Imperial College London

DrBarrySeemungal

Faculty of MedicineDepartment of Medicine

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3311 7042b.seemungal

 
 
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Assistant

 

Miss Lorna Stevenson +44 (0)20 3313 5525

 
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Location

 

10L17Lab BlockCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

93 results found

Bednarczuk NF, Bonsu A, Ortega MC, Fluri A-S, Chan J, Rust H, de Melo F, Sharif M, Seemungal BM, Golding JF, Kaski D, Bronstein AM, Arshad Qet al., 2019, Abnormal visuo-vestibular interactions in vestibular migraine: a cross sectional study., Brain, Vol: 142, Pages: 606-616

Vestibular migraine is among the commonest causes of episodic vertigo. Chronically, patients with vestibular migraine develop abnormal responsiveness to both vestibular and visual stimuli characterized by heightened self-motion sensitivity and visually-induced dizziness. Yet, the neural mechanisms mediating such symptoms remain unknown. We postulate that such symptoms are attributable to impaired visuo-vestibular cortical interactions, which in turn disrupts normal vestibular function. To assess this, we investigated whether prolonged, full-field visual motion exposure, which has been previously shown to modulate visual cortical excitability in both healthy individuals and avestibular patients, could disrupt vestibular ocular reflex and vestibular-perceptual thresholds of self-motion during rotations. Our findings reveal that vestibular migraine patients exhibited abnormally elevated reflexive and perceptual vestibular thresholds at baseline. Following visual motion exposure, both reflex and perceptual thresholds were significantly further increased in vestibular migraine patients relative to healthy controls, migraineurs without vestibular symptoms and patients with episodic vertigo due to a peripheral inner-ear disorder. Our results provide support for the notion of altered visuo-vestibular cortical interactions in vestibular migraine, as evidenced by vestibular threshold elevation following visual motion exposure.

JOURNAL ARTICLE

Papathanasiou ES, Cronin T, Seemungal B, Sandhu Jet al., 2018, Electrophysiological testing in concussion: A guide to clinical applications, Journal of Concussion, Vol: 2, ISSN: 2059-7002

The diagnosis of mild traumatic brain injury in concussion is difficult since it is often unwitnessed, the patient’s recall is unreliable and initial clinical examination is often unrevealing, correlating poorly with the extent of brain injury. At present, there are no objective biomarkers of mild traumatic brain injury in concussion. Thus, a sensitive gold standard test is required to enable the effective and safe triage of patients who present to the acute services. As well as triage, objective monitoring of patients’ recovery over time and separate from clinical features that patients may develop following the injury (e.g. depression and migraine) is also needed. In contrast to neuroimaging, which is widely used to investigate traumatic brain injury patients, electrophysiology is readily available, is cheap and there are internationally recognized standardised methodologies. Herein, we review the existing literature on electrophysiological testing in concussion and mild traumatic brain injury; specifically, electroencephalogram, polysomnography, brainstem auditory evoked potentials, electro- and videonystagmography, vestibular evoked myogenic potentials, visually evoked potentials, somatosensory evoked potentials and transcranial magnetic stimulation.

JOURNAL ARTICLE

Sargeant M, Sykes E, Saviour M, Sawhney A, Calzolari E, Arthur J, McGoldrick A, Seemungal BMet al., 2018, The utility of the Sports Concussion Assessment Tool in hospitalized traumatic brain injury patients, Journal of Concussion, Vol: 2, ISSN: 2059-7002

The Sports Concussion Assessment Tool 3rd version is a sports screening tool that is often used to support return to play decisions following a head injury. The Sports Concussion Assessment Tool 3rd version is presumed to identify brain dysfunction (implying a degree of brain injury); however, the Sports Concussion Assessment Tool has never been validated with patients with definite acute brain injury. In this study, we found that all three Sports Concussion Assessment Tool 3rd version domains – symptoms, cognitive and balance assessments – were sensitive in discriminating traumatic brain injury patients (all with abnormal acute neuroimaging) from healthy controls. Through a correlation matrix (Bonferroni corrected), we found no correlation between the subjective (symptoms) and objective (examination) Sports Concussion Assessment Tool 3rd version assessments, e.g. complaints of imbalance and memory dysfunction were not correlated, respectively, with performance on testing balance and memory function. When relaxing the correction for multiple comparisons we found that of all Sports Concussion Assessment Tool 3rd version symptoms, a feeling of ‘pressure in the head’ had the largest number of co-correlations (including affective symptoms) and overwhelmingly in a pattern indicative of migraine. Taken together, that objective and subjective assessments in the Sports Concussion Assessment Tool 3rd version are poorly correlated, could suggest that symptoms in the Sports Concussion Assessment Tool 3rd version poorly reflect brain injury but rather indicate non-brain injury processes such as migraine. It follows that the current prominent orthodoxy of resting athletes following a head injury until their symptoms settle for fear of exacerbating brain injury may be unfavourable for their recovery – at least in some cases. Prospective clinical studies would be required to assess patient recovery from concussion with early active investigation and t

JOURNAL ARTICLE

Xiang M, Glasauer S, Seemungal BM, 2018, Quantitative postural models as biomarkers of balance in Parkinson's disease, BRAIN, Vol: 141, Pages: 2824-2827, ISSN: 0006-8950

JOURNAL ARTICLE

Seemungal BM, Passamonti L, 2018, Persistent postural-perceptual dizziness: a useful new syndrome., Pract Neurol, Vol: 18, Pages: 3-4

JOURNAL ARTICLE

Cronin T, Arshad Q, Seemungal BM, 2017, Vestibular Deficits in Neurodegenerative Disorders: Balance, Dizziness, and Spatial Disorientation, FRONTIERS IN NEUROLOGY, Vol: 8, ISSN: 1664-2295

JOURNAL ARTICLE

Ahmad H, Roberts RE, Patel M, Lobo R, Seemungal B, Arshad Q, Bronstein Aet al., 2017, Downregulation of early visual cortex excitability mediates oscillopsia suppression, NEUROLOGY, Vol: 89, Pages: 1179-1185, ISSN: 0028-3878

JOURNAL ARTICLE

Allen D, Ribeiro L, Arshad Q, Seemungal BMet al., 2017, Age-Related Vestibular Loss: Current Understanding and Future Research Directions (vol 7, 231, 2016), FRONTIERS IN NEUROLOGY, Vol: 8, ISSN: 1664-2295

JOURNAL ARTICLE

Roberts RE, Ahmad H, Arshad Q, Patel M, Dima D, Leech R, Seemungal BM, Sharp DJ, Bronstein AMet al., 2017, Functional neuroimaging of visuo-vestibular interaction, BRAIN STRUCTURE & FUNCTION, Vol: 222, Pages: 2329-2343, ISSN: 1863-2653

JOURNAL ARTICLE

Cousins S, Kaski D, Cutfield N, Arshad Q, Ahmad H, Gresty MA, Seemungal BM, Golding J, Bronstein AMet al., 2017, Predictors of clinical recovery from vestibular neuritis: a prospective study, ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY, Vol: 4, Pages: 340-346, ISSN: 2328-9503

JOURNAL ARTICLE

Arshad Q, Roberts RE, Ahmad H, Lobo R, Patel M, Ham T, Sharp DJ, Seemungal BMet al., 2017, Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction, CLINICAL NEUROLOGY AND NEUROSURGERY, Vol: 155, Pages: 17-19, ISSN: 0303-8467

JOURNAL ARTICLE

Arshad Q, Seemungal BM, 2016, Age-Related Vestibular Loss: Current Understanding and Future Research Directions, FRONTIERS IN NEUROLOGY, Vol: 7, ISSN: 1664-2295

JOURNAL ARTICLE

Patel M, Agarwal K, Arshad Q, Hariri M, Rea P, Seemungal BM, Golding JF, Harcourt JP, Bronstein AMet 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

JOURNAL ARTICLE

Ahmad H, Arshad Q, Roberts R, Patel M, Ham T, Sharp D, Seemungal Bet al., 2016, CHRONIC DIZZINESS POST TRAUMATIC BRAIN INJURY: A CROSS-SECTIONAL STUDY, Annual Meeting of the Association-of-British-Neurologists (ABN), Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050

CONFERENCE PAPER

Yousif N, Fu RZ, Bourquin BA-E-E, Bhrugubanda V, Schultz SR, Seemungal BMet al., 2016, Dopamine Activation Preserves Visual Motion Perception Despite Noise Interference of Human V5/MT, JOURNAL OF NEUROSCIENCE, Vol: 36, Pages: 9303-9312, ISSN: 0270-6474

JOURNAL ARTICLE

Patel M, Agarwal K, Arshad Q, Hariri M, Rea P, Seemungal BM, Golding JF, Harcourt JP, Bronstein AMet 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

JOURNAL ARTICLE

Murdin L, Seemungal BM, Bronstein AM, 2016, Dizziness, Medicine (United Kingdom), Vol: 44, Pages: 484-487, ISSN: 1357-3039

© 2016 Elsevier Ltd Dizziness and vertigo are common symptoms. Because there are effective treatments for vestibular disorders, it is always important to make an accurate diagnosis. In acute vertigo, expert clinical assessment is critically important in discerning stroke from non-stroke causes because stroke-protocol brain magnetic resonance imaging results, including diffusion-weighted imaging, can be falsely negative in the first 24 hours. It follows that acute medical services must have access to clinicians expert in assessing acute vertigo. Expertise in clinical examination and the interpretation of findings requires appropriate training, but in this article we outline the basic diagnostic and therapeutic approach to patients with dizziness.

JOURNAL ARTICLE

Seemungal BM, 2016, Screening for BPPV in falls: an easy but big clinical "win", BMJ-BRITISH MEDICAL JOURNAL, Vol: 353, ISSN: 1756-1833

JOURNAL ARTICLE

Yousif N, Fu R, Abou-El-Ela-Bourquin B, Bhrugubanda V, Schultz S, Seemungal BMet al., 2016, Dopamine preserves visual motion perception despite noise interference of human V5/MT, European Academy of Neurology, Publisher: WILEY, Pages: 874-874, ISSN: 1351-5101

CONFERENCE PAPER

Braga RM, Fu RZ, Seemungal BM, Wise RJS, Leech Ret al., 2016, Eye Movements during Auditory Attention Predict Individual Differences in Dorsal Attention Network Activity, FRONTIERS IN HUMAN NEUROSCIENCE, Vol: 10, ISSN: 1662-5161

JOURNAL ARTICLE

Yousif N, Bhatt H, Bain PG, Nandi D, Seemungal BMet al., 2016, The effect of pedunculopontine nucleus deep brain stimulation on postural sway and vestibular perception, EUROPEAN JOURNAL OF NEUROLOGY, Vol: 23, Pages: 668-670, ISSN: 1351-5101

JOURNAL ARTICLE

Kaski D, Quadir S, Nigmatullina Y, Malhotra PA, Bronstein AM, Seemungal BMet al., 2016, Temporoparietal encoding of space and time during vestibular-guided orientation, BRAIN, Vol: 139, Pages: 392-403, ISSN: 0006-8950

JOURNAL ARTICLE

Li LM, Leech R, Scott G, Malhotra P, Seemungal B, Sharp DJet al., 2015, The effect of oppositional parietal transcranial direct current stimulation on lateralized brain functions, EUROPEAN JOURNAL OF NEUROSCIENCE, Vol: 42, Pages: 2904-2914, ISSN: 0953-816X

JOURNAL ARTICLE

Li L, Leech R, Seemungal B, Malhotra P, Sharp Det al., 2015, A SENSE OF DIRECTION: BRAIN STIMULATION IN LATERALISED BRAIN FUNCTION, JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, Vol: 86, ISSN: 0022-3050

JOURNAL ARTICLE

Seemungal B, Kaski D, Antonio Lopez-Escamez J, 2015, Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Meniere's Disease, NEUROLOGIC CLINICS, Vol: 33, Pages: 619-+, ISSN: 0733-8619

JOURNAL ARTICLE

Seemungal BM, Arshad Q, Paine H, Milburn J, Wolstenholme S, Collins K, Marcus HJ, Wilson Met al., 2015, What is post-concussion dizziness? Expert neuro-otological assessment in acute Traumatic Brain Injury (TBI), 1st Congress of the European-Academy-of-Neurology, Publisher: WILEY, Pages: 52-52, ISSN: 1351-5101

CONFERENCE PAPER

Cousins S, Kaski D, Cutfield N, Ahmad H, Arshad Q, Seemungal B, Golding J, Gresty M, Bronstein Aet al., 2015, Clinical recovery after acute vestibular neuritis, 1st Congress of the European-Academy-of-Neurology, Publisher: WILEY, Pages: 364-364, ISSN: 1351-5101

CONFERENCE PAPER

Nigmatullina Y, Arshad Q, Wu K, Seemungal BM, Bronstein AM, Soto Det al., 2015, HOW IMAGERY CHANGES SELF-MOTION PERCEPTION, NEUROSCIENCE, Vol: 291, Pages: 46-52, ISSN: 0306-4522

JOURNAL ARTICLE

Nigmatullina Y, Hellyer PJ, Nachev P, Sharp DJ, Seemungal BMet al., 2015, The Neuroanatomical Correlates of Training-Related Perceptuo-Reflex Uncoupling in Dancers, CEREBRAL CORTEX, Vol: 25, Pages: 554-562, ISSN: 1047-3211

JOURNAL ARTICLE

Seemungal BM, 2015, The Components of Vestibular Cognition-Motion Versus Spatial Perception, MULTISENSORY RESEARCH, Vol: 28, Pages: 507-524, ISSN: 2213-4794

JOURNAL ARTICLE

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