, ISSN: 0006-8950
Nigmatullina Y, Siddiqui S, Khan S, et al., 2016, Lateralisation of the Vestibular Cortex Is More Pronounced in Left-Handers, BRAIN STIMULATION, Vol: 9, Pages: 942-944, ISSN: 1935-861X
Patel M, Agarwal K, Arshad Q, et al., 2016, Intratympanic methylprednisolone versus gentamicin in patients with unilateral Meniere's disease: a randomised, double-blind, comparative effectiveness trial, LANCET, Vol: 388, Pages: 2753-2762, ISSN: 0140-6736
Patel M, Arshad Q, Roberts RE, et al., 2016, Chronic Symptoms After Vestibular Neuritis and the High-Velocity Vestibulo-Ocular Reflex, OTOLOGY & NEUROTOLOGY, Vol: 37, Pages: 179-184, ISSN: 1531-7129
Ahmad H, Arshad Q, Patel M, et al., 2015, ACQUIRED PENDULAR NYSTAGMUS IN STARGARDT'S SYNDROME SUPPRESSED BY ALCOHOL, Annual Meeting of the Association-of-British-Neurologists (ABN), Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050
Ahmad H, Cerchiai N, Mancuso M, et al., 2015, ARE WHITE MATTER ABNORMALITIES A CAUSE OF 'UNEXPLAINED DIZZINESS'? A RETROSPECTIVE BICENTRE STUDY, Annual Meeting of the Association-of-British-Neurologists (ABN), Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050
Ahmad H, Cerchiai N, Mancuso M, et al., 2015, White matter abnormalities in dizzy patients: retrospective cohort multi - centre study, 1st Congress of the European-Academy-of-Neurology, Publisher: WILEY-BLACKWELL, Pages: 365-365, ISSN: 1351-5101
Ahmad H, Cerchiai N, Mancuso M, et al., 2015, Are white matter abnormalities associated with "unexplained dizziness"?, JOURNAL OF THE NEUROLOGICAL SCIENCES, Vol: 358, Pages: 428-431, ISSN: 0022-510X
Ahmad H, Cerchiai N, Mancuso M, et al., 2015, Are white matter abnormalities a cause of "unexplained dizziness"?: A retrospective bi-centre study, 22nd World Congress of Neurology (WCN), Publisher: ELSEVIER SCIENCE BV, Pages: E45-E45, ISSN: 0022-510X
Ahmad H, Roberts R, Arshad QA, et al., 2015, USING TRANSCRANIAL MAGNETIC STIMULATION (TMS) TO PROBE EFFECTS OF VISUAL MOTION ADAPTATION ON PRIMARY VISUAL CORTEX (V1) EXCITABILITY IN BILATERAL VESTIBULAR FAILURE (BVF) PATIENTS, Annual Meeting of the Association-of-British-Neurologists (ABN), Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050
Ahmad H, Roberts R, Patel M, et al., 2015, Using transcranial magnetic stimulation (TMS) to probe effects of visual motion adaptation on primary visual cortex (V1) excitability in bilateral vestibular failure patients, 1st Congress of the European-Academy-of-Neurology, Publisher: WILEY-BLACKWELL, Pages: 51-51, ISSN: 1351-5101
Ahmad H, Roberts RE, Arshad Q, et al., 2015, Probing effects of visual motion adaptation on primary visual cortex (V1) excitability using Tms in Bilateral Vestibular Failure (Bvf) patients, JOURNAL OF THE NEUROLOGICAL SCIENCES, Vol: 357, Pages: E172-E172, ISSN: 0022-510X
Anastasopoulos D, Naushahi J, Sklavos S, et al., 2015, Fast gaze reorientations by combined movements of the eye, head, trunk and lower extremities, EXPERIMENTAL BRAIN RESEARCH, Vol: 233, Pages: 1639-1650, ISSN: 0014-4819
Arshad Q, Patel M, Goga U, et al., 2015, Role of handedness-related vestibular cortical dominance upon the vestibular-ocular reflex, JOURNAL OF NEUROLOGY, Vol: 262, Pages: 1069-1071, ISSN: 0340-5354
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