Imperial College London

DrDiegoKaski

Faculty of MedicineDepartment of Brain Sciences

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3313 5526d.kaski

 
 
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Location

 

Neuro-otologyLab BlockCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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128 results found

Mikkonen J, Leinonen V, Kaski D, Hartvigsen J, Luomajoki H, Selander T, Airaksinen Oet al., 2022, Postural sway does not differentiate individuals with chronic low back pain, single and multisite chronic musculoskeletal pain, or pain free controls: a cross-sectional study of 229 subjects., Spine J

BACKGROUND CONTEXT: Physical activity in its various forms are the most recommended prevention and treatment strategy for chronic low back pain (CLBP). Standing postural stability is a prerequisite for many types of physical activities. Systematic reviews have investigated the evidence for an association between CLBP and postural stability but results remain inconclusive. PURPOSE: Our primary objective was to compare postural stability between pain free controls and subjects with CLBP with or without leg pain and single and multisite chronic musculoskeletal pain subjects. The secondary objectives were to evaluate the association between postural stability with CLBP intensity and duration, demographics, physical characteristics, and validated health and pain related patient-reported outcome measures (PROMs). STUDY DESIGN/SETTING: Cross-sectional study in private chiropractic clinic setting PATIENT SAMPLE: Subjects included 42 pain free controls and 187 patients with chronic musculoskeletal pain divided into CLBP with or without leg pain and single and multisite pain groups. OUTCOME MEASURES: Pain intensity was measured using the numerical pain rating scale, and PROMs Central Sensitization Inventory, Tampa Scale of Kinesiophobia, The Depression Scale, EuroQol-5D, Roland-Morris Disability Questionnaire, and Pain and Sleep Questionnaire Three-Item Index disability. Group differences were measured using area and velocity of sway on the force plate. METHODS: Postural stability was assessed using force plate on four 60 second bipedal quiet stance tests: eyes open on a stable surface, eyes closed on a stable surface, eyes open on an unstable foam surface, eyes closed on an unstable foam surface. Following the clinic visit, subjects completed an online web-based data entry detailing pain history, demographic data, physical characteristics, pain intensity via the numerical pain rating scale, and PROMS. RESULTS: Postural sway parameters did not differ between pain free control

Journal article

Rashid SMU, Sumaria S, Koohi N, Arshad Q, Kaski Det al., 2022, Patient Experience of Flunarizine for Vestibular Migraine: Single Centre Observational Study, BRAIN SCIENCES, Vol: 12

Journal article

Mendis S, Longley N, Morley S, Korres G, Kaski Det al., 2022, Autoimmune Vestibulopathy-A Case Series, BRAIN SCIENCES, Vol: 12

Journal article

Rivlin W, Habershon C, Tsang BK-T, Kaski Det al., 2022, Practical approach to vertigo: a synthesis of the emerging evidence., Intern Med J, Vol: 52, Pages: 356-364

Vestibular presentations are common in both the acute and recurrent setting, burdening emergency departments and community clinics alike. Commonly, an unease among the emergency or general physician is felt, and historically focus has been on gaining knowledge of each potential disease rather than honing the diagnostic process. Consequently, this paper focuses on the approach itself, helping to categorise this common complaint into one of four main syndromes: the Acute Vestibular Syndrome, Recurrent Positional Vertigo, Recurrent Spontaneous Vertigo, and Imbalance. Its simplicity is aimed to minimise uncertainty and highlight clear scenarios when to refer. Together with descriptions of the clinically relevant pathophysiology, the reader should approach the vertiginous patient with a new clarity.

Journal article

Bennett E, Holmes S, Koohi N, Islam S, Bancroft M, Male A, Hanna MG, Pitceathly RDS, Kaski Det al., 2022, Self-reported postural symptoms predict vestibular dysfunction and falls in patients with multi-sensory impairment, JOURNAL OF NEUROLOGY, Vol: 269, Pages: 2788-2791, ISSN: 0340-5354

Journal article

Coebergh J, Zimianiti I, Kaski D, 2021, Shoulder-Tap Test for Functional Gait Disorders A Sign of Abnormal Anticipatory Behavior, NEUROLOGY, Vol: 97, Pages: 1070-1071, ISSN: 0028-3878

Journal article

Warner CL, Bunn L, Koohi N, Schmidtmann G, Freeman J, Kaski Det al., 2021, Clinician's perspectives in using head impulse-nystagmus-test of skew (HINTS) for acute vestibular syndrome: UK experience, STROKE AND VASCULAR NEUROLOGY, ISSN: 2059-8688

Journal article

Mendis S, Ealing J, Larkin J, Turajlic S, Carr A, Bronstein A, Kaski Det al., 2021, Isolated imbalance due to bilateral vestibular failure following immune checkpoint inhibitor administration: two cases, EUROPEAN JOURNAL OF CANCER, Vol: 156, Pages: 187-189, ISSN: 0959-8049

Journal article

Castro Abarca P, Vadera S, Bancroft MJ, Butell J, Kaski Det al., 2021, Acute onset fear of falling and treatment with “Cognitive Physical Therapy”, Frontiers in Neurology, Vol: 12, Pages: 1-7, ISSN: 1664-2295

Fear of falling (FoF) is prevalent in older adults, especially those with previous falls, and typically starts insidiously. We present a 78-year-old woman with an abrupt onset FoF and no history of falls, balance problems, vertigo, oscillopsia, psychiatric or psychological issues to account for this. These cognitive changes led to a behavioural alteration of her gait that became slow and wide-based, with her gaze fixed on the floor. She began a tailored program of “Cognitive Physical Therapy (CPT)” combining cognitive behavioural therapy (CBT) and physical rehabilitation. One month later her 6m walk time and steps were reduced by a 25% and 35%, respectively and the stride length increased by 34%, with further improvement 2 months later. We postulate that the abrupt onset of symptoms triggered a central shift towards postural hypervigilance and anxiety, suppression of anticipatory (feed forward) postural adjustments (APA) leading to FoF. CPT improved objective gait parameters related to FoF and reduced postural anxiety suggesting that early diagnosis and prompt treatment may avoid chronic symptoms and social isolation.

Journal article

Man Chan Y, Wong Y, Khalid N, Wastling S, Flores-Martin A, Frank L-A, Koohi N, Arshad Q, Davagnanam I, Kaski Det al., 2021, Prevalence of acute dizziness and vertigo in cortical stroke, EUROPEAN JOURNAL OF NEUROLOGY, Vol: 28, Pages: 3177-3181, ISSN: 1351-5101

Journal article

Kamourieh S, Sokolska M, Akram H, Patel J, Jager HR, Arshad Q, Matharu M, Kaski Det al., 2021, Miners' Nystagmus Following Visual Deprivation: A Case Report, ANNALS OF INTERNAL MEDICINE, Vol: 174, Pages: 1021-+, ISSN: 0003-4819

Journal article

Koohi N, Bancroft MJ, Patel J, Castro P, Akram H, Warner TT, Kaski Det al., 2021, Saccadic Bradykinesia in Parkinson's Disease: Preliminary Observations., Mov Disord, Vol: 36, Pages: 1729-1731

Journal article

Curro R, Salvalaggio A, Tozza S, Gemelli C, Dominik N, Deforie VG, Magrinelli F, Castellani F, Vegezzi E, Businaro P, Callegari I, Pichiecchio A, Cosentino G, Alfonsi E, Marchioni E, Colnaghi S, Gana S, Valente EM, Tassorelli C, Efthymiou S, Facchini S, Carr A, Laura M, Rossor AM, Manji H, Lunn MP, Pegoraro E, Santoro L, Grandis M, Bellone E, Beauchamp NJ, Hadjivassiliou M, Kaski D, Bronstein AM, Houlden H, Reilly MM, Mandich P, Schenone A, Manganelli F, Briani C, Cortese Aet al., 2021, RFC1 expansions are a common cause of idiopathic sensory neuropathy, BRAIN, Vol: 144, Pages: 1542-1550, ISSN: 0006-8950

Journal article

Bonsu A, Walker P, Edey J, Rea P, Kaski D, Kheradmand A, Saman Y, Staab JP, Arshad Qet al., 2021, Time to consider the role of rationalisation in health psychology, PUBLIC HEALTH, Vol: 196, Pages: 59-61, ISSN: 0033-3506

Journal article

McCarthy J, Castro P, Cottier R, Buttell J, Arshad Q, Kheradmand A, Kaski Det al., 2021, Multisensory contribution in visuospatial orientation: an interaction between neck and trunk proprioception, EXPERIMENTAL BRAIN RESEARCH, Vol: 239, Pages: 2501-2508, ISSN: 0014-4819

Journal article

Klarendic M, Hribar M, Urbancic NB, Zupancic N, Kramberger MG, Trost M, Battelino S, Kaski D, Kojovic Met al., 2021, Central nystagmus in progressive supranuclear palsy: A neglected clinical feature?, Parkinsonism Relat Disord, Vol: 84, Pages: 15-22

BACKGROUND: Progressive supranuclear palsy (PSP) features parkinsonism characterized by early postural instability, falls and prominent eye movement abnormalities that consist of saccadic slowing, followed by gaze limitation. Nystagmus is not considered typical for PSP, being more commonly associated with multiple system atrophy. OBJECTIVES: To describe the prevalence and phenomenology of nystagmus in patients with PSP. METHODS: 42 patients with probable PSP underwent detailed clinical eye movement examination. Patients with nystagmus performed video-nystagmography. T-test, Chi-Square test and Wilcoxon signed-rank test were used to test differences in demographic data, disease duration and PSP subtype between patients with and without nystagmus, and for analysis of video-nystagmographic data. RESULTS: Among 42 patients with PSP, we identified 15 patients (35,7%) with gaze-evoked nystagmus, predominantly horizontal. Clinically, 10/15 patients had symmetrical or asymmetrical gaze - evoked nystagmus (Type 1), while 5/15 patients had dissociated gaze-evoked nystagmus related to internuclear ophthalmoplegia (Type 2). Nystagmus and eye movement abnormalities were further characterized by video-nystagmography. There was no significant difference in age, disease duration or PSP subtypes between patients with and without nystagmus. CONCLUSION: Central nystagmus is present in more than a third of patients with progressive supranuclear palsy. It may present as symmetrical or asymmetrical gaze-evoked nystagmus or as dissociated gaze-evoked nystagmus related to internuclear ophthalmoplegia and probably arises from neurodegeneration of the neural integrator. Nystagmus in PSP has been a hitherto under-described feature and its presence should not deter clinicians from a diagnosis of PSP.

Journal article

Russell LL, Greaves CV, Convery RS, Nicholas J, Warren JD, Kaski D, Rohrer JDet al., 2021, Novel instructionless eye tracking tasks identify emotion recognition deficits in frontotemporal dementia., Alzheimers Res Ther, Vol: 13

BACKGROUND: Current tasks measuring social cognition are usually 'pen and paper' tasks, have ceiling effects and include complicated test instructions that may be difficult to understand for those with cognitive impairment. We therefore aimed to develop a set of simple, instructionless, quantitative, tasks of emotion recognition using the methodology of eye tracking, with the subsequent aim of assessing their utility in individuals with behavioural variant frontotemporal dementia (bvFTD). METHODS: Using the Eyelink 1000 Plus eye tracker, 18 bvFTD and 22 controls completed tasks of simple and complex emotion recognition that involved viewing four images (one target face (simple) or pair of eyes (complex) and the others non-target) followed by a target emotion word and lastly the original four images alongside the emotion word. A dwell time change score was then calculated as the main outcome measure by subtracting the percentage dwell time for the target image before the emotion word appeared away from the percentage dwell time for the target image after the emotion word appeared. All participants also underwent a standard cognitive battery and volumetric T1-weighted magnetic resonance imaging. RESULTS: Analysis using a mixed effects model showed that the average (standard deviation) mean dwell time change score in the target interest area was 35 (27)% for the control group compared with only 4 (18)% for the bvFTD group (p < 0.05) for the simple emotion recognition task, and 15 (26)% for the control group compared with only 2 (18)% for the bvFTD group (p < 0.05) for the complex emotion recognition task. Worse performance in the bvFTD group correlated with atrophy in the right ventromedial prefrontal and orbitofrontal cortices, brain regions previously implicated in social cognition. CONCLUSIONS: In summary, eye tracking is a viable tool for assessing social cognition in individuals with bvFTD, being well-tolerated and able to overcom

Journal article

Evangelista VRP, Mermelstein SA, da Silva MM, Kaski Det al., 2021, Bedside video-ophthalmoscopy as an aid in the diagnosis of central vestibular syndromes, JOURNAL OF NEUROLOGY, Vol: 269, Pages: 217-220, ISSN: 0340-5354

Journal article

Chandratheva A, Werring D, Kaski D, 2021, Vertebrobasilar insufficiency: an insufficient term that should be retired, PRACTICAL NEUROLOGY, Vol: 21, Pages: 2-3, ISSN: 1474-7758

Journal article

Di Stadio A, Ralli M, Altieri M, Brenner MJ, Dipietro L, Messineo D, Kaski D, Bernitsas Eet al., 2021, ENT-MS-12 questionnaire: A novel tool to investigate otolaryngology symptoms in patients with relapsing-remitting multiple sclerosis. Results from a pilot study., Mult Scler Relat Disord, Vol: 47

BACKGROUND: Multiple sclerosis (MS) is associated with otolaryngology-related manifestations including vestibular or auditory symptoms; facial motor or sensory disorders; voice or swallowing impairment; and snoring/sleep apnea. Because these symptoms are nonspecific, their significance in MS is seldom recognized by patients with MS and their physicians; yet, presence of these symptoms may be a harbinger of impending relapse or disease progression. We developed and investigated a survey instrument, the ENT-MS-12, to standardize reporting of otolaryngology symptoms in patients with MS, correlating its scoring with disability and lesions. METHODS: The ENT-MS-12 was administered to 40 patients with relapsing-remitting MS in different phases of their disease. We collected data using the Expanded Disability Status Scale (EDSS) and analyzed patient brain MRIs to evaluate the state (active or non-active) of brain lesions based on gadolinium enhancement. Odds ratios for diverse otolaryngology symptoms across the EDSS scores and brain lesions were calculated. RESULTS: Higher EDSS scores were associated with auditory and vestibular symptoms (Odd Ratio (OR): 3.06; p: 0.0003); voice and swallowing symptoms (OR: 6.8; p=0.007); and snoring/sleep apnea (OR: 5.1; p=0.03). Presence of active brain lesions was also associated with auditory and vestibular symptoms (OR: 6.7); voice and swallowing symptoms (OR: 5.7); and snoring/sleep apnea (OR: 5). CONCLUSIONS: The ENT-MS-12 survey instrument standardizes reporting of otolaryngology symptoms in patients with MS and documents association between symptoms and phase of disease in this series. Because ear, nose and throat (ENT)- related symptoms (i.e., sensory symptoms, such as numbness) are under-reported in MS, further investigation is warranted, as such data may improve clinical management of MS.

Journal article

Kaski D, Herron D, Nachev P, 2021, Deconstructing Dizziness., Front Neurol, Vol: 12, ISSN: 1664-2295

Journal article

Totilienė M, Uloza V, Lesauskaitė V, Damulevičienė G, Kregždytė R, Kaski D, Ulozienė Iet al., 2021, Impaired Subjective Visual Vertical and Increased Visual Dependence in Older Adults With Falls., Front Aging Neurosci, Vol: 13, ISSN: 1663-4365

Aging affects the vestibular system and may disturb the perception of verticality and lead to increased visual dependence (VD). Studies have identified that abnormal upright perception influences the risk of falling. The aim of our study was to evaluate subjective visual vertical (SVV) and VD using a mobile virtual reality-based system for SVV assessment (VIRVEST) in older adults with falls and evaluate its relationship with clinical balance assessment tools, dizziness, mental state, and depression level. This study included 37 adults >65 years who experienced falls and 40 non-faller age-matched controls. Three tests were performed using the VIRVEST system: a static SVV, dynamic SVV with clockwise and counter-clockwise background stimulus motion. VD was calculated as the mean of absolute values of the rod tilt from each trial of dynamic SVV minus the mean static SVV rod tilt. Older adults who experienced falls manifested significantly larger biases in static SVV (p = 0.012), dynamic SVV (p < 0.001), and VD (p = 0.014) than controls. The increase in static SVV (odds ratio = 1.365, p = 0.023), dynamic SVV (odds ratio = 1.623, p < 0.001) and VD (odds ratio = 1.460, p = 0.010) tilt by one degree significantly related to falls risk in the faller group. Fallers who had a high risk of falling according to the Tinetti test exhibited significantly higher tilts of dynamic SVV than those who had a low or medium risk (p = 0.037). In the faller group, the increase of the dynamic SVV tilt by one degree was significantly related to falls risk according to the Tinetti test (odds ratio = 1.356, p = 0.049). SVV errors, particularly with the dynamic SVV test (i.e., greater VD) were associated with an increased risk of falling in the faller group. The VIRVEST system may be applicable in clinical settings for SVV testing and predicting falls in older adults.

Journal article

Mustafa MM, Akram H, Oliva-Domínguez M, Kaski Det al., 2020, Functional positional eye and eyelid movements., J Neurol, Vol: 267, Pages: 3425-3428

BACKGROUND: Positional manoeuvres are an important part of the neurological examination, particularly in patients with vertigo where the presence and characteristics of provoked nystagmus can help differentiate central from peripheral neurological disorders. METHODS: Case series of functional positional eye and eyelid movements. RESULTS: We report four patients with functional eye and eyelid movements provoked during positional manoeuvres. The range of abnormalities observed included positional convergence spasm, brief functional saccadic oscillations, and excessive positional blinking mimicking upbeat nystagmus. The functional movements described were present on a background of pre-existing peripheral or central nystagmus, or positional vertigo. CONCLUSION: Functional positional eye and eyelid movements may co-exist with organic nystagmus that renders an accurate interpretation of the manoeuvre more challenging. A thorough understanding of the clinical features that differentiate these two categories of eye/eyelid movements makes the analysis easier, thus preventing misdiagnosis and avoiding unnecessary investigations.

Journal article

Rau CJ, Terling L, Elkhodair S, Kaski Det al., 2020, Acute vertigo in the emergency department: use of bedside oculomotor examination., Eur J Emerg Med, Vol: 27, Pages: 381-383

Journal article

Uloziene I, Totiliene M, Balnyte R, Kuzminiene A, Kregzdyte R, Paulauskas A, Blazauskas T, Marozas V, Uloza V, Kaski Det al., 2020, Subjective visual vertical and visual dependency in patients with multiple sclerosis, MULTIPLE SCLEROSIS AND RELATED DISORDERS, Vol: 44, ISSN: 2211-0348

Journal article

Rau C, Terling L, Elkhodair S, Kaski Det al., 2020, 92. Acute Vertigo in the Emergency Department - a retrospective study., Eur J Emerg Med, Vol: 27, Pages: e4-e5

Journal article

Lin D, Castro P, Edwards A, Sekar A, Edwards MJ, Coebergh J, Bronstein AM, Kaski Det al., 2020, Dissociated motor learning and de-adaptation in patients with functional gait disorders, BRAIN, Vol: 143, Pages: 2594-2606, ISSN: 0006-8950

Journal article

Klarendic M, Kaski D, 2020, Deep brain stimulation and eye movements, EUROPEAN JOURNAL OF NEUROSCIENCE, Vol: 53, Pages: 2344-2361, ISSN: 0953-816X

Journal article

Kaski D, 2020, Neurological update: dizziness, Journal of Neurology, Vol: 267, Pages: 1864-1869, ISSN: 0340-5354

The diagnosis and management of vertigo remains a challenge for clinicians, including general neurology. In recent years there have been advances in the understanding of established vestibular syndromes, and the development of treatments for existing vestibular diagnoses. In this ‘update’ I will review how our understanding of previously “unexplained” dizziness in the elderly is changing, explore novel insights into the pathophysiology of vestibular migraine, and its relationship to the newly coined term ‘persistent postural perceptual dizziness’, and finally discuss how a simple bedside oculomotor assessment may help identify vestibular presentations of stroke.

Journal article

Patel M, Roberts E, Arshad Q, Bunday K, Golding JF, Kaski D, Bronstein AMet al., 2020, The "broken escalator" phenomenon: vestibular dizziness interferes with locomotor adaptation, Journal of Vestibular Research: Equilibrium and Orientation: an international journal of experimental and clinical vestibular science, Vol: 30, Pages: 81-94, ISSN: 0957-4271

BACKGROUND: Although vestibular lesions degrade postural control we do not know the relative contributions of the magnitude of the vestibular loss and subjective vestibular symptoms to locomotor adaptation. OBJECTIVE: To study how dizzy symptoms interfere with adaptive locomotor learning. METHODS: We examined patients with contrasting peripheral vestibular deficits, vestibular neuritis in the chronic stable phase (n = 20) and strongly symptomatic unilateral Meniere's disease (n = 15), compared to age-matched healthy controls (n = 15). We measured locomotor adaptive learning using the "broken escalator" aftereffect, simulated on a motorised moving sled. RESULTS: Patients with Meniere's disease had an enhanced "broken escalator" postural aftereffect. More generally, the size of the locomotor aftereffect was related to how symptomatic patients were across both groups. Contrastingly, the degree of peripheral vestibular loss was not correlated with symptom load or locomotor aftereffect size. During the MOVING trials, both patient groups had larger levels of instability (trunk sway) and reduced adaptation than normal controls. CONCLUSION: Dizziness symptoms influence locomotor adaptation and its subsequent expression through motor aftereffects. Given that the unsteadiness experienced during the "broken escalator" paradigm is internally driven, the enhanced aftereffect found represents a new type of self-generated postural challenge for vestibular/unsteady patients.

Journal article

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