Research in Vestibular Science

Original Articles

Clinical Significance of Spontaneous Nystagmus in Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo: Jun Lee, Sehun Chang, Ho Yun Lee; Res Vestib Sci. 2018;17(1):18-22. Published online March 15, 2018; DOI: https://doi.org/10.21790/rvs.2018.17.1.18

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Abstract PDF: Objectives
We aimed to assess the clinical significance of spontaneous nystagmus (SN) in horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV).
Methods
Twenty-four patients who were diagnosed with HC-BPPV in Eulji University Hospital from January 2015 to December 2016 were recruited. Various bed-side examinations including SN in both sitting and supine position, head roll test, and bithermal caloric test were evaluated. The number of canalith repositioning maneuvers were counted in all patients.
Results
SN was observed in 18.2% of geotropic HC-BPPV and 38.5% of apogeotropic HC-BPPV, respectively. There was no significant difference between presence of SN and the direction of initial nystagmus (p=0.386, 2-tailed Fisher exact test). The mean number of otolith repositioning maneuvers in patients with SN was 3.29±1.799 and this was significantly higher than in patients without SN (1.76±0.831) (p=0.009). Although the mean number of repositioning maneuver in patients in apogeotropic HC-BPPV and SN (3.80±1.924) tended to be higher than those who were diagnosed with apogeotropic HC-BPPV without SN (1.88±1.991) (p=0.035), the post hoc analysis with Bonferroni correction revealed that it was not significant because it was higher than the adjusted p-value (p=0.017). The initial direction of nystagmus was changed into the opposite direction in 29.17% of patient. However, this change was not different according to presence of SN (p=0.374, 2-tailed Fisher exact test).
Conclusions
The presence of SN in HC-BPPV may be associated with lower treatment response. In particular, cautions are needed in patients with apogeotropic HC-BPPV.

Pseudo-Spontaneous Nystagmus and Head-Shaking Nystagmus in Horizontal Canal Benign Paroxysmal Positional Vertigo: Yong Gook Shin, Ja Won Gu, Jin Wook Kang, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2017;16(4):129-134. Published online December 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.4.129

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Objectives
The purpose of this study was to examine the clinical manifestations and significance of pseudo-spontaneous nystagmus (PSN) and head-shaking nystagmus (HSN) in horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Methods: Two hundred fifty-two patients diagnosed as HC-BPPV were reviewed retrospectively. After excluding 55 patients with ipsilateral vestibular diseases, multiple canal BPPV, or those who were lost to follow-up, we analyzed the direction of PSN and HSN in patients with HC-BPPV. We also compared the clinical characteristics and treatment outcome between PSN-positive and PSN-negative groups. Results: Our study included 197 patients composed of 80 patients with geotropic HC-BPPV and 117 patients with apogeotropic HC-BPPV. PSN was observed in 13.7% patients and HSN was observed in 45.2%. The incidence of HSN was higher in apogeotropic HC-BPPV, while the proportion of PSN was not statistically significant between the two subtypes. There was no directional preponderance in geotropic HC-BPPV, while ipsilesional PSN and contralesional HSN showed higher incidence in apogeotropic HC-BPPV. The dizziness handicap inventory score in the PSN-positive group was higher than that in the PSN-negative group (p＜0.001), and the duration of symptom onset in the PSN-positive group was shorter than that in the PSN-negative group (p=0.047). However, there was no significant difference in the treatment outcome between the two groups. Conclusions: The incidence of HSN was higher than that of PSN in patients with apogeotropic HC-BPPV. Patients with HC-BPPV showing PSN demonstrated more severe initial symptoms and visited the hospital in a shorter period of time after the onset of symptoms.

Citations

Citations to this article as recorded by

Benign Paroxysmal Positional Vertigo: Diagnostic Criteria and Updated Practice Guideline in Diagnosis
Dae Bo Shim
Research in Vestibular Science.2020; 19(4): 111. CrossRef

Competence in Suppressing the Visual Fixation among Different Types of Frenzel Glasses: Sungdo Jung, Jae Yun Jung, Chung Ku Rhee, Myung Whan Suh; Res Vestib Sci. 2010;9(4):134-138.

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Abstract PDF: Background and Objectives: Several manufacturers supply different types of Frenzel glasses, but the quality of these varied Frenzel glasses seems to be quite different. The aim of this study was to compare the competence in suppressing visual fixation (VF) among different types of Frenzel glasses. The second aim was to develop a new type of Frenzel glasses which is cheaper and more convenient to carry, but has an equivalent competence. Materials and Methods: Four different types of Frenzel glasses were evaluated: 30 diopter Frenzel glasses manufactured by Nagashima (N), 10 diopter Frenzel glasses manufactured by Jungang (J), 13 diopter conventional magnifying glasses (M) and 17 diopter Fresnel lens glasses assembled by the authors. The amplitude of the spontaneous nystagmus (SN) was measured though the electronystagmography system. The SN was measured 35 times from 15 patients who were diagnosed as vestibular neuritis. Results: The mean amplitude of the SN was 8.8±3.2°/sec when measured with the videonystagmography goggles. When the same SN was measured through the 4 different Frenzel glasses, it was 7.5±2.8 (N), 6.3±3.0 (F), 6.2±3.0 (M), and 5.7±2.6 (J) °/sec respectively. The amplitude of the SN was significantly bigger when wearing the N glasses compared to the other 3 glasses. The SN was significantly smaller when wearing the J glasses compared to the F glasses. Conclusion: The competence of suppressing VF was significantly different among the varied types of glasses. The F glasses seem to have a similar or better competence with the J glasses. F glasses seems to be a fairly good alternative which is very portable and cheap.

Effects of Galvanic Stimulation on Spontaneous Nystagmus in Meniere’s Disease and Vestibular Neuritis: A Preliminary Study: Seong Hae Jeong, Ji Soo Kim; Res Vestib Sci. 2010;9(2):64-69.

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Abstract PDF: Background and Objectives Galvanic vestibular stimulation (GVS) is known to induce nystagmus, ocular torsion, a tilt of subjective visual vertical, and perceptual and postural shift. The aim of this study was to compare the findings of GVS among the patients with spontaneous nystagmus (SN) caused by Meniere’s disease (MD) or vestibular neuritis (VN). Materials and Methods Three-dimensional video-oculography was performed without fixation in 4 patients with MD and 2 with VN, as diagnosed by history, independent vestibular function tests and neuroimaging. We recorded the eye-movements in response to bilateral, bipolar, and surface GVS (2.5~3 mA) for 30 seconds, and analyzed mean slow phase velocity of SN. Results Of the 4 patients with MD, two exhibited a suppression of the left beating SN during anode stimulation of left mastoid and an augmentation of the nystagmus during cathode stimulation of left mastoid. The same patterns of galvanic modulation were observed in the other 2 patients with right beating SN due to MD. In contrast, the patients with VN showed an absent or decreased response to GVS. Conclusion In MD, the responses to GVS were preserved while the responses were impaired in VN. These results suggest that the irregular vestibular fibers, which are sensitive to GVS, are relatively spared in MD. In contrast, both regular and irregular fibers appear to be damaged in VN. GVS may be helpful in discriminating MD from VN, especially when the patients presented without auditory symptoms.

Correlation between Spontaneous Nystagmus and Vestibular Function Test Parameters according to Gender and Age in Vestibular Neuritis: Jae Yun Jung, Eun Seok Lim, Young Saeng Kim, Min Young Lee, Yong Won Chung, Chung Ku Rhee; J Korean Bal Soc. 2006;5(2):248-252.

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Abstract PDF: Background
and Objectives: There are caloric test, SCEP, DP in Step velocity and VOR asymmetry in SHA test as parameters for evaluation in unilateral peripheral vestibulopathy in parameter of vestibular function test. The aim of this study is to assess the correlation between these parameters and intensity of spontaneous nystagmus in vestibular neuritis. Materials and Method: We evaluated 75 patients who were diagnosed as vestibular neuritis with 3 degree spontaneous nystagmus at vestibular function test lab from January 2000 to July 2005 in Dankook university hospital. The correlations between direction and intensity of spontaneous nystagmus and monothermal caloric test, SCEP and DP in step velocity, VOR asymmetry (0.01, 0.04, 0.16 Hz) in SHA test were analysed. And correlations according to sex, age were also analysed.
Results
The correlation coefficient between intensity of spontaneous nystagmus and monothermal caloric test was 0.60. The correlation coefficient between intensity of spontaneous nystagmus and SCEP was 0.35. The correlation coefficient between intensity of spontaneous nystagmus and Tc DP was 0.36 and it showed no significant correlation. The correlation coefficient between intensity of spontaneous nystagmus and VOR asymmetry (0.01, 0.04, 0.16) was 0.57, 0.46, 0.51, respectively and there was higher correlation in man, age under 60.
Conclusion
Intensity of spontaneous nystagmus showed close relations to monothermal caloric test, VOR asymmetry of SHA, Tc DP, SCEP DP in sequence. In addition, young male patients tends to be closely related to intensity of spontaneous nystagmus. Key Words : Spontaneous nystagmus, Vestibular function test, Vestibular neuritis

Effect of Ginkgo biloba on Expression of c-Fos Protein in the Vestibular Nuclear Complex following Unilateral Labyrinthectomy in Rats: Dong Ok Choi, Sun Kyung Kim, Myung Ae Choi, Moon Young Lee, Min Sun Kim, Eun Ho Park, Byung Rim Park; J Korean Bal Soc. 2003;2(2):163-169.

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Abstract PDF: Background
and Objectives: The neuroprotective effect of Ginkgo biloba has been demonstrated in several in vivo and in vitro models. The effect of Ginkgo biloba on vestibular compensation following unilateral labyrinthectomy (UL) was investigated. Material and Methods: Spontaneous nystagmus and c-Fos protein expression were measured following UL in Sprague-Dawley rats with pretreatment of Ginkgo biloba (50 mg/kg, i.p.).
Results
After pretreatment with Ginkgo biloba (50 mg/kg, i.p.) expression of c-Fos protein in the vestibular nuclear complex and frequency of spontaneous nystagmus were measured till 24 hours after UL. UL produced spontaneous nystagmus with frequency of 124±2.2 beats/min at post-op 2 hrs and 70±3.1 beats/min at post-op 24 hrs. Pretreatment with Ginkgo biloba significantly decreased the frequency of spontaneous nystagmus till post-op 24 hrs compared to control group (p<0.05). UL produced marked expression of c-Fos protein in bilateral medial vestibular nucleus, inferior vestibular nucleus, and superior vestibular nucleus, and the number of expression was significantly higher in contralateral vestibular nuclei to the lesion than ipsilateral vestibular nuclei at post-op 2 hrs (p<0.01). The number of c-Fos protein expression was decreased with time and significantly higher in ipsilateral vestibular nuclei than contralateral ones at post-op 24 hrs (p<0.01). Pretreatment with Ginkgo biloba significantly decreased the number of c-Fos protein expression following UL (p<0.01) and abolished the asymmetry of c-Fos protein expression in bilateral vestibular nuclei at post-op 24 hrs.
Conclusion
These results suggest that Ginkgo biloba may facilitate vestibular compensation following UL through modulation of neurotransmitters and neuroprotective effects.

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