Skip to main content

Advertisement

SpringerLink
Log in

Noisy vestibular stimulation improves vestibulospinal function in patients with bilateral vestibulopathy

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Objectives

To examine the mechanism underlying previously reported ameliorating effects of noisy galvanic vestibular stimulation (GVS) on balance performance in patients with bilateral vestibulopathy (BVP) and determine those patients (incomplete versus complete vestibular loss) that might benefit from this intervention.

Methods

Vestibulospinal reflex thresholds were determined in 12 patients with BVP [2 with complete loss (cBVP) and 10 with residual function (rBVP)]. Patients were stimulated with 1 Hz sinusoidal GVS of increasing amplitudes (0–1.9 mA). Coherence between GVS input and stimulation-induced body motion was determined and psychometric function fits were subsequently used to determine individual vestibulospinal reflex thresholds. The procedure was repeated with an additional application of imperceptible white noise GVS (nGVS).

Results

All patients with rBVP but none with cBVP exhibited stimulation-induced vestibulospinal reflex responses with a mean threshold level of 1.26 ± 0.08 mA. Additional nGVS resulted in improved processing of weak subthreshold vestibular stimuli (p = 0.015) and thereby effectively decreased the vestibulospinal threshold in 90% of patients with rBVP (mean reduction 17.3 ± 3.9%; p < 0.001).

Conclusion

The present findings allow to identify the mechanism by which nGVS appears to stabilize stance and gait performance in patients with BVP. Accordingly, nGVS effectively lowers the vestibular threshold to elicit balance-related reflexes that are required to adequately regulate postural equilibrium. This intervention is only effective in the presence of a residual vestibular functionality, which, however, applies for the majority of patients with BVP. Low-intensity noise stimulation thereby provides a non-invasive treatment option to optimize residual vestibular resources in BVP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Angelaki DE, Cullen KE (2008) Vestibular system: the many facets of a multimodal sense. Annu Rev Neurosci 31:125–150

    Article  CAS  Google Scholar 

  2. Flores A, Manilla S, Huidobro N, De la Torre-Valdovinos B, Kristeva R, Mendez-Balbuena I, Galindo F, Trevino M, Manjarrez E (2016) Stochastic resonance in the synaptic transmission between hair cells and vestibular primary afferents in development. Neuroscience 322:416–429

    Article  CAS  Google Scholar 

  3. Forbes PA, Siegmund GP, Schouten AC, Blouin JS (2014) Task, muscle and frequency dependent vestibular control of posture. Front Integr Neurosci 8:94

    PubMed  Google Scholar 

  4. Gillespie MB, Minor LB (1999) Prognosis in bilateral vestibular hypofunction. Laryngoscope 109:35–41

    Article  CAS  Google Scholar 

  5. Goel R, Kofman I, Jeevarajan J, De Dios Y, Cohen HS, Bloomberg JJ, Mulavara AP (2015) Using low levels of stochastic vestibular stimulation to improve balance function. PLoS One 10:e0136335

    Article  Google Scholar 

  6. Iwasaki S, Karino S, Kamogashira T, Togo F, Fujimoto C, Yamamoto Y, Yamasoba T (2017) Effect of noisy galvanic vestibular stimulation on ocular vestibular-evoked myogenic potentials to bone-conducted vibration. Front Neurol 8:26

    Article  Google Scholar 

  7. Iwasaki S, Yamamoto Y, Togo F, Kinoshita M, Yoshifuji Y, Fujimoto C, Yamasoba T (2014) Noisy vestibular stimulation improves body balance in bilateral vestibulopathy. Neurology 82:969–975

    Article  Google Scholar 

  8. Keywan A, Wuehr M, Pradhan C, Jahn K (2018) Noisy galvanic stimulation improves roll-tilt vestibular perception in healthy subjects. Front Neurol 9:83

    Article  Google Scholar 

  9. Moss F, Ward LM, Sannita WG (2004) Stochastic resonance and sensory information processing: a tutorial and review of application. Clin Neurophysiol 115:267–281

    Article  Google Scholar 

  10. Pavlik AE, Inglis JT, Lauk M, Oddsson L, Collins JJ (1999) The effects of stochastic galvanic vestibular stimulation on human postural sway. Exp Brain Res 124:273–280

    Article  CAS  Google Scholar 

  11. Priesol AJ, Valko Y, Merfeld DM, Lewis RF (2014) Motion perception in patients with idiopathic bilateral vestibular hypofunction. Otolaryngol Head Neck Surg 150:1040–1042

    Article  Google Scholar 

  12. Rosenberg J, Amjad A, Breeze P, Brillinger D, Halliday D (1989) The Fourier approach to the identification of functional coupling between neuronal spike trains. Prog Biophys Mol Biol 53:1–31

    Article  CAS  Google Scholar 

  13. Schlick C, Schniepp R, Loidl V, Wuehr M, Hesselbarth K, Jahn K (2016) Falls and fear of falling in vertigo and balance disorders: a controlled cross-sectional study. J Vestib Res 25:241–251

    Article  Google Scholar 

  14. Schniepp R, Schlick C, Schenkel F, Pradhan C, Jahn K, Brandt T, Wuehr M (2017) Clinical and neurophysiological risk factors for falls in patients with bilateral vestibulopathy. J Neurol 264:277–283

    Article  Google Scholar 

  15. Strupp M, Feil K, Dieterich M, Brandt T (2016) Bilateral vestibulopathy. Handb Clin Neurol 137:235–240

    Article  CAS  Google Scholar 

  16. Whitney SL, Alghadir AH, Anwer S (2016) Recent evidence about the effectiveness of vestibular rehabilitation. Curr Treat Options Neurol 18:13

    Article  Google Scholar 

  17. Wuehr M, Boerner JC, Pradhan C, Decker J, Jahn K, Brandt T, Schniepp R (2018) Stochastic resonance in the human vestibular system—noise-induced facilitation of vestibulospinal reflexes. Brain Stimul 11:261–263

    Article  CAS  Google Scholar 

  18. Wuehr M, Decker J, Schniepp R (2017) Noisy galvanic vestibular stimulation: an emerging treatment option for bilateral vestibulopathy. J Neurol 264:81–86

    Article  Google Scholar 

  19. Wuehr M, Nusser E, Decker J, Krafczyk S, Straube A, Brandt T, Jahn K, Schniepp R (2016) Noisy vestibular stimulation improves dynamic walking stability in bilateral vestibulopathy. Neurology 86:2196–2202

    Article  Google Scholar 

  20. Wuehr M, Nusser E, Krafczyk S, Straube A, Brandt T, Jahn K, Schniepp R (2016) Noise-enhanced vestibular input improves dynamic walking stability in healthy subjects. Brain Stimul 9:109–116

    Article  CAS  Google Scholar 

  21. Zingler VC, Weintz E, Jahn K, Huppert D, Cnyrim C, Brandt T, Strupp M (2009) Causative factors, epidemiology, and follow-up of bilateral vestibulopathy. Ann N Y Acad Sci 1164:505–508

    Article  Google Scholar 

  22. Zingler VC, Weintz E, Jahn K, Mike A, Huppert D, Rettinger N, Brandt T, Strupp M (2008) Follow-up of vestibular function in bilateral vestibulopathy. J Neurol Neurosurg Psychiatry 79:284–288

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by the German Federal Ministry of Education and Research (01EO1401).

Author information

Author notes

  1. R. Schniepp and J. C. Boerner are contributed equally.

Authors and Affiliations

  1. German Center for Vertigo and Balance Disorders, University of Munich, Munich, Germany

    R. Schniepp, K. Jahn, T. Brandt & Max Wuehr

  2. Department of Neurology, University of Munich, Munich, Germany

    R. Schniepp, J. C. Boerner & J. Decker

  3. Schön Klinik Bad Aibling, Bad Aibling, Germany

    K. Jahn

  4. Institute for Clinical Neuroscience, University of Munich, Munich, Germany

    T. Brandt

Authors
  1. R. Schniepp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. C. Boerner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Decker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Jahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Brandt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Max Wuehr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Max Wuehr.

Ethics declarations

Conflicts of interest

All authors declare that there are no financial disclosures or conflicts of interest.

Ethical standards

All experimental procedures were approved by the appropriate Ethics Committee.

Additional information

This manuscript is part of a supplement sponsored by the German Federal Ministry of Education and Research within the funding initiative for integrated research and treatment centers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schniepp, R., Boerner, J.C., Decker, J. et al. Noisy vestibular stimulation improves vestibulospinal function in patients with bilateral vestibulopathy. J Neurol 265 (Suppl 1), 57–62 (2018). https://doi.org/10.1007/s00415-018-8814-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-018-8814-y

Keywords

Search

Navigation