Studies on the correlation between vestibular function test and autonomic nervous system.
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OBJECTIVES: Benzodiazepines, particularly diazepam (DZ), are used in clinical practice to suppress acute vestibular symptoms. There have been limited studies looking at the effects of tolerance to DZ on parameters designed to measure the integrity of the vestibular system and its interaction with the oculomotor and balance systems. METHODS: In a double-blinded, repeated-measures design, we randomized 30 young healthy men into one of two treatment groups (diazepam and placebo) and assessed with electro-oculography the effects of clinical divided doses of DZ on saccadic eye movements and sedation over 16 days. RESULTS: Only sedation and saccadic latency were significant (p < .05) for treatment group, indicating selective effects on different central nervous system mechanisms. No significant effect for time was seen in any of the variables measured. Bonferroni t-test comparisons of the DZ group among 3 days were significant (p < .017) between baseline and day 3 for saccadic latency and accuracy and between day 3 and day 16 for self-ratings of sedation. CONCLUSIONS: Saccadic latency and accuracy and sedation ratings appear to be more sensitive to changes over time and less affected by subject variability than saccadic eye velocity. It remains questionable whether patients who have been on DZ for acute or extended periods of time need to discontinue the drug 48 hours before testing.
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Conceptual, technological, electronic and computer revolutions have transformed the methodology for evaluating the patient with dysequilibrium. What has been said and written for the past 25 years is not currently applicable. Present day, cost effective, clinical evaluation format is presented, including changes and deletions in the conventional ENG test battery. It also includes the addition of computer technology in the rotation and ocular tracking tests. These deletions and additions in technique provide the clinician with more useful practical data for diagnosis. There is also capability for patient follow-up and monitoring. These concepts are presented from the clinical vantage point and are supported with patient evaluation examples.
Patients with chronic fatigue syndrome (CFS) often complain of dysequilibrium that is nonspecific. The basis of this complaint is unknown but may be related to vestibular system abnormalities, in that an association between inner-ear deficits and infectious mononucleosis has been established in the medical literature. An overview of quantitative vestibular function testing is given, including vestibulo-ocular and vestibulospinal tests. The basic principles of caloric and rotational testing are provided, including the interaction between vision and the vestibular system. Moving-platform posturography is described. Preliminary results from quantitative vestibular function testing of a small group of individuals with CFS are provided.
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OBJECTIVES: The purpose of this prospective study was to determine whether clinical doses of diazepam (DZ; 10 mg/d) administered for 14 days result in tolerance as measured by the sinuosidal harmonic acceleration (SHA) rotational test. It has been shown that repeated dosing with DZ leads to accumulation and tolerance in outcome measures that assess memory, sedation, and psychomotor tasks. METHODS: In a double-blinded, repeated-measures design, 30 normal male subjects who ranged in age from 20 to 36 years were randomly assigned to a placebo group or a DZ group and participated in 6 SHA rotational sessions over a 2-week period. Analysis of drug-placebo differences in percent change from baseline was performed with a 1-way analysis of variance. RESULTS: Vestibulo-ocular reflex gain and phase frequencies at 0.01, 0.02, 0.04, and 0.08 Hz were significant (p < .05) for treatment group. No significant effect was observed for gain and phase frequency at 0.16 Hz--a finding that indicates selective effects on different central nervous system mechanisms. There was no statistical significance for time. CONCLUSIONS: Clinically, the DZ subjects' scores remained within the normal ranges for vestibulo-ocular phase and gain, suggesting that patients in whom drug cessation is problematic may not have to discontinue DZ before testing with the SHA rotational system.
Electronystagmography was used to examine 103 elderly patients complaining of dizziness. This series of tests included tests for pathologic nystagmus, saccades, smooth pursuit, and optokinetic nystagmus, as well as bithermal caloric testing and rotational testing. One or more specific diagnoses were identified in 100 patients (86.2%), with the two most common diagnoses being benign positional vertigo (30 patients, or 25.9%) and cerebrovascular disorders (25 patients, or 21.6%). An abnormality was found on ENG in 75 (65%) of the patients tested, the most common of these being a unilateral hypoexcitability to caloric stimulation. In most cases, the ENG data was used to support a presumptive diagnosis that was based on the patient's history and examination, although in 4 cases ENG provided the critical diagnostic information by identifying decreased caloric and rotational responses in patients with nonspecific dizziness and dysequilibrium.