Arshad Q, Cousins S, Golding J F, Bronstein A M
Neuro-otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, UK; inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK.
Bristol Population Health Science Institute, University of Bristol, UK.
J Neurol Sci. 2023 Mar 15;446:120579. doi: 10.1016/j.jns.2023.120579. Epub 2023 Feb 3.
Following vestibular neuritis (VN), long term prognosis is not dependent on the magnitude of the residual peripheral function as measured with either caloric or the video head-impulse test. Rather, recovery is determined by a combination of visuo-vestibular (visual dependence), psychological (anxiety) and vestibular perceptual factors. Our recent research in healthy individuals has also revealed a strong association between the degree of lateralisation of vestibulo-cortical processing and gating of vestibular signals, anxiety and visual dependence. In the context of several functional brain changes occurring in the interaction between visual, vestibular and emotional cortices, which underpin the aforementioned psycho-physiological features in patients with VN, we re-examined our previously published findings focusing on additional factors impacting long term clinical outcome and function. These included: (i) the role of concomitant neuro-otological dysfunction (i.e. migraine and benign paroxysmal positional vertigo (BPPV)) and (ii) the degree to which brain lateralisation of vestibulo-cortical processing influences gating of vestibular function in the acute stage. We found that migraine and BPPV interfere with symptomatic recovery following VN. That is, dizziness handicap at short-term recovery stage was significantly predicted by migraine (r = 0.523, n = 28, p = .002), BPPV (r = 0.658, n = 31, p < .001) and acute visual dependency (r = 0.504, n = 28, p = .003). Moreover, dizziness handicap in the long-term recovery stage continued to be predicted by migraine (r = 0.640, n = 22, p = .001), BPPV (r = 0.626, n = 24, p = .001) and acute visual dependency (r = 0.667, n = 22, p < .001). Furthermore, surrogate measures of vestibulo-cortical lateralisation were predictive of the amount of cortical suppression exerted over vestibular thresholds. That is, in right-sided VN patients, we observed a positive correlation between visual dependence and acute ipsilesional oculomotor thresholds (R 0.497; p < .001), but not contralateral thresholds (R 0.017: p > .05). In left-sided VN patients, we observed a negative correlation between visual dependence and ipsilesional oculomotor thresholds (R 0.459; p < .001), but not for contralateral thresholds (R 0.013; p > .05). To surmise, our findings illustrate that in VN, neuro-otological co-morbidities retard recovery, and that measures of the peripheral vestibular system are an aggregate of residual function and cortically mediated gating of vestibular input.
在前庭神经炎（VN）之后，长期预后并不取决于通过冷热试验或视频头脉冲试验所测量的残余外周功能的大小。相反，恢复情况由视前庭（视觉依赖）、心理（焦虑）和前庭感知因素共同决定。我们最近在健康个体中的研究还揭示了前庭 - 皮质处理的偏侧化程度与前庭信号的门控、焦虑和视觉依赖之间存在密切关联。鉴于在视觉、前庭和情感皮质之间的相互作用中发生了多种功能性脑变化，这些变化是VN患者上述心理生理特征的基础，我们重新审视了我们之前发表的研究结果，重点关注影响长期临床结局和功能的其他因素。这些因素包括：（i）伴随的神经耳科功能障碍（即偏头痛和良性阵发性位置性眩晕（BPPV））的作用，以及（ii）前庭 - 皮质处理的脑偏侧化程度在急性期对前庭功能门控的影响程度。我们发现偏头痛和BPPV会干扰VN后的症状恢复。也就是说，偏头痛（r = 0.523，n = 28，p = 0.002）、BPPV（r = 0.658，n = 31，p < 0.001）和急性视觉依赖（r = 0.504，n = 28，p = 0.003）可显著预测短期恢复阶段的头晕障碍。此外，偏头痛（r = 0.640，n = 22，p = 0.001）、BPPV（r = 0.626，n = 24，p = 0.001）和急性视觉依赖（r = 0.667，n = 22，p < 0.001）仍可预测长期恢复阶段的头晕障碍。此外，前庭 - 皮质偏侧化的替代指标可预测皮质对前庭阈值施加的抑制量。也就是说，在右侧VN患者中，我们观察到视觉依赖与急性同侧动眼阈值之间存在正相关（R = 0.497；p < 0.001），但与对侧阈值无关（R = 0.017：p > 0.05）。在左侧VN患者中，我们观察到视觉依赖与同侧动眼阈值之间存在负相关（R = 0.459；p < 0.001），但对侧阈值无此相关性（R = 0.013；p > 0.05）。可以推测，我们的研究结果表明，在VN中，神经耳科合并症会延缓恢复，并且外周前庭系统的测量是残余功能和皮质介导的前庭输入门控的总和。
