Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
BMC Neurol. 2021 Oct 12;21(1):394. doi: 10.1186/s12883-021-02417-z.
Persistent postural-perceptual dizziness (PPPD) is the most common functional vestibular disorder. A multisensory mismatch altered by psychological influences is considered to be an important pathophysiological mechanism. Increased cortical and subcortical excitability may play a role in the pathophysiology of PPPD. We hypothesized that decreased motion perception thresholds reflect one mechanism of the abnormal vestibular responsiveness in this disorder. We investigated the vestibular perception thresholds and the vestibular ocular reflex with a rotatory chair experiment to gain insights in the processing and adaption to vestibular provocation.
In this cross-sectional study 26 female PPPD patients and 33 healthy female age matched controls (HC) were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli. The chair was rotated for 20 minutes with slowly increasing velocity to a maximum of 72°/s. We functionally tested motion perception thresholds and vegetative responses to rotation as well as vestibular-ocular reflex thresholds. We additionally investigated several psychological comorbidities (i.e. depression, anxiety, somatosensory amplification) using validated scores. Conventional dizziness scores were obtained to quantify the experienced dizziness and impact on daily life.
PPPD patients showed a significant reduced vestibulo-perceptual threshold (PPPD: 10.9°/s vs. HC: 29.5°/s; p<0.001) with increased motion sensitivity and concomitant vegetative response during and after the chair rotation compared to healthy controls. The extent of increased vestibular sensitivity was in correlation with the duration of the disease (p=0.043). No significant difference was measured regarding nystagmus parameters between both groups.
PPPD patients showed increased vegetative response as well as decreased vestibulo-perceptual thresholds which are related to disease duration. This is of interest as PPPD might be sustained by increased vestibular excitability leading to motion intolerance and induction of dizziness when exposed to movement.
持续性姿势-感知性头晕（PPPD）是最常见的功能性前庭障碍。心理影响导致的多感觉不匹配被认为是重要的病理生理学机制。皮质和皮质下兴奋性增加可能在 PPPD 的病理生理学中起作用。我们假设运动感知阈值的降低反映了该疾病中异常前庭反应的一种机制。我们通过旋转椅实验研究了前庭感知阈值和前庭眼反射，以深入了解前庭刺激的处理和适应。
在这项横断面研究中，我们调查了 26 名女性 PPPD 患者和 33 名年龄匹配的健康女性对照者（HC）坐在一个屏蔽视觉和听觉刺激的电动旋转椅上。椅子以逐渐增加的速度旋转 20 分钟，最大速度为 72°/s。我们功能测试了运动感知阈值和旋转时的植物性反应以及前庭眼反射阈值。我们还使用经过验证的评分调查了几种心理共病（即抑郁、焦虑、躯体感觉放大）。获得了常规眩晕评分以量化所经历的眩晕和对日常生活的影响。
与健康对照组相比，PPPD 患者在旋转椅期间和之后表现出显著降低的前庭感知阈值（PPPD：10.9°/s 与 HC：29.5°/s；p<0.001），表现出运动敏感性增加和伴随的植物性反应。增加的前庭敏感性程度与疾病持续时间相关（p=0.043）。两组之间的眼震参数没有明显差异。
PPPD 患者表现出增加的植物性反应以及降低的前庭感知阈值，这与疾病持续时间有关。这很有趣，因为 PPPD 可能是由于前庭兴奋性增加导致的，当暴露于运动时会导致运动不耐受和头晕发作。
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