Vertigo Symptom Scale Research Articles

Cross-cultural adaptation, reliability, and validity of the vestibular rehabilitation benefit questionnaire in the central Kurdish version

Background and objectives: The vestibular rehabilitation benefit questionnaire is a new patient-reported outcome measures with psychometric properties, to assess the efficacy of vestibular rehabilitation. The present study aims to cross-culturally adapt the questionnaire into the central Kurdish dialect and to examine its psychometric properties. Methods: This is a cross-sectional study conducted in Sulaimani city- Kurdistan Region of Iraq from March to September 2022, on 127 patients diagnosed with vestibular disorders between 18 to 79 years old. The vestibular rehabilitation benefit questionnaire Kurdish version was created through a regulated process of cross-cultural adaptation. The Kurdish participants were responded to the questionnaire, vertigo symptom scale short form and dizziness handicap inventory to assess validity of the questionnaire. The reliability of the questionnaire was assessed by randomly selecting 40 participants to repeat the questionnaire responses over a 24-hour timeline. Results: The results revealed that the ? for subscales of dizziness, anxiety, motion-provoked dizziness, quality of life and the scale of vestibular rehabilitation benefit questionnaire -total were 0.81, 0.82, 0.78, 0.77, and 0.92, respectively. The intra-class correlation coefficient was 0.96 for the questionnaire total scale; 0.97 and 0.93 for symptoms and quality of life subscales, respectively. Spearman rho correlation coefficient revealed a powerfully positive relationship between total the questionnaire and dizziness handicap inventory, and a strong positive relationship between total questionnaire and vertigo symptom scale short form. Conclusion: The vestibular rehabilitation benefit questionnaire Kurdish version is a reliable and validated patient-reported outcome measures that can be utilized for the Kurdish-speaking population.

Evaluating the impact of COVID-19 on vertigo and hearing impairment: A post-recovery analysis.

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has manifested with respiratory symptoms and a spectrum of extra-pulmonary complications. Emerging evidence suggests potential impacts on the auditory and vestibular systems, but the extent and nature of these effects in recovered individuals remain unclear. This study aimed to investigate the prevalence and severity of vertigo and hearing impairment in individuals who have recovered from COVID-19 and to identify potential risk factors associated with these sensory symptoms. A cohort of 250 recovered COVID-19 patients was assessed. Standardized questionnaires, including the Dizziness Handicap Inventory and the Vertigo Symptom Scale, were used to evaluate vertigo. Hearing assessment was conducted using pure-tone audiometry, speech audiometry, tympanometry, and oto-acoustic emissions testing. Logistic regression analysis was performed to assess the association between COVID-19 severity and the occurrence of sensory symptoms, controlling for confounding variables such as age and comorbidities. Of the participants, 10% reported vertigo, varying severity. Hearing assessments revealed that most participants had normal hearing, with an average speech discrimination score of 94.6. Logistic regression analysis indicated a significant association between severe COVID-19 and an increased likelihood of vertigo (OR 2.11, 95% CI 1.02-4.35, P = .043) and hearing impairment (OR 3.29, 95% CI 1.60-6.78, P = .002). This study suggests a significant association between COVID-19 severity and vertigo and hearing impairment prevalence. The findings underscore the importance of sensory symptom assessment in the post-recovery phase of COVID-19, highlighting the need for comprehensive healthcare approaches to manage long-term sequelae.

Reliability and Validity of Gujarati Version of the Vertigo Symptom Scale – Short form in Menopausal Women

Background: Vertigo, a sensation of dizziness and spinning, can occur in menopausal women due to hormonal changes. To measure these vertigo symptoms, a tool called the Vertigo Symptom Scales Short-form (VSS-SF) is commonly used. The VSS-SF is currently not available in Gujarati language so there is a need to develop a scale which can be used by the Gujarati language speaking population. Material & method: An observational study was conducted, translating the scale VSS-SF comprises 15 items, each scored on a 5-point scale (0–4) into Gujarati through double forward and backward translation. Experts scored each question as accepted or rejected. The finalized Gujarati version's reliability were assessed with a sample of 20 menopausal women. Result: Result calculated by using SPSS. The Gujarati version of the VSS-SF has high internal consistency (Cronbach’s α=0.873). Conclusion: The translation of the VSS-SF into Gujarati successfully maintained the semantic and measurement properties of the original version. The resulting Gujarati version proved to be a valid and reliable scale for assessing vertigo symptoms in the Gujarati population. Keywords: VSS-sf, Menopausal women, Reliability, Validity

Assessing the impact of migraine on benign paroxysmal positional vertigo symptoms and recovery

BackgroundDuring episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV.MethodsAll patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent.ResultsCompared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p < 0.001] and on one-month follow-up [10.9 (9.3) vs. 2.2 (2.7), p < 0.001]; experienced more severe dizziness and imbalance symptoms based on the VDI-SS at baseline (61.9% vs. 77.3%; p < 0.001) and after one month (78.9% vs. 93.7%, p < 0.001); and more significantly impaired quality of life according to the VDI-HRQoLS at baseline (77.4% vs. 91.8%, p < 0.001) and after one month (86.3% vs. 97.6%, p < 0.001).On the one-month follow-up, the subgroups of patients with moderate and severe scores of the BAI were higher in the MG (39.2%, n = 24) than in the BPPV w/o MG (21.8%, n = 14) and the number of patients who had normal scores of the BDI was lower in the MG than in the BPPV w/o MG (67.1% vs. 87.5%, p = 0.038).ConclusionClinicians are advised to inquire about migraine when evaluating patients with BPPV because it may lead to more intricate and severe clinical presentation. Further studies will be elaborated the genuine nature of the causal relationship between migraine and BPPV.

Effects of the Kahramanmaras, Turkey 2023 earthquakes on balance perception, dizziness and post-traumatic stress: A relational screening model between subjective balance problems and post-traumatic stress

ObjectiveThe aim of the present study was to investigate the effects of the February 6, 2023, earthquakes in Turkey and recurrent aftershocks on balance and post-traumatic stress in surviving victims. MethodsOur study included 1004 participants aged 18–65 years who were exposed to the February 6 earthquakes and aftershocks in Turkey. After obtaining online consent from all participants, the Vertigo Symptom Scale (VSS), the Dizziness Handicap Index (DHI), and the Posttraumatic Post-Traumatic Disorder Checklist Scale (PCL-5) were administered online, and the interactions between the variable sets were examined using a correlational screening model. ResultsAs a result of the structural equation model established with the observed variables, it was found that VSS total scores had a statistically significant positive effect on PCL-5 (β1 = 0.56; p = 0.001 < 0.05). In addition, statistically significant positive high-level correlations were found between VSS and DHI (covVSS-DHI = 0.71), and a positive low level correlation with the number of days with dizziness (covVSS-number of days with dizziness = 0.34), and a positive low level correlation with frequency of days with dizziness (covVSS-frequency of days with dizziness = 0.37). A statistically significant positive low-level relationship was found between DHI and the number of days with dizziness (covDHI-number of days with dizziness = 0.34) and a positive low-level correlation between DHI and the frequency of days with dizziness (covDHI-frequency of days with dizziness = 0.29). ConclusionThe structural equation modeling analysis showed that post-traumatic stress disorder had a significant effect on balance and dizziness.

The importance of Epley maneuver in posterior canal benign paroxysmal positional vertigo.

We investigated symptom scores and quality of life in unilateral posterior canal benign paroxysmal positional vertigo (BPPV) patients. In this retrospective and multicentric study, 78 patients with unilateral posterior canal BPPV (47 right-sided and 31 left-sided) were included. All patients have performed the Standard Epley maneuver. Features of the nystagmus [nystagmus duration (second), latent period (second)] and features of the disease [side (right or left-sided), disease duration (years), and recurrence of disease (present or absent)] were noted. Before and 1 week after the Epley maneuver, all patients were evaluated using the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), and Vertigo Dizziness Imbalance health-related quality of life scale (VDI-HQoL). Our results showed that VSSs of the right-sided group were significantly higher than those in the left-sided group before and 1 week after the maneuver (p<0.05). One week after the maneuver, VDI-HQoLs of the left-sided group were significantly higher than those in the right-sided group (p<0.05). In all right-sided and left-sided groups, at 1 week after the maneuver, VSSs were significantly lower, and VDI-SSs and VDI-HQoLs were significantly higher than those before the maneuver (p<0.05). As VSS values increased, VDI-SS and VDI-HQoL values decreased (p<0.05). In the left-sided group, VSS values decreased, and VDI-HQoL values increased. As disease duration increased, VSS values increased before the maneuver (p<0.05). In females, VSS values increased, and VDI-SS and VDI-HQoL values decreased before the maneuver (p<0.05). In posterior canal BPPV, the Epley maneuver effectively decreased VSS values and increased VDI-SS and VDI-HQoL values. In the left-sided BPPV group, there were lower VSS values and higher VDI-HQoL values that showed better quality of life of the patients. Older age and female gender are other factors related to lower quality of life with higher symptom scores.

Galvanic vestibular stimulation versus transcutaneous electrical nerve stimulation in patients with unilateral benign paroxysmal positional vertigo

Abstract OBJECTIVE: The purpose of this study was to compare the efficacy of galvanic vestibular stimulation (GVS) with transcutaneous electrical nerve stimulation (TENS) in patients with benign paroxysmal positional vertigo (BPPV) due to unilateral vestibular dysfunction. MATERIALS AND METHODS: Twenty patients both males and females with unilateral BPPV and mini-mental status examination ≥24 were randomized equally in either of the two groups (group A and group B). Galvanic stimulus was delivered to group A patients transcutaneously, whereas TENS was administered to group B patients. The study included the pre and posttest measurement of the dependent variables on the scores obtained on vestibular ocular motor screening and Vertigo Symptom Scale (VSS). RESULTS: The GVS group improved in their levels of dizziness, with pretest score of 2.53 ± 1.599 and posttest score of 0.33 ± 0.705; P = 0.00 and the levels of headache with pretest score of 2.30 ± 2.25 and posttest score of 0.92 ± 1.279; P = 0.015, which is statistically significant compared to those in peripheral nerve stimulation group with TENS on neck muscles. The GVS group improved on two items on the VSS scale pain in the heart or chest region with a pretest score value of 1.89 ± 0.315 and posttest score value of 0.00 ± 0.000; feeling of ear pressure with a pretest score of 1.75 ± 0.215 and posttest score value of 0.00 ± 0.000; P = 0 compared with those in peripheral stimulation group. RESULTS: GVS was more effective in reducing the symptoms associated with unilateral BPPV than TENS.

Optimizing vestibular neuritis management with modular strategies.

This study proposes a "modular management" approach for vestibular neuritis (VN) to reduce chronicization and improve patient prognosis. The approach involves multi-factor grading and hierarchical intervention and was found to be more effective than traditional treatment strategies. This retrospective analysis compared two groups of VN patients from two medical institutions. The intervention group of 52 patients received "modular management," while the control group of 51 patients did not receive this kind of management. Analyzed the early treatment strategies, 6-month prognosis, and other indicators of the two groups of patients, compared and analyzed their overall prognosis, and identified the risk factors affecting the chronicization. The modular management group had lower dizziness severity, better balance, lower anxiety, and higher video head impulse testing (v-HIT) gain after 6 months of onset. Analysis of factors related to persistent postural-perceptual dizziness (PPPD) in patients with VN showed positive correlations between the time from onset to diagnosis and PPPD, and Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), anxiety, and depression. Normalized vestibular rehabilitation was negatively correlated with PPPD, while gender, age, and early steroid use had no significant correlation. The multi-factor logistic regression model correctly classified 93.20% of the study subjects with a sensitivity of 87.50% and specificity of 94.90%. The proposed "modular management" scheme for VN is a comprehensive and dynamic approach that includes health education, assessment, rehabilitation, therapy, evaluation, and prevention. It can significantly improve patient prognosis and reduce chronicization by shifting from simple acute treatment to continuous management.

Structured ABEV Exercises for the Treatment of vestibular dysfunction

In addition to medication, the standard clinical treatment for vestibular vertigo primarily includes physical therapy in the form of regular exercises. Vertidisan is a future digital health application (DiGA) for structured dizziness therapy. Its content is multimodal and consists of Adaptive Balance and Eye Movements and Visual Stimulation (ABEV) exercises, which are expected to have an anti-vertigo effect through neural learning. A cohort study with 104 patients with intra-individual control was conducted to examine the clinical efficacy of solely 16 ABEV exercises for the treatment of peripheral vestibulopathies which are also used digitally in the future DiGA Vertidisan. Using the short version vertigo symptom scale short form1 vertigo and related symptoms (VSS-sf1-VER) of the vertigo-specific and validated VSS rating scale (Vertigo Symptom Scale) as the primary outcome variable, the vertigo scores before therapy (time T0) were compared with the corresponding data at the end of a period of 12-16 weeks (time T1). Complete datasets on T0 and T1 were available for N=104 patients. The mean VSS-sf1-V score decreased from 3.80 (median 4, SD 0.47) to 0.92 (median 1, SD 1.19) from T0 to T1 (weeks 12-16). The result is statistically significant (p=0.001) and shows a high clinical effect size. In summary, the analysis of the dizziness score shows a statistically and clinically significant reduction in dizziness through the use of the 16 ABEV exercises.

Therapeutic effectiveness of virtual reality-based exercise through Oculus Quest 2 on balance, dizziness, nystagmus, and quality of life in patients with posterior canal benign paroxysmal positional vertigo - a randomized control trial protocol

BPPV (benign paroxysmal positional vertigo) is one of the most prevalent causes of vertigo.The clinical features include nausea, imbalance, nystagmus, light-headedness, dizziness, fear of fall. Various exercises and maneuvers have been proved to be beneficial till date. Many technologies had also contributed in the physical rehabilitation. Virtual rehabilitation using virtual reality (VR) is a novel innovation in therapy. Virtual reality is widely used in treating the patients and adding to get back to their day-to-day life. Occulus quest 2 is a VR device. Depending on the patient's motions, Oculus Quest enables you to interact genuinely while immersing yourself in a virtual reality. BPPV is a very common condition and Posterior canal BPPV (PC-BPPV) is commonest of all. Most of the available literature targets conventional treatment including Exercises for repositioning and adaptation of otoconia. Comparative studies between the conventional rehabilitation protocols have also been done. There is paucity of research on virtual rehabilitation in PC-BPPV. VR utilizing Oculus Quest 2, a device designed to incorporate VR environment can be used to mobilize the patients head position there by repositioning the otoconia. Lack of evidence related to Virtual rehabilitation and specifically Oculus Quest 2 emphasises the need to study its effects on BPPV outcomes like balance, dizziness, quality of life and nystagmus. In this study, an attempt is made to use the oculus quest 2 for BPPV rehabilitation in addition to standard treatment. Patients will be divided into 2 groups control and experimental. Control group will receive Brandt-droff exercise on the other hand experimental will receive occulus quest 2 game “Coaster combat” in adjunct to the conventional. Berg balance scale, nystagmus time quality of life, dizziness handicap index and vertigo symptom scale are the outcomes. Outcomes will be assed at baseline and after 4 weeks.

Chronic symptoms in patients with unilateral vestibular hypofunction: systematic review and meta-analysis.

To systematically evaluate the full spectrum of self-reported chronic symptoms in patients with unilateral vestibular hypofunction (UVH) and to investigate the effect of interventions on these symptoms. A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA). A literature search was performed in Pubmed, Web of Science, Embase, and Scopus to investigate self-reported symptoms and self-report questionnaires in patients with UVH. All original studies ranging from full-text clinical trials to case reports, written in English, German, and French, were included. The frequency of self-reported symptoms was presented. For self-report questionnaires, a meta-analysis was carried out to synthesize scale means by the pre- and post-intervention means and mean changes for studies that investigated interventions. A total of 2,110 studies were retrieved. Forty-seven studies were included after title-abstract selection and full-text selection by two independent reviewers. The symptoms of UVH patients included chronic dizziness (98%), imbalance (81%), symptoms worsened by head movements (75%), visually induced dizziness (61%), symptoms worsened in darkness (51%), and oscillopsia (22%). Additionally, UVH could be accompanied by recurrent vertigo (77%), tiredness (68%), cognitive symptoms (58%), and autonomic symptoms (46%). Regarding self-report questionnaires, UVH resulted on average in a moderate handicap, with an estimated mean total score on the Dizziness Handicap Inventory (DHI) and the Vertigo Symptom Scale (VSS) of 46.31 (95% CI: 41.17-51.44) and 15.50 (95% CI: 12.59-18.41), respectively. In studies that investigated the effect of vestibular intervention, a significant decrease in the estimated mean total DHI scores from 51.79 (95% CI: 46.61-56.97) (pre-intervention) to 27.39 (95% CI: 23.16-31.62) (post intervention) was found (p < 0.0001). In three studies, the estimated mean total Visual Analog Scale (VAS) scores were 7.05 (95% CI, 5.64-8.46) (pre-intervention) and 2.56 (95% CI, 1.15-3.97) (post-intervention). Finally, a subgroup of patients (≥32%) persists with at least a moderate handicap, despite vestibular rehabilitation. A spectrum of symptoms is associated with UVH, of which chronic dizziness and imbalance are most frequently reported. However, semi-structured interviews should be conducted to define the whole spectrum of UVH symptoms more precisely, in order to establish a validated patient-reported outcome measure (PROM) for UVH patients. Furthermore, vestibular interventions can significantly decrease self-reported handicap, although this is insufficient for a subgroup of patients. It could therefore be considered for this subgroup of patients to explore new intervention strategies like vibrotactile feedback or the vestibular implant. [https://www.crd.york.ac.uk/prospero/], identifier [CRD42023389185].

Vertigo symptom scores and videonystagmographic examinations in recovered coronavirus disease 2019 patients.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be among the viral agents that affect the audio-vestibular system. This study aimed to investigate vestibular symptoms and videonystagmographic examinations in recovered coronavirus disease 2019 (Covid-19) patients compared with the control group. The patients were evaluated with Vertigo Symptom Scale questionnaire and audiometric, tympanometric, stapedial reflex and videonystagmographic examinations. A total of 92 of the patients in the coronavirus disease 2019 patients group and 25 of the volunteers in the control group were included in the study. The mean Vertigo Symptom Scale score was found to be significantly higher (p < 0.001) in the coronavirus disease 2019 group. Furthermore, one of the hospitalised patients was diagnosed with vestibular neuritis. The vestibular system may also be affected in some coronavirus disease 2019 patients. Although this may be seen as dizziness in some patients, in rare cases it can cause severe issues, such as vestibular neuritis.

Anterior cervical discectomy and fusion to treat cervical instability with vertigo and dizziness: A single center, retrospective, observational study.

The current study attempts to investigate the role of anterior cervical discectomy and fusion (ACDF) in alleviating symptoms in patients with cervical vertigo associated with cervical instability. The patients of cervical instability with vertigo and dizziness who underwent ACDF between January 2011 and December 2019 were followed-up for more than two years. Demographic data (age, sex, follow up period and levels of instable cervical segments) were assessed; Symptoms of vertigo and dizziness before and after surgery were assessed by the 15-item version of the Vertigo Symptom Scale (VSS) and the 25-item Dizziness Handicap Inventory (DHI). The severity and frequency of other symptoms like neck and occipital pain, gastrointestinal discomfort, nausea, vomiting, tinnitus, palpitations, headache, diplopia and blurring of vision before and after surgery were also assessed. A total of 92 patients underwent ACDF for cervical instability with vertigo and dizziness between January 2011 and December 2019, of which 79 patients were included in the final analysis. The number of instable levels had no correlation with VSS and DHI scores before surgery (p > 0.05), while patients with C3/4 instability suffering a severer vertigo than other levels. Both DHI and VSS scores were significantly reduced after ACDF and this was sustained within two years after surgery (p < 0.001). Although there was no statistical difference in the ratio of patients with vertigo relief, patients with one-level cervical instability demonstrated a more rapid recovery than patients with multi-level cervical instability (p = 0.048). Also, there was improvement in other symptoms such as neck and occipital pain, gastrointestinal discomfort, nausea, vomiting, tinnitus, palpitations, headache and blurring of vision after surgery. Vertigo caused by C3/4 instability was severer than other levels such as C4/5 and C5/6. During 2 years' follow-up the significant relief of vertigo and dizziness was observed after anterior cervical surgery. Other accompanying symptoms except hypomnesia were also extenuated in follow-up period.

Assessment of Quality of Life in Patients with Balance Disorders Using Vertigo Symptom Scale–Short Form and Dizziness Handicap Inventory

Background: Dizziness is a common complaint presenting in general practice of ears, nose, and throat (ENT). Vertigo constitutes approximately 54% of cases of dizziness. This study aims at evaluating balance disorders with the aid of Vertigo Symptom Scale and Dizziness Handicap Inventory (DHI) to assess the quality of life in patients. Materials and Methods: This cross-sectional study was carried out on subjects that presented with complaints of vertigo to the ENT indoor patient department and outpatient department at the Yenepoya Medical College Hospital in Mangalore. Patients with known case of head injury, cardiovascular disease, seizure, and cervical spondylosis were excluded from the study. The patients were assessed for Vertigo Symptom Scale- Short Form vertigo balance subscale score (VSS-sf-V), Vertigo Symptom Scale-Short form autonomic anxiety subscale score (VSS-sf-A)and DHI questionnaire. Data obtained were recorded into MS Excel work sheets, and statistical analysis was done using IBM SPSS version 23 program running on windows operating system. P &lt; 0.05 was considered statistically significant. Results: A total of 49 patients fulfilling the inclusion criteria were included, with a mean age of 44.16 ± 11.78 years, and among them, 25 were male and 24 were female patients. Diabetes was observed in 6.1% (n = 3), while 14.3% (n = 7) had diabetes and hypertension. Nearly 73.5% (n = 36) of the participants had no comorbidities. There was a significant association between complaints and DHI with P = 0.001. Whereas, there was no association between comorbidities and DHI with P = 0.334. Conclusion: The present study evaluated the participants based on Vertigo Symptom Scale–Short Form and DHI to assess the impact of vertigo on quality of life. The study showed a good utility of these questionnaires in assessing the quality of life.

Vestibular Migraine versus Méniere's Disease: Diagnostic Utility of Electrocochleography.

Objectives: The diagnostic criteria for vestibular migraine (VM) and Méniere’s disease (MD) present an important overlap, which leads to a difficult diagnosis in patients presenting with headache, vertigo, hearing loss, ear fullness, and tinnitus. The objective of our study is to determine whether the area-under-the-curve ratio of the summating potentials (SP) and action potentials (AP) curves on electrocochleography (ECoG) helps differentiate VM from MD with or without the use of the well-established clinical criteria. Method: A retrospective review of patients filling either VM or MD criteria was undertaken between September 2015 and December 2018. All patients underwent ECoG before the introduction of anti-migraine therapy. The prediction of symptom improvement between the clinical criteria and ECoG results was compared by using the Vertigo Symptom Scale. Results: In total, 119 patients were included. An overlap of 36% exists between patients filling VM and MD criteria. Clinical criteria alone did not demonstrate a significant prediction of symptom response to anti-migraine therapy (VM 83%, MD 51%; p = 0.10). However, ECoG results alone did demonstrate adequate prediction (VM 94%, MD 32%; p < 0.001). A negative ECoG result combined with the clinical criteria of VM (100% symptom improvement) was shown to be more predictive of treatment response when compared to clinical criteria alone (83% symptom improvement) (p = 0.017). Finally, when used in patients filling both the VM and MD criteria (VMMD), ECoG was able to predict symptom improvement, thus better differentiating both diseases (normal ECoG: 95%, abnormal ECoG 29%; p < 0.001). Conclusion: Combining VM criteria with normal ECoG using the AUC ratio seems superior in predicting adequate symptom improvement than VM criteria alone.

Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study.

Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. Patients scheduled to receive autoHSCT (78/156, 50%) and controls (78/156, 50%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale-short form), and depression (Center for Epidemiological Studies-Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability (ß=.001; P=.005) and heel strike angle (ß=-.088; P=.02). Pain was associated with worse gait speed (ß=-.003; P=.003), stride time variability (ß=.012; P=.02), stride length (ß=-.002; P=.004), and distance traveled (ß=-.786; P=.005). Nausea and pain explained 17% to 33% and 14% to 36% of gait variance measured in patients, respectively. Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term.

Relationships between the Pittsburgh Sleep Quality Index (PSQI) and vertigo outcome

ABSTRACT Objective This retrospective cohort study aimed to investigate the association of sleep characteristics measured by the Pittsburgh Sleep Quality Index (PSQI) with the vertigo outcome in vertiginous patients with comorbid cardiometabolic diseases. Methods Four hundred and thirteen patients with comorbid cardiometabolic diseases who consecutively visiting vertigo and dizziness clinic were enrolled between October 2018 and January 2020 in a tertiary teaching medical center. Regression analyses and stratified analyses were used to explore the relationship between PSQI and vertigo outcome, which was measured by the visual analogue scale (VAS) score. Results In the study sample, 73.8% (305/413) were defined as ‘poor sleep’ (PSQI>5). Participants with better recovery tended to have better baseline PSQI global score, PSQI sleep quality, PSQI sleep onset latency, PSQI daytime dysfunction, less severe baseline vertigo symptoms indicated by VAS, Vertigo Symptom Scale (VSS) and Dizziness Handicap Inventory (DHI) scores. Moreover, baseline PSQI global score and PSQI daytime dysfunction score were independently associated with the vertigo VAS scores at the last follow-up. Conclusion The present results clearly indicated that poor sleep is common and inversely associated with vertigo outcome in vertiginous patients with co-morbid cardiometabolic diseases. Therefore, sleep deserves greater attention in the total medical care in specific subgroup of vertiginous patients.

A systematic review and meta-analysis of prophylactic medication of vestibular migraine.

Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication. A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored. Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by -13.31 points and -4.16 points, respectively, and the Dizziness Handicap Inventory score by -32.24 and -21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control. Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant.

A preliminary trial of botulinum toxin type A in patients with vestibular migraine: A longitudinal fMRI study.

ObjectiveThis study aims to investigate the efficacy of botulinum toxin type A (BTX-A) in the prophylactic management of vestibular migraine (VM) and to determine whether this treatment modulates intrinsic functional brain network.MethodsVestibular migraine patients (n = 20, mean age 45.4 years) who were resistant to conventional prophylactic therapies had BTX-A injection and rs-fMRI before and 2 months after the injection. We also measured the changes in the frequency of vertigo and migraine attacks, symptomatic functional disability scores, and neuropsychiatric inventories.ResultsAfter BTX-A injection, the mean monthly frequencies of migraine and vertigo episodes decreased significantly compared with the baseline (p < 0.01, paired t-test). The Headache Impact Test-6 score and the Migraine Disability Assessment, and the vertigo parameters, measured by the Dizziness Handicap Inventory and the Vertigo Symptom Scale, showed an improvement, as did the anxiety and depression scores 2 months after BTX-A treatment. The low-frequency fluctuation analysis of the rs-fMRI data found significant changes in the functional connectivity of the right superior temporal gyrus. Adoption of this cluster as the seed region increased the functional connectivity with the left post-central gyrus, right supramarginal gyrus, and right middle temporal gyrus after BTX-A treatment.ConclusionThis prospective study suggests that BTX-A treatment is effective at ameliorating migraine and vertigo symptoms in VM patients who were resistant to conventional therapies. Along with symptomatic improvements, changes in the functional connectivity within the multisensory vestibular and pain networks suggest a dysmodulation of multimodal sensory integration and abnormal cortical processing of the vestibular and pain signals in VM patients.

Tolerance to Dizziness Intensity Increases With Age in People With Chronic Dizziness.

BackgroundDizziness is a common complaint in older adults. To know which factors are instrumental in enabling patients with chronic dizziness to tolerate their symptoms to a certain degree in everyday life can help to develop tailored therapies.MethodsData from 358 patients with chronic dizziness and vertigo who had attended a multimodal daycare treatment program were recorded. Data included sociodemographic parameters, dizziness-related characteristics, the Vertigo Symptom Scale (VSS), and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics, elastic net regression, and mediation analysis were used.ResultsA higher tolerance of dizziness was associated with higher age, higher intensity of dizziness, lower burden of dizziness, higher HADS depression, structural reason for dizziness (type), permanent dizziness, absence of attacks, and longer disease duration. In contrast, younger persons with attack-like dizziness reported to tolerate less dizziness. Age had a significant direct effect on tolerance (72% of the total effect) and a significant indirect effect via intensity on tolerance (28% of the total effect) in the mediation analysis.ConclusionIt can only be speculated that negative stereotypes about age-related complaints may play a role in this. Why older people tolerate more dizziness and to what extent this may contribute to lower healthcare utilization need to be investigated in further studies.