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前庭眼反射的再适应可缓解晕动病。

Readaptation of the vestibulo-ocular reflex relieves the mal de debarquement syndrome.

机构信息

Department of Neurology, Icahn School of Medicine at Mount Sinai , New York, NY , USA.

Department of Otolaryngology, Icahn School of Medicine at Mount Sinai , New York, NY , USA.

出版信息

Front Neurol. 2014 Jul 15;5:124. doi: 10.3389/fneur.2014.00124. eCollection 2014.

Abstract

The mal de debarquement syndrome (MdDS), a continuous feeling of swaying, rocking, and/or bobbing, generally follows travel on the sea. The associated symptoms cause considerable distress. The underlying neural mechanisms are unknown, and to date there have been no effective treatments for this condition. Results in monkeys and humans suggested that MdDS was caused by maladaptation of the vestibulo-ocular reflex (VOR) to roll of the head during rotation. We studied 24 subjects with persistent MdDS (3 males, 21 females; 19.1 ± 33 months). Physical findings included body oscillation at 0.2 Hz, oscillating vertical nystagmus when the head was rolled from side-to-side in darkness, and unilateral rotation during the Fukuda stepping test. We posited that the maladapted rocking and the physical symptoms could be diminished or extinguished by readapting the VOR. Subjects were treated by rolling the head from side-to-side while watching a rotating full-field visual stimulus. Seventeen of the 24 subjects had a complete or substantial recovery on average for approximately 1 year. Six were initially better, but the symptoms recurred. One subject did not respond to treatment. Thus, readaptation of the VOR has led to a cure or substantial improvement in 70% of the subjects with MdDS. We conclude that the adaptive processes associated with roll-while-rotating are responsible for producing MdDS, and that the symptoms can be reduced or resolved by readapting the VOR.

摘要

晕动病(MdDS)是一种持续的摇摆、晃动和/或颠簸感,通常发生在海上旅行后。相关症状会引起相当大的痛苦。其潜在的神经机制尚不清楚,迄今为止,这种疾病还没有有效的治疗方法。猴子和人类的研究结果表明,MdDS 是由头部在旋转过程中滚动时前庭眼反射(VOR)适应不良引起的。我们研究了 24 名持续 MdDS 患者(3 名男性,21 名女性;19.1±33 个月)。体检发现包括身体以 0.2Hz 摆动、在黑暗中头部从一侧滚到另一侧时出现摆动性垂直性眼球震颤、以及 Fukuda 踏步试验时出现单侧旋转。我们假设通过重新适应 VOR,可以减轻或消除不适应的摇摆和身体症状。通过头部从一侧滚到另一侧的同时观看旋转的全视野视觉刺激来对患者进行治疗。24 名患者中有 17 名平均在大约 1 年内完全或显著恢复。6 名患者最初症状改善,但后来又复发。1 名患者对治疗无反应。因此,VOR 的重新适应使 70%的 MdDS 患者得到治愈或显著改善。我们得出结论,与旋转时滚动相关的适应过程是产生 MdDS 的原因,并且可以通过重新适应 VOR 来减轻或消除症状。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b047/4097942/46c657e9e1c2/fneur-05-00124-g001.jpg

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