Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Center for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany; Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Planegg, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Planegg, Germany.
Prog Brain Res. 2019;249:385-400. doi: 10.1016/bs.pbr.2019.02.006. Epub 2019 Mar 22.
Understanding the mechanisms of symptoms that are insufficiently explained by organic dysfunction remains challenging. Recently, it has been proposed that such "functional symptoms" are based on erroneous sensory processing in the central nervous system (CNS), with internal expectations dominating sensory inputs. In a pilot study, we used a head motor control set-up to assess the interplay between sensory input and expectation on the example of patients with functional dizziness. Eight patients and 11 age-matched healthy controls performed large active eye-head gaze shifts towards visual targets in the natural situation and with the head moment of inertia 3.3-fold increased. The latter induces head oscillations and the expected sensory outcome of the movement, estimated in the CNS, does not match the actual sensory input. Head oscillations were assessed in patients and in healthy subjects and compared to prior results from patients with organic disease (vestibular loss and cerebellar ataxia). Head oscillations in patients with functional dizziness were different from those of healthy subjects (F(1,17)=27.26, P<0.001, partial η=0.62), and similar to those of patients with cerebellar ataxia, and with vestibular loss (F(2,19)=0.56, P=0.58). Even in the natural, unweighted, condition, head oscillations were higher in functional dizziness patients than in healthy subjects (P=0.001). Since an extensive work-up failed to demonstrate any explanatory peripheral vestibular, motor, or cerebellar organic dysfunction, these motor control deficits are a first indication of erroneous interplay between expectations and sensory input in the CNS that could account for persistent physical symptoms.
理解无法用器质性功能障碍解释的症状的机制仍然具有挑战性。最近，有人提出，这种“功能性症状”是基于中枢神经系统（CNS）中错误的感觉处理，内部预期主导着感觉输入。在一项初步研究中，我们使用头部运动控制装置，以评估感觉输入和预期在功能性头晕患者中的相互作用。8 名患者和 11 名年龄匹配的健康对照者在自然情况下和头部惯性增加 3.3 倍的情况下，向视觉目标进行大的主动眼-头扫视。后者会引起头部振动，而运动在中枢神经系统中估计的预期感觉结果与实际感觉输入不匹配。我们评估了患者和健康受试者的头部振动，并与有机疾病（前庭损失和小脑共济失调）患者的先前结果进行了比较。功能性头晕患者的头部振动与健康受试者不同（F(1,17)=27.26，P<0.001，偏η=0.62），与小脑共济失调患者和前庭损失患者相似（F(2,19)=0.56，P=0.58）。即使在自然、无负荷的情况下，功能性头晕患者的头部振动也高于健康受试者（P=0.001）。由于广泛的检查未能显示任何解释性的外周前庭、运动或小脑器质性功能障碍，这些运动控制缺陷是中枢神经系统中期望与感觉输入错误相互作用的第一个迹象，可能导致持续的身体症状。
