I am neurologist expert in brain conditions that affect balance and spatial orientation and since Nov 2020 am head of the Centre for Vestibular Neurology at Imperial College London.
I am originally from Trinidad. I obtained my PhD in Vestibular Neurosciences from UCL (Institute of Neurology) at the MRC Human Movement and Balance Unit (supervised by Profs Gresty and Bronstein). My postdoctoral training at Imperial College was funded by an Academy of Medical Sciences and Health Foundation Clinician Scientist Fellowship. I am a Health Foundation Leadership alumnus.
Our research group combines sophisticated vestibular function testing and advanced brain imaging to investigate the effect of brain disease upon imbalance and spatial orientation.
I am also involved in national and international committees that publish guidelines and diagnostic criteria for neurological and vestibular conditions including the Association of British Neurologists (Acute Neurology Advisory Group), Royal College of Physicians (Joint Clinical Neurosciences Committee) , NICE (National Institute for Health & Care Excellence) and The Bárány Society (Classification OverSight Committee).
BRAIN AND VESTIBULAR GROUP team
Dr Elena Calzolari: Post-Doctoral Research Associate
Ms Mariya Chepisheva: Doctoral research student
Dr Matteo Ciocca: Consultant Neurologist & Doctoral Fellow
Mr Zaeem Hadi: Post-graduate Research Assistant
Dr Mo Mahmud: Doctoral Clinical Research Fellow
Ms Yuscah Pondeca: Post-graduate Research Assistant
Dr Heiko Rust: Consultant Neurologist and Senior Research Associate
Dr Abdel Rahman Saad: Clinical Research Fellow
Ms Rebecca Smith: NIHR Clinical (Physiotherapy) Doctoral Research Fellow
- A Imperial Health Charity project to develop remote assessment of acute stroke with vertigo (ReActiVe study). Position available in 2021.
- An MRC-funded project (contact: Dr Calzolari) to assess the brain mechanisms of imbalance in Traumatic Brain Injury 'TBI' (MRC);
- JP Moulton Charitable Foundation grant with Dr Yen Tai to complement our MRC CARP (see below).
- A US Dep't of Defense project (contact: Dr Mahmud) - in collaboration with colleagues from the US (Mayo clinic) and Rome (Tor Vergata) - to assess the factors impairing recovery from mild TBI;
- An NIHR Doctoral Fellowship (for Rebecca Smith) to assess the barriers to treating a common inner ear problem in TBI (called 'BPPV');
- An MRC-funded Clinical Academic Research Partnership (CARP) study with Dr Yen Tai, to trial the effect of spinal cord stimulation upon balance and falls in Parkinson's Disease patients;
- Pilot study (local funding) in balance and spatial orientation in dementia patients (contact: Ms Mariya Chepisheva).
- A Racing Foundation-funded study to develop automated diagnostics for concussion detection (contacts: Ms Yuscah Pondeca and Mr Zaeem Hadi).
- Prof Anil Bharath (Imperial): AI video diagnosis of stroke.
- Dr Caroline Burgess (Kings College London): Joint PhD student.
- Prof Danilo Mandic (Imperial): Remote concussion diagnosis & monitoring.
- Prof Jon Marsden (Univ of Plymouth): Joint PhD student.
- Prof James Rowe (Univ of Cambridge): Joint PhD student.
- Prof Simon Schultz (Imperial): Using information theory and non-invasive brain stimulation as a biomarker of functional motor cortex connectivity.
- Prof David Sharp (Imperial): MRC project (vestibular dysfynction in TBI).
- Prof Jeff Staab (Mayo Clinic): US Military mTBI & chronic vestibular disability
Dr Seemungal was born and raised in Trinidad, West Indies and then studied medicine in Cardiff. Following general medical training in London, then three years as a specialist registrar in internal medicine and endocrinology in Oxford, he then trained as a neurologist in London. He completed a PhD in vestibular neurosciences - 'The Mechanisms and Loci of Vestibular Perception' - at the MRC Human Movement and Balance Unit (Institute of Neurology, Queen Square, London) under Profs Adolfo Bronstein and Michael Gresty. During his PhD, Dr Seemungal acquired expertise in all elements of vestibular neuroscience and laboratory techniques, including advanced neurophysiological techniques and non-invasive brain stimulation (with Prof John Rothwell).
Dr Seemungal was awarded a prestigious Health Foundation & Academy of Medical Sciences and Clinician Scientist Fellowship in 2008.
He enjoys teaching and training. In 2003, in his first year as a neurology trainee, he held the now historical post of Resident Medical Officer at the Hammersmith Hospital. More recently he has developed an interest in service delivery and led the development of a GP referral pathway for patients with diziness and imbalance for the North West London area (population 2.2 million).
He relaxes by playing football and going on outdoor holidays with his family. He has been a keen photographer since childhood and enjoys the visual arts.
If you are interested in working with us, please contact Dr Seemungal (firstname.lastname@example.org).
Keywords: Vestibular Perception, Balance, Falls, Vertigo, TBI, Stroke, Dementia, Dopamine, Brain Imaging, Brain Stimulation.
Previous grant funding:
Brain Mechanisms and Loci of Human Vestibular Perception.
A particular theme of our research is the uncoupling of perception and reflex function in the vestibular and ocular-motor system. We have published a brain imaging study which showed that the vestibular cerebellar grey matter is key in modulating sensations of dizziness separate from vestibular ocular reflex responses. In addition, we have demonstrated an extensive white matter cortical network involved in mediating vertigo sensation. These findings in healthy humans were corroborated in a recent human lesion study in which the loci of vestibular perception were probed in acute stroke patients.
Vestibular Mechanisms in neurodegeneration
We are now extending our techniques into understanding the higher-order vestibular contributions to neurodegenerative diseases such as Parkinson's Disease and Alzheimer's Disease. For example, we have shown that the brain mechanisms underlying effects upon balance function with novel deep brain stimulation targets in Parkinson's patients, may be mediated by higher order vestibular mechanisms.
PAST ORGANISED RESEARCH MEETINGS
fens satellite meeting, berlin july 12th 2018.
progress in concussion research.
This meeting provided an overview of the latest research in concussion and mild traumatic brain injury. The meeting inlcuded a pre-meeting evening meeting in a typical Berlin eaterie, with local food and drink.
fens satellite meeting, como 3-4th july 2014.
Brain Plasticity of the vestibular and ocular motior systems.
This meeting focused on the brain plasticity in the vestibular and ocular motor systems. The speakers were from a variety of backgrounds including electrophysiology, pharmacology, optogenetics, computational modelling, scientific studies of human brain function as well as clinical studies. (Conference webpage).
LAB TO BEDSIDE EXAMPLES
How the brain adapts to repeated pirouetting.
We showed that the brain adaptation in dancers that enable them to suppress dizziness following a pirouette involves changes in the vestibular cerebellar grey matter. We aim to translate these findings in developing a new therapy (dance-based therapy) for chronic dizzy patients together with colleagues from Kings College London and University College London. A modified version of this therapy may be used for rehabilitating other neurological conditions such as stroke and traumatic brain injury.
TURBOCHARGING REHABILITATION WITH DOPAMINE.
In this study, we address the issue of whether dopamine activation improves visual perception despite increasing sensory noise in the visual cortex. We show specifically that dopamine D1 (or combined D1/D2) receptor activation enhances the cortical signal-to-noise-ratio to boost perceptual performance. Together with the previously reported effects of dopamine upon brain plasticity and learning (Wolf et al., 2003; Hansen and Manahan-Vaughan, 2014), our results suggest that combining rehabilitation with dopamine agonists could enhance both the saliency of the training signal and the long-term effects on brain plasticity to boost rehabilitation regimens for brain injury.
Dr Yuliya Nigmatullina
Dr Shamim Quadir
NIHR Research MSc
Dr Hena Ahmad
Dr Diego Kaski
Previous visiting and fixed term researchers:
Tom Cronin. Clinical Research Fellow (current - neurology academic clinical fellow Newcastle).
Hannah Streat: Visiting researcher (Engineering undergraduate, Cambridge University).
Recent Project students (including MSc & BSc)
Raymond Fu, Bilal Abou-El-Ela Bourquin, Matt Sargeant, Emiko Sykes, Joy Arthur, Crystal Yang, Jay Kotecha, Hetvi Bhatt.
Calzolari E, et al., Sharp DJ, Seemungal BM. Vestibular agnosia in traumatic brain injury and its link to imbalance. Brain 2021;144(1):128-143. [OPEN ACCESS].
Smith R, et al., Burgess C, Marsden J, Seemungal BM. A mixed methods randomised feasibility trial investigating the management of benign paroxysmal positional vertigo in acute traumatic brain injury. BMC Pilot and Feasibility Studies 2020; 6:130. [OPEN ACCESS]
Yousif N, Fu RZ, Abou-El-Ela Bourquin B, Bhrugubanda V, Schultz SR, Seemungal BM. Dopamine Activation Preserves Visual Motion Perception Despite Noise Interference of Human V5/MT. J Neurosci. 2016 Sep 7;36(36):9303-12. [OPEN ACCESS].
Kaski D, Quadir S, Nigmatullina Y, Malhotra PA, Bronstein AM, Seemungal BM. Temporoparietal encoding of space and time during vestibular-guided orientation. Brain. 2016 Feb;139(Pt 2):392-403. [OPEN ACCESS].
Yousif N, Bhatt H, Bain PG, Nandi D, Seemungal BM. The effect of pedunculopontine nucleus deep brain stimulation on postural sway and vestibular perception. Eur J Neurol. 2016 Mar;23(3):668-70. [OPEN ACCESS]
Nigmatullina Y, Hellyer PJ, Nachev P, Sharp DJ, Seemungal BM. The neuroanatomical correlates of training-related perceptuo-reflex uncoupling in dancers. Cereb Cortex. 2015;25:554-62. [OPEN ACCESS].
Seemungal BM, Guzman-Lopez J, Arshad Q, Schultz SR, Walsh V, Yousif N. Vestibular activation differentially modulates human early visual cortex and V5/MT excitability and response entropy. Cereb Cortex. 2013 Jan;23(1):12-9. [OPEN ACCESS].
Seemungal BM. The cognitive neurology of the vestibular system. Curr Opin Neurol. 2014 Feb;27(1):125-32.
(Consensus paper) Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D. Vestibular migraine: diagnostic criteria. J Vestib Res. 2012;22(4):167-72. [OPEN ACCESS].
GUIDELINES AND TOOLS FOR DOCTORS
- Online tools to help General Practitioners to manage the dizzy patient - Click Online tool.
- Help for hospital doctors dealing with acute vertigo - WHEN DOES A PATIENT WITH ACUTE VERTIGO NEED A BRAIN SCAN?
Taken from Seemungal. Current Opinions in Neurology, 2007:
Acute brain imaging (ideally MRI) is mandatory if there are one or more of the following in a case with acute persisting vertigo:
- Hyperacute onset vertigo (seconds) that persists.
- Acute vertigo with a normal head impulse test.
- Acute vertigo with new onset headache (especially occpital).
- Acute vertigo with any central signs, inlcuding gait or truncal ataxia.
- Acute vertigo and deafness without a typical Meniere's history.
Member of NHS England Strategic Clinical Network for Neurology (London) - I was involved in the neurology 'common conditions' working group (click for the report published in December 2016). The aim of this working group was to rebalance the referral pattern between the community and acute hospitals for common neurological conditions. One model involves a fully integrated service linking the community and the acute hospital. For example, for dizziness, the hospital team would train and support a community team to see the majority of dizzy patients. More complex and/or acute vertigo cases (e.g. potential strokes) would be seen by the hospital team.
Member of Association of British Neurologists Acute Neurology Advisory board.
Member of the Barany Society Vestibular Migraine Workign Group - involved in the working group that published the first classification for vestibular migraine.
Registered expert on the European Research and Innovation database.
Expert review of the United Kingdom ‘NICE’ guidelines for vertigo & dizziness.
FENS Satellite meeting - Chaired a European conference on Brain Plasticity in the Vestibular system (‘FENS’ Satellite conference – 2014).
This includes masterclasses on managing dizziness at the Royal College of Physicians, at BMJ Masterclasses in India and at the 1st and 2nd European Academy of Neurology (EAN) meetings in Berlin (2015) and Copenhagen (2016).
Participates in the Trust acute neurology rota. Provides an acute vertigo service with colleagues (Prof Adolfo Bronstein) at Imperial Healthcare NHS Trust. Together, they provide an acute vertigo service to the Trust A&E's, Hyperacute Stroke Unit at Charing Cross and the Major Trauma Unit at St Mary’s Hospital.
et al., 2021, Vestibular agnosia in traumatic brain injury and its link to imbalance., Brain, Vol:144, Pages:128-143
et al., 2015, Temporoparietal encoding of space and time during vestibular-guided orientation, Brain, Vol:139, ISSN:0006-8950, Pages:392-403
et al., 2013, The Neuroanatomical Correlates of Training-Related Perceptuo-Reflex Uncoupling in Dancers, Cerebral Cortex, Vol:25, Pages:554-562
et al., 2012, Vestibular Activation Differentially Modulates Excitability and Response Entropy in Human V5/MT and Early Visual Cortex., Cerebral Cortex, Vol:23, ISSN:1047-3211, Pages:12-19
Guzman-Lopez J, Silvanto J, Seemungal BM, 2011, Visual motion adaptation increasesthe susceptibility of area V5/MT to phosphene induction by transcranial magnetic stimulation, Clinical Neurophysiology
Seemungal BM, 2007, Neuro-otological emergencies, Current Opinion in Neurology, Vol:20, ISSN:1350-7540, Pages:32-39