Altered Insular and Occipital Responses to Simulated Vertical Self-Motion in Patients with Persistent Postural-Perceptual Dizziness.
Altered Insular and Occipital Responses to Simulated Vertical Self-Motion in Patients with Persistent Postural-Perceptual Dizziness.
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DOI：
10.3389/fneur.2017.00529
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发表时间：
2017
影响因子：
3.4
通讯作者：
Indovina I
中科院分区：
文献类型：
--
作者：
Riccelli R;Passamonti L;Toschi N;Nigro S;Chiarella G;Petrolo C;Lacquaniti F;Staab JP;Indovina I
持续性体位-知觉性头晕（PPPD）是一种常见的前庭功能障碍，其特征是非眩晕性头晕和不稳定的持续症状，直立姿势、自我运动和暴露于复杂或移动的视觉刺激会加重这些症状。最近的生理学和神经影像学数据表明，姿势控制更依赖视觉线索（与前庭线索相反，一种称为视觉依赖的现象）和中央视觉-前庭网络功能障碍可能是PPPD的重要病理生理机制。功能障碍被认为与岛状区域有关，岛状区域负责对引力场中运动的视觉效果进行识别。我们测试了15名PPPD患者和15名健康对照者（hc）在通过视觉虚拟现实过山车刺激获得的自我运动模拟中前庭和视觉皮层活动的改变。我们比较了两组之间大脑对垂直和水平方向模拟位移的反应差异，并将方向反应差异与PPPD患者的头晕障碍联系起来。相对于水平运动，HCs在垂直运动时显示中央岛沟前岸的活动增加，这在PPPD患者中未见。然而，在相同的比较中，PPPD患者的头晕障碍与视觉皮层（V1， V2和V3）的活动呈正相关。我们为PPPD的病理生理机制提供了新的见解，包括影响平衡控制和空间运动输入重加权以支持视觉提示的大脑过程的功能改变。对于PPPD患者，使用视觉数据辨别重力对自我运动的影响的困难可能会对平衡控制产生不利影响，特别是对于同时过度依赖视觉刺激的个体。此外，视觉皮层活动的增加与眩晕障碍的严重程度相关，这可能是视觉依赖的神经关联。
Persistent postural-perceptual dizziness (PPPD) is a common functional vestibular disorder characterized by persistent symptoms of non-vertiginous dizziness and unsteadiness that are exacerbated by upright posture, self-motion, and exposure to complex or moving visual stimuli. Recent physiologic and neuroimaging data suggest that greater reliance on visual cues for postural control (as opposed to vestibular cues—a phenomenon termed visual dependence) and dysfunction in central visuo-vestibular networks may be important pathophysiologic mechanisms underlying PPPD. Dysfunctions are thought to involve insular regions that encode recognition of the visual effects of motion in the gravitational field. We tested for altered activity in vestibular and visual cortices during self-motion simulation obtained via a visual virtual-reality rollercoaster stimulation using functional magnetic resonance imaging in 15 patients with PPPD and 15 healthy controls (HCs). We compared between groups differences in brain responses to simulated displacements in vertical vs horizontal directions and correlated the difference in directional responses with dizziness handicap in patients with PPPD. HCs showed increased activity in the anterior bank of the central insular sulcus during vertical relative to horizontal motion, which was not seen in patients with PPPD. However, for the same comparison, dizziness handicap correlated positively with activity in the visual cortex (V1, V2, and V3) in patients with PPPD. We provide novel insight into the pathophysiologic mechanisms underlying PPPD, including functional alterations in brain processes that affect balance control and reweighting of space-motion inputs to favor visual cues. For patients with PPPD, difficulties using visual data to discern the effects of gravity on self-motion may adversely affect balance control, particularly for individuals who simultaneously rely too heavily on visual stimuli. In addition, increased activity in the visual cortex, which correlated with severity of dizziness handicap, may be a neural correlate of visual dependence.
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DOI：
10.1093/cercor/bhw157
发表时间：
2016-08
期刊：
Cerebral cortex (New York, N.Y. : 1991)
影响因子：
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影响因子：
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