Woo Donghoon, Kim Yukang, Baik Kyoungwon, Lee Sun-Uk, Park Euyhyun, Lee Chan-Nyoung, Kwag Seoui, Park Hyunsoh, Kim Ji-Soo, Park Kun-Woo
Neurotology and Neuro-ophthalmology Laboratory, Korea University Medical Center, Seoul, South Korea.
Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
J Neurol. 2024 Aug;271(8):5223-5232. doi: 10.1007/s00415-024-12488-w. Epub 2024 Jun 6.
Video head impulse tests (video-HITs) are commonly used for vestibular evaluation; however, the results can be contaminated by various artifacts, including technical errors, recording problems, and participant factors. Although video-HITs can be used in patients with Parkinson's disease (PD), the effect of neck rigidity has not been systematically investigated. This study aimed to investigate the effect of neck rigidity on video-HIT results in patients with PD. We prospectively recruited 140 consecutive patients with PD (mean age ± standard deviation = 68 ± 10 years, 69 men) between September 2021 and April 2024 at Korea University Medical Center. The video-HIT results were compared with those of 19 age- and sex-matched healthy participants. Neck rigidity was stratified as a subdomain of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III). In 59 patients, the vestibulo-ocular reflex (VOR) gain was overestimated in at least one canal plane (58/140, 41%), mostly in the anterior canal (AC, n = 44), followed by the horizontal (HC, n = 15) and posterior canals (PC, n = 7). VOR gain overestimation was also observed in patients with no (18/58, 35%), subtle (20/58, 34%), or mild (17/58, 29%) neck rigidity. Multivariable logistic regression analysis showed that VOR overestimation was positively associated with neck rigidity (odds ratio [OR] [95% confidence interval] = 1.51 [1.01-2.25], p = 0.043). The head velocities of patients decreased during head impulses for the AC (p = 0.033 for the right AC; p = 0.014 for the left AC), whereas eye velocities were similar to those of healthy participants. Our findings suggest that neck rigidity may be a confounder that can contaminate video-HIT results. Thus, the results of video-HITs, especially for the AC, should be interpreted with the context of head velocity during head impulses in patients with neck rigidity.
视频头脉冲试验（video-HITs）常用于前庭评估；然而，结果可能会受到各种伪影的影响，包括技术误差、记录问题和受试者因素。尽管video-HITs可用于帕金森病（PD）患者，但颈部僵硬的影响尚未得到系统研究。本研究旨在探讨颈部僵硬对PD患者video-HIT结果的影响。我们在2021年9月至2024年4月期间，于韩国大学医学中心前瞻性地连续招募了140例PD患者（平均年龄±标准差=68±10岁，男性69例）。将video-HIT结果与19名年龄和性别匹配的健康受试者的结果进行比较。颈部僵硬被分层为运动障碍协会统一帕金森病评定量表运动部分（MDS-UPDRS-III）的一个子领域。在59例患者中，至少在一个半规管平面中前庭眼反射（VOR）增益被高估（58/140，41%），主要在前庭半规管（AC，n=44），其次是水平半规管（HC，n=15）和后半规管（PC，n=7）。在无（18/58，35%）、轻度（20/58，34%）或中度（17/58，29%）颈部僵硬的患者中也观察到VOR增益高估。多变量逻辑回归分析显示，VOR高估与颈部僵硬呈正相关（优势比[OR][95%置信区间]=1.51[1.01-2.25]，p=0.043）。在前庭半规管进行头脉冲时，患者的头部速度降低（右侧AC为p=0.033；左侧AC为p=0.014），而眼速度与健康受试者相似。我们的研究结果表明，颈部僵硬可能是一个会影响video-HIT结果的混杂因素。因此，对于颈部僵硬的患者，video-HITs的结果，尤其是在前庭半规管方面的结果，应结合头脉冲期间的头部速度进行解读。
