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Centre for Vestibular Neurology

A diagram of the balance system in the brain — Figure: Barry Seemungal

The main organ of balance is the brain. Indeed, the majority of balance problems stem from disorders of the brain, e.g. vestibular migraine, but also imbalance and falls from neurodegenerative diseases such as Alzheimer’s and Parkinson’s Disease, cerebral small vessel disease in the elderly, traumatic brain injury which affects all age groups, and psychological disorders linked to chronic anxiety syndromes, and associated changes in attentional processing (see Ellmers et al., 2021)

Investigating balance function and dysfunction requires understanding the nervous system in general, from sensory systems, including the inner ear to complex motor mechanisms and cognitive and psychological functioning that all influence our balance. Although as a research unit we focus on brain-related vestibular dysfunction, necessarily, we are expert in assessing, diagnosing, and treating all types of peripheral vestibular disorders including common conditions like ‘BPPV’ (second only to migraine as a cause of vertigo) to rare conditions such as Meniere’s (see our Meniere’s study in The Lancet).

Our fully-equipped laboratories probe disease mechanisms using advanced techniques including oculography (eye-tracking), virtual reality with whole-body motion tracking, neurophysiology (evoked potentials and transcranial magnetic stimulation), and whole-body movement devices such as a 7-metre linear sled, two rotating chairs (including off-axis rotation), a flight simulator and posturography platforms.

A man demonstrating a piece of equipment and a doctor speaking to a patient

A typical study may combine several techniques, e.g. clinical scales, reflex and perceptual testing as well as neurophysiology and brain imaging in patients (see Calzolari et al 2021 in acute TBI) or in healthy subjects sometimes combined with pharmacological modulation (see Yousif et al., 2016).

Clinical service (NHS clinics)

Clinics: We are a de facto national referral centre for complex vestibular cases. We run general vestibular neurology clinics and a combined vestibular and movement disorder clinic called the ‘BAN’ clinic (Balance And Neurodegeneration clinic) for neurodegenerative disease with imbalance, dizziness and eye movement abnormalities.
Acute: We provide acute vestibular neurology support for the North-West London sector, supporting Hyper-Acute Stroke and the Major Trauma Centre. Fellowships in vestibular neurology will include hands-on training in acute patients.

Vestibular Neurology Fellowships and training courses

The 2023 Imperial eye movement course - 16 November 2023, 13:30 - 18:00

This clinically oriented half-day course for medical doctors and scientists will cover the topics of disorders of the oribit and the eye, oculo-motor nerves, brainstem and cerebellum, basal ganglia and cortex, multiple sclerosis, vertigo and vestibular disorders strokes and more!

This course is organised by Prof Adolfo Bronstein. Download the brochure to find out more.

Please contact Rhiannon Kirby (r.kirby@imperial.ac.uk) for details concerning fellowships and training courses.

Funding

Our team

There are currently three Principal Investigators: Dr Barry Seemungal, Centre head since November 2020, trained in vestibular neurology at the MRC Human Movement and Balance Unit at the Institute of Neurology, UCL, and has current funding from the MRC, UK Ministry of Defence, US Department of Defense, Moulton Foundation, Imperial Charity, NIHR and the Imperial BRC; Professor Adolfo Bronstein, a world authority in clinical vestibular research, having had over 20 years of continuous MRC funding, was head of the vestibular unit for two decades, bringing the unit across from UCL in 2001. Adolfo remains research active and will mentor our newest PI, Dr Toby Ellmers. Toby has won a prestigious 4-year Sir Henry Wellcome Post-Doctoral Fellowship and brings new expertise to the Centre with his background in researching the effect of anxiety and attention on balance control.