Development of a diagnostic framework for vestibular causes of dizziness and unsteadiness in patients with multisensory neurological disease: a Delphi consensus.
Development of a diagnostic framework for vestibular causes of dizziness and unsteadiness in patients with multisensory neurological disease: a Delphi consensus.
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多感觉神经系统疾病患者头晕和不稳定的前庭原因诊断框架的开发：德尔菲共识。
DOI：
10.1007/s00415-023-11640-2
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发表时间：
2023
影响因子：
6
通讯作者：
Male AJ
中科院分区：
文献类型：
--
作者：
Male AJ
神经系统疾病通常表现为多感觉和多系统受累[1]。不稳定和头晕是常见的报告，并经常归因于中枢原因，或周围神经病变。解开和识别所涉及的系统可能是复杂的，前庭功能障碍通常不被考虑[2]。然而，识别前庭功能障碍为成年人提供了一个获得循证治疗选择的机会[3]。线粒体疾病（MD）是多感觉神经疾病的一个例子。它们形成了由核和线粒体DNA（mtDNA）编码基因突变引起的一组不同的遗传疾病，并且是成人中最常见的遗传性神经系统疾病[4]。对MD患者的治疗投入侧重于支持个人保存能量，优化活动和健身，并提供适当的辅助和适应。平衡障碍是成年MD患者的常见症状，通常归因于潜在的周围神经病变、骨骼肌病变和/或小脑疾病。然而，97%（30/33）的成年MD患者[3]的前庭诊断报告头晕和/或不稳定，包括周围前庭病变（23/30）、中枢前庭功能障碍（3/30）、前庭功能障碍（3/30）和前庭功能障碍（3/30）。良性阵发性位置性眩晕（BPPV）2例。除了周围神经病变和小脑疾病外，前庭功能障碍的高患病率突出了MD患者头晕和不稳定的多因素原因。没有诊断工具或途径存在，以帮助确定共存的前庭疾病的患者与MD。一旦发现前庭疾病，就有机会获得既定的前庭康复[5-8]，否则将不会考虑特定的前庭治疗。本研究的目的是从前庭神经学，神经耳科或前庭医学的顾问那里获得共识，关于决策框架中包括的问题，以确定MD患者头晕和不稳定的前庭原因。德尔菲法指的是一个旨在收集专家对特定主题的意见，以达成共识的过程。在这里，一个修改后的电子德尔菲的方法被用来获得小组的共识，从国际顾问的主要利益，并已接受专门的临床培训，在前庭神经学，神经耳科或视听前庭医学。
Neurological diseases typically manifest with multisensory and multisystem involvement [1]. Unsteadiness and dizziness are commonly reported, and frequently attributed to central causes, or peripheral neuropathy. Disentangling and identifying the systems involved can be complex, with vestibular dysfunction commonly not considered [2]. However, identifying vestibular dysfunction, provides an opportunity for adults to access evidence-based treatment options [3]. Mitochondrial diseases (MD) are an example of a multisensory neurological disease. They form a diverse group of genetic disorders caused by mutations in nuclear-and mitochondrial DNA (mtDNA)-encoded genes and are among the commonest form of inherited neurological disorders in adults [4]. Therapeutic input for people with MD focuses on supporting individuals to conserve energy, optimise activity and fitness, and provide appropriate aids and adaptations. Impaired balance is a common symptom in adults with MD and usually attributed to an underlying peripheral neuropathy, skeletal myopathy and/or cerebellar disease.However, a vestibular diagnosis was identified in 97%(30/33) of adults with MD [3], that reported dizziness and/or unsteadiness, and included peripheral vestibulopathy (23/30); central vestibular dysfunction (3/30); vestibular migraine (2/30); and benign paroxysmal positional vertigo (BPPV)(2/30). This high prevalence of vestibular dysfunction, in addition to peripheral neuropathy and cerebellar disease, highlights the multifactorial causes of dizziness and unsteadiness for patients with MD. No diagnostic tools or pathways exist to help identify co-existing vestibular disorders in patients with MD. Once vestibular disorders are identified, it proffers a chance to access established vestibular rehabilitation [5–8], when otherwise no specific vestibular treatment would be considered. The aim of this study was to gain a consensus opinion from consultants working in vestibular neurology, neurootology or audiovestibular medicine, about the questions to include in a decision-making framework, to identify vestibular causes of dizziness and unsteadiness in people with MD. The Delphi method refers to a process that aims to collect expert opinions on a particular topic, to gain consensus. Here, a modified electronic Delphi approach was used to gain group consensus from international consultants with a primary interest, and who have received specialised clinical training, in vestibular neurology, neuro-otology or audiovestibular medicine.