German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
Department of Neurology, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
J Neurol. 2017 Oct;264(Suppl 1):81-86. doi: 10.1007/s00415-017-8481-4. Epub 2017 Apr 8.
Patients with bilateral vestibulopathy (BVP) suffer from persistent imbalance during standing and walking as well as an impaired gaze stabilization during head movements. Disabilities associated with BVP severely compromise patients' daily activities and are often linked to an increased risk of falls. Currently, the only established treatment option in BVP is physical therapy. However, treatment effects of physical therapy in BVP are most often limited and many patients do not adequately recover performance. Therefore, a number of technical therapeutic approaches are being explored that either try to substitute lost vestibular sensation with a congruent stimulation of other sense modalities or to artificially mimic vestibular function by means of an implantable vestibular prosthesis. Besides, attempts have recently been made to augment and optimize residual vestibular function in patients with BVP using an imperceptible noisy galvanic vestibular stimulation (nGVS). This approach is based on the natural phenomenon of stochastic resonance, wherein the signal processing in sensory systems can be improved by adding an appropriate level of noise to the system. Promising first study outcomes of nGVS treatment in patients with BVP indicate the feasibility of a future non-invasive sensory prosthetic device for BVP rehabilitation. This paper gives an overview about recent research on nGVS treatment in patients with BVP and discusses future research perspectives in this field.
双侧前庭病 (BVP) 患者在站立和行走时会持续感到失衡,头部运动时眼球稳定性也会受损。BVP 相关的残疾严重影响患者的日常活动,往往会增加跌倒的风险。目前,BVP 的唯一既定治疗选择是物理疗法。然而,物理疗法在 BVP 中的治疗效果通常很有限,许多患者的恢复效果不佳。因此,目前正在探索许多技术治疗方法,这些方法试图通过其他感觉模式的一致刺激来替代丧失的前庭感觉,或者通过植入式前庭假体来人为模拟前庭功能。此外,最近还尝试使用不易察觉的噪声电前庭刺激 (nGVS) 来增强和优化 BVP 患者的残留前庭功能。这种方法基于随机共振的自然现象,其中通过向系统添加适当水平的噪声,可以改善感觉系统中的信号处理。nGVS 治疗 BVP 患者的初步研究结果令人鼓舞,表明未来用于 BVP 康复的非侵入性感觉假体设备具有可行性。本文概述了 nGVS 治疗 BVP 患者的最新研究,并讨论了该领域的未来研究前景。