Guinand Nils, Van de Berg Raymond, Cavuscens Samuel, Ranieri Maurizio, Schneider Erich, Lucieer Floor, Kingma Herman, Guyot Jean-Philippe, Pérez Fornos Angélica
Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
Division of Balance Disorders, Department of ENT, Maastricht University Medical Centre, Maastricht, Netherlands.
Front Neurol. 2017 Nov 14;8:600. doi: 10.3389/fneur.2017.00600. eCollection 2017.
The purpose of this study was to evaluate whether it is possible to restore the high-frequency angular vestibulo-ocular reflex (aVOR) in patients suffering from a severe bilateral vestibulopathy (BV) and implanted with a vestibular implant prototype. Three patients (S1-3) participated in the study. They received a prototype vestibular implant with one to three electrode branches implanted in the proximity of the ampullary branches of the vestibular nerve. Five electrodes were available for electrical stimulation: one implanted in proximity of the left posterior ampullary nerve in S1, one in the left lateral and another one in the superior ampullary nerves in S2, and one in the right lateral and another one in the superior ampullary nerves in S3. The high-frequency aVOR was assessed using the video head impulse test (EyeSeeCam; EyeSeeTec, Munich, Germany), while motion-modulated electrical stimulation was delivered one of the implanted vestibular electrodes at a time. aVOR gains were compared to control measurements obtained in the same patients when the device was not activated. In three out of the five tested electrodes the aVOR gain increased monotonically with increased stimulation strength when head impulses were delivered in the plane of the implanted canal. In these cases, gains ranging from 0.4 to values above 1 were measured. A "reversed" aVOR could also be generated when inversed stimulation paradigms were used. In most cases, the gain for excitatory head impulses was superior to that recorded for inhibitory head impulses, consistent with unilateral vestibular stimulation. Improvements of aVOR gain were generally accompanied by a concomitant decrease of corrective saccades, providing additional evidence of an effective aVOR. High inter-electrode and inter-subject variability were observed. These results, together with previous research, demonstrate that it is possible to restore the aVOR in a broad frequency range using motion-modulated electrical stimulation of the vestibular afferents. This provides additional encouraging evidence of the possibility of achieving a useful rehabilitation alternative for patients with BV in the near future.
本研究的目的是评估对于患有严重双侧前庭病（BV）并植入前庭植入物原型的患者，恢复高频角向前庭眼反射（aVOR）是否可行。三名患者（S1 - 3）参与了该研究。他们接受了一个前庭植入物原型，其中一到三个电极分支植入在前庭神经壶腹分支附近。有五个电极可用于电刺激：在S1中，一个电极植入在左后壶腹神经附近；在S2中，一个电极植入在左外侧壶腹神经，另一个植入在上壶腹神经；在S3中，一个电极植入在右外侧壶腹神经，另一个植入在上壶腹神经。使用视频头脉冲测试（EyeSeeCam；EyeSeeTec，德国慕尼黑）评估高频aVOR，同时一次对一个植入的前庭电极进行运动调制电刺激。将aVOR增益与在设备未激活时同一患者获得的对照测量值进行比较。在五个测试电极中的三个电极上，当在植入半规管平面内进行头脉冲时，aVOR增益随刺激强度增加而单调增加。在这些情况下，测量到的增益范围从0.4到高于1的值。当使用反向刺激模式时，也可以产生“反向”aVOR。在大多数情况下，兴奋性头脉冲的增益优于抑制性头脉冲记录的增益，这与单侧前庭刺激一致。aVOR增益的改善通常伴随着矫正扫视的相应减少，这为有效的aVOR提供了额外证据。观察到电极间和受试者间的高变异性。这些结果与先前的研究一起表明，使用前庭传入神经的运动调制电刺激可以在很宽的频率范围内恢复aVOR。这为在不久的将来为BV患者实现有用的康复替代方案的可能性提供了额外的令人鼓舞的证据。
