Abstract
Introduction: Brainstem stroke sometimes causes long-lasting dizziness. A cerebellar control disorder of the vestibulo-ocular reflex (VOR) has been postulated as a mechanism of dizziness in such patients. We conducted a proof-of-principle cohort study to assess the potential efficacy of cerebellar repetitive transcranial magnetic stimulation (rTMS) as treatment for long-lasting post-brainstem stroke dizziness. Methods: We first applied cerebellar rTMS in healthy volunteers (n=11) and showed that cerebellar intermittent theta burst stimulation (iTBS) affected vestibulocerebellar neural activity. Then, we enrolled 11 patients with long-lasting post-brainstem stroke dizziness (lateral medullary infarction, 9; lateral pontine infarction, 1; and lateral pontine hemorrhage, 1), applied cerebellar rTMS (iTBS for 5 days), and followed these patients up for clinical symptoms (Dizziness Handicap Inventory [DHI]), signs (nystagmus), and VOR gain. Results: After rTMS, DHI scores were significantly reduced with disappearance or attenuation of the ipsilesional nystagmus characteristic of the long-lasting post-brainstem stroke dizziness. Reduction in the absolute VOR gain was also associated with reduced DHI scores. Relative cerebellar blood flow to the brainstem, measured in 4 patients, was increased. However, the effects of cerebellar rTMS did not always persist. Conclusion: Our study showed the potential efficacy of cerebellar rTMS for treatment of long-lasting post-brainstem stroke dizziness. Further large-scale randomized studies are warranted to confirm our findings.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call