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To evaluate pre- and post-operative semicircular canal function in patients with vestibular schwannoma (VS) by the video Head Impulse Test (vHIT). Nineteen patients with VS who underwent surgery were enrolled in this study. The gain in vestibulo-ocular reflex (VOR) and the degree of scatter in catch-up saccades were examined pre- and post-operatively for the semicircular canals in VS patients. Ten of 19 cases (52.6 %) with VS were defined as demonstrating both superior vestibular nerve (SVN) and inferior vestibular nerve (IVN) impairment from the results of pre-operative vHIT. Hearing level and subjective vestibular symptoms showed significant correlations with pre-operative semicircular canal function. Compared to pre-operative vHIT results, VOR gains within 1 month after surgery were significantly reduced in all three canals; however, significant differences had disappeared in the anterior and posterior semicircular canals at 6 months after surgery. Cases of unknown origin had a significantly greater reduction in posterior semicircular canal function after surgery compared with those with disease of IVN origin. As vHIT could evaluate pre-operative vestibular nerve impairment, post-operative VOR gain reduction and the degree of vestibular compensation, semicircular canal function evaluated by vHIT provides a good deal of useful information regarding VS patients undergoing surgery compared to caloric testing, and vHIT should be performed pre- and post-operatively for patients with VS. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the vestibular system of children who had undergone cochlear implant surgery and to compare them with the healthy population by vestibulo-ocular reflex (VOR) gains in unilateral and bilateral implant users, with the implants both on and off. Patients older than 5 years who had undergone cochlear implant surgery between 2012 and 2020 and who were cochlear implant users for at least one year were included. After consent was obtained, a video head impulse test (VHIT) was performed to evaluate the three semicircular canals, with devices on and off, and VOR gains were evaluated. VHIT was also used to assess VOR gains in the control group. The VOR gains of the study and control groups, VOR gains of unilateral and bilateral implant users, and VOR gains with implants on and off were compared. When the VOR gains of 24 unilateral and 13 bilateral cochlear implant users and the control group (n = 30) were compared, a significant difference was found only in the anterior semicircular canal, although the VOR gains were found to be low in all three semicircular canals in the implant users (p < 0.05). There was no significant difference between the VOR gains of unilateral and bilateral implant users. There was no significant difference between the VOR gains when either on or off. There was no correlation between cochlear implant usage time, implant insertion age, patient age and VOR gain. The effects of cochlear implant surgery on the vestibular system continue in the late period, but no correlation was observed between implant usage time and VOR gain after the first year. It was observed that having the cochlear implant on or off had no effect on VOR gain. Furthermore, bilateral implant surgery did not lead to additional vestibular dysfunction compared to unilateral implant surgery. [ABSTRACT FROM AUTHOR]

After unilateral peripheral vestibular lesions, the neural activity of neurons in the ipsi-lesional medial vestibular nucleus (ipsi-MVe) are markedly decreased, resulting in static and dynamic asymmetries of the vestibulo-ocular and vestibulo-spinal reflexes. Consequently, static vestibular symptoms such as spontaneous nystagmus and postural deviation and dynamic vestibular symptoms such as oscillopsia and swaying gait are induced. However, these behavioral asymmetries gradually recover after the lesion. Progressive balance restoration is termed vestibular compensation, which is divided into two phases: static and dynamic. Static vestibular compensation is further divided into initial and late processes. In the initial process of static vestibular compensation after unilateral labyrinthectomy (UL) in rats, plastic changes in the cerebello-vestibular and vestibular commissural inhibitory pathways suppress neurons in the contra-lesional MVe (contra-MVe), resulting in the restoration of symmetrical resting activity of MVe neurons on both sides at low levels. The declining frequency of spontaneous nystagmus after UL is an index of the initial process, and short-term administration of diazepam, a GABA A receptor agonist, has been shown to accelerate the initial process in rats. Accordingly, short-term administration of diazepam is recommended for the treatment of acute vertigo in patients with unilateral vestibular dysfunction. In the late process of static vestibular compensation after UL in rats, the resting activity of ipsi-MVe neurons gradually recovers due to changes in cell membrane properties, resulting in the reinforcement of balanced intervestibular nuclear activities to nearly normal levels without the suppression of contra-MVe neurons. The declining number of MK801-induced Fos-positive neurons in contra-MVe after UL is an index of the late process, and long-term administration of betahistine, a histamine H 3 receptor antagonist, has been shown to accelerate the late process in rats. Accordingly, long-term administration of betahistine is recommended for the treatment of subacute vertigo in patients who were not compensated for unilateral vestibular dysfunction. In the process of dynamic vestibular compensation after UL, the sensitivity of ipsi-MVe neurons to head velocity and acceleration is restored due to synaptic changes such as long-term potentiation and sprouting of commissures, resulting in the restoration of the dynamic vestibulo-ocular and vestibulo-spinal reflexes. To facilitate dynamic vestibular compensation, early ambulation and subsequent vestibular rehabilitation exercise are recommended for the treatment of chronic vertigo in patients with uncompensated unilateral vestibular dysfunction. Although vestibular compensation after bilateral vestibular loss is not expected, vestibular rehabilitation with a sensory-substitution strategy can improve imbalance in patients with bilateral vestibular lesions. [ABSTRACT FROM AUTHOR]

• Comparison between looking behavior in laboratory and naturalistic conditions (77). • Neural circuits driving voluntary and reflexive gaze shifts and stabilization (77). • Superior colliculus that receives and integrates gaze driving signals to brainstem (82). • Listings Law implemented by commissural connections between the superior colliculi (82). • Saccade system and VOR system share common semicircular canal coordinate (72). Organisms control their visual worlds by moving their eyes, heads, and bodies. This control of "gaze" or "looking" is key to survival and intelligence, but our investigation of the underlying neural mechanisms in natural conditions is hindered by technical limitations. Recent advances have enabled measurement of both brain and behavior in freely moving animals in complex environments, expanding on historical head-fixed laboratory investigations. We juxtapose looking behavior as traditionally measured in the laboratory against looking behavior in naturalistic conditions, finding that behavior changes when animals are free to move or when stimuli have depth or sound. We specifically focus on the brainstem circuits driving gaze shifts and gaze stabilization. The overarching goal of this review is to reconcile historical understanding of the differential neural circuits for different "classes" of gaze shift with two inconvenient truths. (1) "classes" of gaze behavior are artificial. (2) The neural circuits historically identified to control each "class" of behavior do not operate in isolation during natural behavior. Instead, multiple pathways combine adaptively and non-linearly depending on individual experience. While the neural circuits for reflexive and voluntary gaze behaviors traverse somewhat independent brainstem and spinal cord circuits, both can be modulated by feedback, meaning that most gaze behaviors are learned rather than hardcoded. Despite this flexibility, there are broadly enumerable neural pathways commonly adopted among primate gaze systems. Parallel pathways which carry simultaneous evolutionary and homeostatic drives converge in superior colliculus, a layered midbrain structure which integrates and relays these volitional signals to brainstem gaze-control circuits. [ABSTRACT FROM AUTHOR]

The vestibular cerebellum integrates multimodal sensory and motor information with vestibular input to compute internal models of self-motion. Adaptive plasticity in the floccular lobe underlies the vital computation that maintains vestibulo-ocular reflex calibration to ensure gaze stability. The anterior vermis plays a key role in two essential computations: (i) it transforms head-centered vestibular signals into the body-centered reference frame required for postural control, and (ii) it constructs a prediction of the sensory consequences of active self-motion. The nodulus and ventral uvula of the posterior vermis compute an internal representation of our spatial orientation and self-motion relative to gravity. The internal models underlying each of these computations are continually updated to account for constraints imposed by changes in the environment and/or neural mechanical dynamics. The vestibular cerebellum plays an essential role in maintaining our balance and ensuring perceptual stability during activities of daily living. Here I examine three key regions of the vestibular cerebellum: the floccular lobe, anterior vermis (lobules I–V), and nodulus and ventral uvula (lobules X–IX of the posterior vermis). These cerebellar regions encode vestibular information and combine it with extravestibular signals to create internal models of eye, head, and body movements, as well as their spatial orientation with respect to gravity. To account for changes in the external environment and/or biomechanics during self-motion, the neural mechanisms underlying these computations are continually updated to ensure accurate motor behavior. To date, studies on the vestibular cerebellum have predominately focused on passive vestibular stimulation, whereas in actuality most stimulation is the result of voluntary movement. Accordingly, I also consider recent research exploring these computations during active self-motion and emerging evidence establishing the cerebellum's role in building predictive models of self-generated movement. [ABSTRACT FROM AUTHOR]

• Transcranial oscillatory currents may stimulate the vestibular cortex in the range of its physiological activity (1 or 2 Hz) • Induced behavioral effects (motion sickness and postural sways) are not due to a peripheral spread of the current towards vestibular receptors. • Motion sickness represents a previously neglected possible side effect of slow-frequency tACS. The vestibular cortex is a multisensory associative region that, in neuroimaging investigations, is activated by slow-frequency (1–2 Hz) galvanic stimulation of peripheral receptors. We aimed to directly activate the vestibular cortex with biophysically modeled transcranial oscillatory current stimulation (tACS) in the same frequency range. Thirty healthy subjects and one rare patient with chronic bilateral vestibular deafferentation underwent, in a randomized, double-blind, controlled trial, to tACS at slow (1 or 2 Hz) or higher (10 Hz) frequency and sham stimulations, over the Parieto-Insular Vestibular Cortex (PIVC), while standing on a stabilometric platform. Subjective symptoms of motion sickness were scored by Simulator Sickness Questionnaire and subjects' postural sways were monitored on the platform. tACS at 1 and 2 Hz induced symptoms of motion sickness, oscillopsia and postural instability, that were supported by posturographic sway recordings. Both 10 Hz-tACS and sham stimulation on the vestibular cortex did not affect vestibular function. As these effects persisted in a rare patient with bilateral peripheral vestibular areflexia documented by the absence of the Vestibular-Ocular Reflex, the possibility of a current spread toward peripheral afferents is unlikely. Conversely, the 10 Hz-tACS significantly reduced his chronic vestibular symptoms in this patient. Weak electrical oscillations in a frequency range corresponding to the physiological cortical activity of the vestibular system may generate motion sickness and postural sways, both in healthy subjects and in the case of bilateral vestibular deafferentation. This should be taken into account as a new side effect of tACS in future studies addressing cognitive functions. Higher frequencies of stimulation applied to the vestibular cortex may represent a new interventional option to reduce motion sickness in different scenarios. [ABSTRACT FROM AUTHOR]

• Changes of retinal function after treatment with PNU-282987. • PNU-282987 affects ERG activity after blast trauma. • Retinal ganglion cells extend axons into optic nerve after PNU-282987 treatment. • PNU-282987 induces changes of retinal neurons after blast exposure. • PNU-282987 prevents amplitude decrease in ERG waveforms after blast. Currently, there is a lack of treatments for retinal neurotrauma. To address this issue, this study uses an alpha7 nAChR agonist, PNU-282987, to determine it effects on functional activity in the retina shortly after a traumatic blast exposure. The objectives of this research include: (1) examination of the cellular and functional damage associated with ocular blast exposure, and (2) evaluation of structural and functional changes that occur post PNU-282987 treatment. Significant ocular blast damage was induced in adult mice after exposure to a single blast of 35 psi to the left eye. Blast-exposed transgenic mice expressing tdTomato Müller glia were treated daily with eyedrops containing PNU-282987 for 4 weeks following the blast exposure. Antibody staining studies in these transgenic mice was conducted to examine lineage tracing and electroretinograms (ERGs) were obtained to examine functional changes. Blast exposure caused a significant loss of cells in all retinal layers after 4 weeks. Immunohistochemical analysis demonstrated tdTomato-positive labeled photoreceptors and retinal ganglion cells in blast-exposed mice treated with PNU-282987. ERG recordings were taken from control animals, from blast-damaged animals and from animals exposed to blast followed by 4 weeks of PNU-282987 treatment. Scotopic ERG recordings from blast-exposed mice had significantly decreased amplitudes of a-wave, b-wave, oscillatory potentials and flicker frequencies, which were prevented after PNU-282987 treatment. In photopic experiments, the PhNR response was reduced significantly after blast exposure but the decrease was prevented after treatment with PNU-282987. These are the first experiments that demonstrate preservation of retinal function after blast exposure using an alpha7 nAChR agonist. [ABSTRACT FROM AUTHOR]

Objective: To evaluate how often the positive sign of HINTS (Head-Impulse, Gaze Evoked Nystagmus, Test of Skew) appears in patients with acute peripheral vestibular lesion, HINTS findings were quantitatively measured and analyzed in patients with peripheral vestibulopathy accompanying spontaneous nystagmus.Methods: HINTS was evaluated in 14 vertigo patients with spontaneous nystagmus. Horizontal vestibulo-ocular reflex (VOR) gain was measured using the video head impulse test (vHIT). To evaluate gaze-evoked nystagmus (GEN), slow-phase velocities at different points of lateral gaze were measured and plotted, then the slope and its inverse value, the neural integrator time constant, were calculated. Skew deviation was tested using anaglyph filters to simulate the alternate cover test, and the degree and latency of vertical eyeball deviation were measured. The ABCD2 score was calculated to evaluate the risk of stroke.Results: Among 13 patients of peripheral vestibulopathy, 7 showed positive signs in HINTS (normal vHIT: 5, direction-changing GEN: 0, skew deviation: 3). One patient with a cerebellopontine angle tumor presented with both a peripheral and central pattern and showed positive HINTS findings (presence of direction-changing GEN). The mean VOR gain of patients with abnormal vHIT was 0.58±0.29 and 1.10±0.11 in the affected and contralateral side, respectively, while those in patients with normal vHIT were 1.04±0.21 and 1.13±0.12, respectively. The neural integrator time constant calculated from the mean slope of horizontal slow-phase velocity according to horizontal eye position was 42.9 s. The mean vertical eyeball deviation of patients with positive skew was 2.14±1.18° while uncovering the eye on the affected side, and -1.97±1.59° while uncovering the eye on the unaffected side. The median ABCD2 score of 14 patients was 2 (range, 1-3).Conclusions: HINTS findings were objectively measured in vertigo patients with spontaneous nystagmus. Although positive findings of HINTS have been recognized as a central sign, 54% (7/13) of cases with peripheral vestibulopathy showed positive HINTS signs. HINTS results should be interpreted carefully considering that a substantial proportion of peripheral vestibulopathy shows a positive HINTS sign. [ABSTRACT FROM AUTHOR]

The inferior olivary (IO) nucleus makes up the signal gateway for several organs to the cerebellar cortex. Located within the sensory–motor-cerebellum pathway, the IO axons, i.e., climbing fibres (CFs), massively synapse onto the cerebellar Purkinje cells (PCs) regulating motor learning whilst the olivary nucleus receives negative feedback through the GABAergic nucleo-olivary​ (NO) pathway. The NO pathway regulates the electrical coupling (EC) amongst the olivary cells thus facilitating synchrony and timing. However, the involvement of this EC regulation on cerebellar adaptive behaviour is still under debate. In our study we have used a spiking cerebellar model to assess the role of the NO pathway in regulating vestibulo-ocular-reflex (VOR) adaptation. The model incorporates spike-based synaptic plasticity at multiple cerebellar sites and an electrically-coupled olivary system. The olivary system plays a central role in regulating the CF spike-firing patterns that drive the PCs, whose axons ultimately shape the cerebellar output. Our results suggest that a systematic GABAergic NO deactivation decreases the spatio-temporal complexity of the IO firing patterns thereby worsening the temporal resolution of the olivary system. Conversely, properly coded IO spatio-temporal firing patterns, thanks to NO modulation, finely shape the balance between long-term depression and potentiation, which optimises VOR adaptation. Significantly, the NO connectivity pattern constrained to the same micro-zone helps maintain the spatio-temporal complexity of the IO firing patterns through time. Moreover, the temporal alignment between the latencies found in the NO fibres and the sensory–motor pathway delay appears to be crucial for facilitating the VOR. When we consider all the above points we believe that these results predict that the NO pathway is instrumental in modulating the olivary coupling and relevant to VOR adaptation. [ABSTRACT FROM AUTHOR]

Background: Oculomotor abnormalities are one of the cardinal clinical features of progressive supranuclear palsy (PSP). Vertical saccadic slowing is an early sign of PSP. The association between oculomotor abnormalities and sleep architecture has not been studied so far.Objectives: To study the association of oculomotor abnormalities of PSP with the sleep stages by using video polysomnography (vPSG).Methods: This was a cross-sectional single-center study. Twenty-two patients with PSP and 15 age and gender-matched controls were recruited. Saccades, vestibulo-ocular reflex, and optokinetic nystagmus were assessed and graded clinically in all patients and one overnight vPSG was done in all cases.Results: Vertical saccades, upward more than downwards, were affected in all cases. While horizontal saccades were normal only in 41% of cases. Vertical optokinetic nystagmus (OKN) was affected in all cases. Horizontal OKN was normal in 36% of patients. The vertical upward saccades had a negative correlation with N1% and duration (r = -0.418; p = 0.05, r = -0.457; p = 0.03), N3% and duration (r = -0.486; p = 0.02, r = -0.510; p = 0.01), REM% (r = -0.449; p = 0.04), total sleep time (r = -0.487; p = 0.02) and sleep efficiency (r = -0.444; p = 0.04). There was a positive correlation between horizontal OKN and sleep onset latency (r = 0.432; p = 0.05).Conclusions: Vertical saccadic restriction in PSP has significant negative correlation with total sleep time and sleep efficiency. The oculomotor and sleep abnormalities in PSP are probably interlinked and their assessment is useful in determining the characteristics of the disease. [ABSTRACT FROM AUTHOR]

To identify the etiology of vertigo/dizziness and determine the effectiveness of the video-head impulse test (vHIT) and the suppression head impulse paradigm (SHIMP) tests in distinguishing between peripheral and non-peripheral etiologies in children who presented to the otolaryngology department with complaints of vertigo/dizziness. The vHIT and SHIMP tests were applied to the children. The vestibulo-ocular reflex (VOR) gain and saccade parameters were compared. In 27 children presenting with vertigo/dizziness, the most common etiological factor was inner ear malformation (IEM) (n = 6/27, 22.2%), followed by cochlear implant surgery (11.1%) and migraine (11.1%). Vestibular hypofunction was indicated by the vHIT results at a rate of 60% (9/15 children) and SHIMP results at 73.3% (11/15 children) among the children with a peripheral etiology, while these rates were 8.3% (1/12 children) and 25% (3/12 children), respectively, in the non-peripheral etiology group. SHIMP-VOR and vHIT-VOR gain values had a moderate positive correlation (p = 0.01, r = 0.349). While there were overt/covert saccades in the vHIT, anti-compensatory saccade (ACSs) were not observed in the SHIMP test (p = 0.041). The rates of abnormal vHIT-VOR gain (p = 0.001), over/covert saccades (p = 0.019), abnormal vHIT response (p = 0.014), ACSs (p = 0.001), and abnormal SHIMP response (p = 0.035) were significantly higher in the peripheral etiology group. IEM was the most common etiological cause, and the rate of vestibular hypofunction was higher in these children with peripheral vertigo. vHIT and SHIMP are effective and useful vestibular tests for distinguishing peripheral etiology from non-peripheral etiology in the pediatric population with vertigo/dizziness. These tests can be used together or alone, but the first choice should be the SHIMP test, considering its short application time (approximately 4–5 min) and simplicity. [ABSTRACT FROM AUTHOR]

• In unoperated vestibular schwannoma, ipsilesional canals show decreased vestibulo-ocular reflex (VOR) gain and increased saccade amplitude and frequency. • One week after unilateral vestibular deafferentation lesioned canal gains drop by 0.22–0.35 and first saccade frequency and amplitudes increase by 37% and 2.9°. • The video head-impulse test excitation/dis-facilitation VOR asymmetry is less for the intact posterior canal than for the other canals. To examine the vestibulo-ocular reflex (VOR) and compensatory-saccades before and after complete unilateral vestibular deafferentation (UVD). Forty patients were studied before and after surgery for vestibular or facial schwannoma using the video head-impulse test (vHIT) and multivariable regression. Prior to UVD (median(IQR), 14(58.4) days), the average VOR-gain towards the lesioned -ear was lower than in normal for all semicircular canals (lateral, anterior, posterior: 0.69, 0.72, 0.49). One-week after UVD (5(3.0) days) VOR gains were further reduced (0.22, 0.37, 0.27), however, within one-year after UVD (171(125.0) days) the lesioned- ear VOR gains had slightly increased (+0.08, +0.11, +0.03), maximally for the anterior-canal. After UVD, the VOR gain asymmetry (gain towards minus away from intact-ear) was lower for the intact posterior-canal plane (0.56, 0.56, 0.22). For the lesioned canals, the frequency and amplitude of the first compensatory-saccade increased from 61–93% and 1.9–3.6° pre-surgery, to 98–99% and to 3.1–5.9° one-week post-surgery and remained unchanged over one-year; second saccade frequency and amplitude decreased over the same timespan. After UVD the high-acceleration VOR for the intact posterior-canal plane is more symmetrical than the other canals. First compensatory-saccades adapt within one week and subsequently change only marginally. Saccade compensation from surgical UVD is near complete by one-week. [ABSTRACT FROM AUTHOR]

Introduction: Progressive supranuclear palsy (PSP) patients show reduced amplitude and velocity of vertical saccades, but saccadic abnormalities have also been reported in Parkinson's disease (PD). We investigated amplitude and velocity of vertical saccades in PSP and PD patients, to establish the best video-oculographic (VOG) parameters for PSP diagnosis.Methods: Fifty-one PSP patients, 113 PD patients and 40 controls were enrolled. The diagnosis was performed on a clinico-radiological basis (MR Parkinsonism index [MRPI] and MRPI 2.0). We used VOG to assess the diagnostic performances of saccadic amplitude, peak velocity, and their product (AxV) in upward or downward direction and in vertical gaze (upward and downward averaged) in distinguishing PSP from PD patients. The vestibulo-ocular reflex, necessary to establish the supranuclear nature of ocular dysfunction, was evaluated clinically.Results: PSP patients showed significantly reduced amplitude and peak velocity of ocular saccades in upward and downward directions compared to PD and healthy subjects. In PD patients, upward gaze amplitude was lower than in controls. In vertical gaze, the peak velocity showed 99.1% specificity and 54.7% sensitivity for PSP classification. The AxV product showed high specificity (94.7%) and sensitivity (84.3%) and yielded higher accuracy (91.5%) than velocity and amplitude used alone in distinguishing PSP from PD.Conclusion: Our study demonstrates that the peak velocity of vertical saccades was a very low sensitive parameter and cannot be used alone for PSP diagnosis. A new index combining amplitude and peak velocity in vertical gaze seems the most suitable video-oculographic biomarker for differentiating PSP from PD and controls. [ABSTRACT FROM AUTHOR]

The vestibulo-ocular reflex (VOR) stabilizes vision during head motion. Age-related changes of vestibular neuroanatomical properties predict a linear decay of VOR function. Nonetheless, human epidemiological data show a stable VOR function across the life span. In this study, we model cerebellum-dependent VOR adaptation to relate structural and functional changes throughout aging. We consider three neurosynaptic factors that may codetermine VOR adaptation during aging: the electrical coupling of inferior olive neurons, the long-term spike timing-dependent plasticity at parallel fiber – Purkinje cell synapses and mossy fiber – medial vestibular nuclei synapses, and the intrinsic plasticity of Purkinje cell synapses Our cross-sectional aging analyses suggest that long-term plasticity acts as a global homeostatic mechanism that underpins the stable temporal profile of VOR function. The results also suggest that the intrinsic plasticity of Purkinje cell synapses operates as a local homeostatic mechanism that further sustains the VOR at older ages. Importantly, the computational epidemiology approach presented in this study allows discrepancies among human cross-sectional studies to be understood in terms of interindividual variability in older individuals. Finally, our longitudinal aging simulations show that the amount of residual fibers coding for the peak and trough of the VOR cycle constitutes a predictive hallmark of VOR trajectories over a lifetime. [ABSTRACT FROM AUTHOR]

Hearing impairment has frequently been described in β-thalassemia patients with a significant impact on the patients' quality of life. Most studies provided evidence of deferoxamine (DFO) dose-related ototoxicity, however, the data is scarce regarding deferasirox (DFX) as a sole iron chelator. We aimed to assess the prevalence and risk factors of sensorineural hearing loss (SNHL) and vestibular dysfunction in regularly transfused β-thalassemia patients who had been treated with DFX film coated tablets. We conducted a case control study on 57 transfusion dependent β-thalassemia patients with a mean age of 15.3 years who received DFX FCT as monotherapy for at least one consecutive year, and 57 healthy age and sex-matching controls. Comprehensive audiological evaluations using pure tone audiometry (PTA) and transient evoked otoacoustic emission (TEOAE) as well as vestibular evaluation using Video-nystagmography (VNG) were done. SNHL was identified in 12 patients (21.1 %) using PTA and a statistically significant difference was detected between controls and patients at 6 KHz and 12 KHz frequencies. A higher incidence of SNHL was detected using TEOAE, 22 patients (43.1 %) failed to pass TEOAE, with a statistically significant decrease in the signal at frequencies 1, 4 KHz bilaterally and at frequencies 1.5, 2 KHz in the right ear compared to controls. Canal paresis was detected in 21 (36.8 %) of thalassemic children using bithermal caloric test with significantly more unilateral weakness than control children (P = 0.008). We found no significant correlation between audio-vestibular dysfunction and age, sex, serum ferritin, frequency of blood transfusion and dose of DFX FCT in thalassemic children. We conclude that the incidence of SNHL and vestibular dysfunction was high among transfusion dependent β-thalassemia patients. Therefore, we recommend performing pre-treatment baseline audio-vestibular assessment and yearly audio-vestibular monitoring to early detect high risk patients and initiate timely management to prevent permanent damage. [ABSTRACT FROM AUTHOR]

Postural instability is a cardinal symptom of Parkinson's disease (PD), which suggests the vestibular system may be affected in PD. This study aimed to determine whether vestibular dysfunction is associated with the risk of falls in PD. We prospectively recruited patients with de-novo PD at a tertiary medical center between December 2019 and March 2023. During initial assessment, each patient was queried about falls within the preceding year. All patients underwent evaluation of video head-impulse tests (video-HITs), motion analysis, mini-mental state examination (MMSE), and Montreal Cognitive Assessment (MOCA). We determined whether head impulse gain of the vestibulo-ocular reflex (VOR) was associated with clinical severity of PD or risk of falls. Overall, 133 patients (mean age ± SD = 68 ± 10, 59 men) were recruited. The median Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III) was 23 (interquartile range = 16–31), and 81 patients (61 %) scored 2 or less on the Hoehn and Yahr scale. Fallers were older (p = 0.001), had longer disease duration (p = 0.001), slower gait velocity (p = 0.009), higher MDS-UPDRS-III (p < 0.001) and H&Y scale (p < 0.001), lower MMSE (p = 0.018) and MOCA scores (p = 0.001) than non-fallers. Multiple logistic regression showed that MDS-UPDRS-III had a positive association with falling (p = 0.004). Falling was not associated with VOR gain (p = 0.405). The VOR gain for each semicircular canal showed no correlation with the MDS-UPDRS-III or disease duration. The semicircular canal function, as determined by video-HITs, is relatively spared and has little effect on the risk of falls in patients with mild-to-moderate PD. • Falling is a major risk for immobilization and consequent poor quality of life in patients with Parkinson's disease (PD). • The canal function is relatively preserved and has little effect on the risk of falls in patients with mild-to-moderate PD. • The vestibulo-ocular reflex gain showed no correlation with the MDS-UPDRS-III or disease duration. [ABSTRACT FROM AUTHOR]

• Integration of an ALIO hexapod (ALIO Industries, Colorado, USA) to a video oculography (VOG) system. • The system enables measuring vestibulo-ocular reflex of small animal under 6-degree of freedom motion real time. • The motion accuracy of the present system is 10 folds higher than the previous single axis VOG built on a servo motor. • Different approaches for eyeball tracking are compared for the implementation. We present a video oculography (VOG) system with 6-degree-of-freedom (6-DOF) mobility for real-time measurements of the binocular 3D eye position of a small animal. A hybrid hexapod that allowed for multi-axis complex motions with the resolution of the microscopic level was used to control the motion of the animal. The instantaneous eyeball movement of the animal was determined based on two approaches: (1) tracking of marker arrays affixed to the cornea; and (2) tracking the pupil outline. The tracking of the eyeball movement and the motion control of the hexapod were implemented with the LabVIEW virtual instruments. Compared with our previous measurements using a servo-motor-based single-axis VOG system, positional error reduced from more than 4% to less than 0.7%. Validation showed that the tracking errors in three rotational axes are less than 2% for the magnitude and less than 5° for the direction angle. The present VOG system is an effective tool for cross-axis 3D vestibulo-ocular reflex study on small animals. [ABSTRACT FROM AUTHOR]

• All vestibular behaviors exhibit imprecision (e.g., trial-to-trial variability). • Vestibular precision is an underappreciated complement to accuracy (e.g., VOR gain). • Studying vestibular precision has led to clinical and basic science advances. • Vestibular precision varies with age, amplitude, frequency, pathology, and medication. • Seemingly dissimilar methods (e.g., thresholds, verticality variability) are related. Precision and accuracy are two fundamental properties of any system, including the nervous system. Reduced precision (i.e., imprecision) results from the presence of neural noise at each level of sensory, motor, and perceptual processing. This review has three objectives: (1) to show the importance of studying vestibular precision, and specifically that studying accuracy without studying precision ignores fundamental aspects of the vestibular system; (2) to synthesize key hypotheses about precision in vestibular perception, the vestibulo-ocular reflex, posture, and neurons; and (3) to show that groups of studies that are thoughts to be distinct (e.g., perceptual thresholds, subjective visual vertical variability, neuronal variability) are actually "two sides of the same coin" – because the methods used allow results to be related to the standard deviation of a Gaussian distribution describing the underlying neural noise. Vestibular precision varies with age, stimulus amplitude, stimulus frequency, body orientation, motion direction, pathology, medication, and electrical/mechanical vestibular stimulation, but does not vary with sex. The brain optimizes precision during integration of vestibular cues with visual, auditory, and/or somatosensory cues. Since a common concern with precision metrics is time required for testing, we describe approaches to optimize data collection and provide evidence that fatigue and session effects are minimal. Finally, we summarize how precision is an individual trait that is correlated with clinical outcomes in patients as well as with performance in functional tasks like balance. These findings highlight the importance of studying vestibular precision and accuracy, and that knowledge gaps remain. [ABSTRACT FROM AUTHOR]

• Vestibulo-collic reflex and linear vestibulo-ocular reflex pathways may be affected in the early period of multiple sclerosis. • Linear vestibulo-ocular reflex is more affected than vestibulo-collic reflex in pediatric-onset multiple sclerosis. • Vestibular myogenic potential abnormalities confirm central involvement in pediatric-onset multiple sclerosis. This study aimed to examine the vestibulo-collic reflex (VCR) and linear vestibulo-ocular reflex (lVOR) and their correlation with brain lesions in pediatric-onset multiple sclerosis (POMS). The study group consisted of 17 patients (34 ears) with POMS (mean age 18.73 ± 2.02, mean age at disease onset 14.64 ± 1.36 years), and the control group included 11 age-matched healthy subjects (22 ears). Ocular and cervical Vestibular Evoked Myogenic Potentials (oVEMP and cVEMP) were performed to assess IVOR and VCR pathways. Magnetic Resonance Imaging was evaluated in the study group. In the POMS group, 47.05 % of oVEMPs and 17.64 % of the cVEMPs were abnormal, while all VEMPs were normal in the control group. The oVEMP amplitude was associated with infratentorial lesion volume (r = −0.459, p = 0.01) and total lesion volume of the brainstem and cerebellum (r = −0.450, p = 0.01). The cVEMP asymmetry ratio was correlated with the deep white matter lesion volume (r = 0.683, p < 0.001). The MVEMP scores were found to correlate only with lesion volumes in the cerebellum (r = 0.488, p = 0.04) and infratentorial region (r = 0.573, p = 0.01). Ocular and cervical VEMP abnormalities confirm that lVOR and VCR pathways may be affected in early POMS. Routine use of the VEMP test, especially the oVEMP test is recommended as a useful tool in the follow-up of POMS patients. [ABSTRACT FROM AUTHOR]

• Frequency selective VOR motor learning was confirmed in goldfish as in other model species. • Sharper tuning of frequency selectivity was found in VOR gain-up than gain-down. • Frequency competitive VOR motor learning was possible in goldfish as in primates. • The cerebellum was shown to be necessary for frequency competitive VOR motor learning. • Purkinje cell activities changed with gain-down but not with gain-up during frequency competitive VOR motor learning. Biological motions commonly contain multiple frequency components in which each fundamental has to be adjusted by motor learning to acquire a new motor skill or maintain acquired skills. At times during this motor performance one frequency component needs to be enhanced (gain-up) while another is suppressed (gain-down). This pattern of simultaneous gain-up and -down adjustments at different frequencies is called frequency competitive motor learning. Currently we investigated cerebellar roles in this behavior utilizing the goldfish vestibulo-ocular reflex (VOR). Previously, VOR motor learning was shown in primates to be frequency selective and exhibit frequency competitive motor learning. Here we demonstrate that the goldfish VOR performs frequency competitive motor learning when high and low frequency components are trained to gain-up and gain-down, respectively. However, when the two frequency components were trained in the opposite directions only gain-up component was observed. We also found that cerebellectomy precluded any frequency competitive VOR motor learning. Complementary single unit recordings from vestibulo-cerebellar Purkinje cells revealed changes in firing modulation along with gain-down learning, but not with gain-up learning irrespective of frequency. These results demonstrate that the cerebellum is required for all frequency competitive VOR motor learning and Purkinje cell activity therein is well correlated with all gain-down behaviors independent of frequency. However, frequency competitive gain-up learning requires intact, recursive brainstem/cerebellar pathways. Collectively these findings support the idea that VOR gain-up and gain-down learning utilize separate brainstem/cerebellar circuitry that, in turn, clearly underlies the unique ability of the oculomotor system to deal with multiple frequency components. [ABSTRACT FROM AUTHOR]

• Ito's pioneering contributions to cerebellar physiology: discoveries of inhibition by Purkinje cells and long-term depression. • Model of cerebellar control of movement: Determination of the vestibuloocular reflex pathways and their floccular inhibition. • Anatomical and electrophysiological identification of cerebello-thalamo-cerebral loops. • Controversial issue on mossy fiber inputs from cerebral cortex to Purkinje and nuclear cells via pontine neurons. • Visualization of the entire axonal trajectories of mossy and climbing fibers that project to cerebellar cortex and nucleus. This article is dedicated to the memory of Masao Ito. Masao Ito made numerous important contributions revealing the function of the cerebellum in motor control. His pioneering contributions to cerebellar physiology began with his discovery of inhibition and disinhibition of target neurons by cerebellar Purkinje cells, and his discovery of the presence of long-term depression in parallel fiber–Purkinje cell synapses. Purkinje cells formed the nodal point of Masao Ito's landmark model of motor control by the cerebellum. These discoveries became the basis for his ideas regarding the flocculus hypothesis, the adaptive motor control system, and motor learning by the cerebellum, inspiring many new experiments to test his hypotheses. This article will trace the achievements of Ito and colleagues in analyzing the neural circuits of the input–output organization of the cerebellar cortex and nuclei, particularly with respect to motor control. The article will discuss some of the important issues that have been solved and also those that remain to be solved for our understanding of motor control by the cerebellum. [ABSTRACT FROM AUTHOR]

• Studies of ocular reflex adaptations support the cerebellar learning hypothesis. • Purkinje cell synapse plasticity driven by climbing fiber inputs induces adaptations. • The memory of adaptation is initially formed in cerebellar flocculus Purkinje cells. • Repetition of adaptations consolidate the memory of adaptations in vestibular nuclei. • The hypothesis includes integrative functions operated by the cerebrocerebellar loop. Masao Ito proposed a cerebellar learning hypothesis with Marr and Albus in the early 1970s. He suggested that cerebellar flocculus (FL) Purkinje cells (PCs), which directly inhibit the vestibular nuclear neurons driving extraocular muscle motor neurons, adaptively control the horizontal vestibulo-ocular reflex (HVOR) through the modification of mossy and parallel fiber-mediated vestibular responsiveness by visual climbing fiber (CF) inputs. Later, it was suggested that the same FL PCs adaptively control the horizontal optokinetic response (HOKR) in the same manner through the modification of optokinetic responsiveness in rodents and rabbits. In 1982, Ito and his colleagues discovered the plasticity of long-term depression (LTD) at parallel fiber (PF)–PC synapses after conjunctive stimulation of mossy or parallel fibers with CFs. Long-term potentiation (LTP) at PF–PC synapses by weak PF stimulation alone was found later. Many lines of experimental evidence have supported their hypothesis using various experimental methods and materials for the past 50 years by many research groups. Although several controversial findings were presented regarding their hypothesis, the reasons underlying many of them were clarified. Today, their hypothesis is considered as a fundamental mechanism of cerebellar learning. Furthermore, it was found that the memory of adaptation is transferred from the FL to vestibular nuclei for consolidation by repetition of adaptation through the plasticity of vestibular nuclear neurons. In this article, after overviewing their cerebellar learning hypothesis, I discuss possible roles of LTD and LTP in gain-up and gain-down HVOR/HOKR adaptations and refer to the expansion of their hypothesis to cognitive functions. [ABSTRACT FROM AUTHOR]

Spinocerebellar ataxia (SCA) 27B, first reported in late 2022, is caused by the abnormal expansion of GAA repeats in the first intron of the FGF14 gene, which encodes the fibroblast growth factor 14. We present two late-onset cases, each manifesting mild cerebellar ataxia accompanied by omnidirectional downbeat nystagmus, which was enhanced in a suspended head position. None of the patients exhibited impaired head impulse or caloric tests. Repeat-primed PCR and targeted long-read nanopore sequence analysis of the FGF14 GAA repeat site identified more than 250 repeats, leading to the diagnosis of SCA27B. Downbeat nystagmus is reported to be associated with disturbances in the suppression of the vestibulo-ocular reflex (VOR). Our patients with SCA27B demonstrated downbeat nystagmus, likely due to a disruption of the VOR at the level of the cerebellar cortex, a potentially characteristic clinical feature of SCA27B. We have included video footages of eye movements recorded using Frenzel goggles for these cases. Omnidirectional downbeat nystagmus may be a distinctive clinical feature of SCA27B. • We report 2 cases of SCA27B accompanied by omnidirectional downbeat nystagmus. • Omnidirectional downbeat nystagmus emerges as potential distinctive marker for SCA27B diagnosis. • We present utilizing Frenzel goggles captures characteristic eye movements, validating downbeat nystagmus in SCA27B. [ABSTRACT FROM AUTHOR]

N-acetylcysteine (NAC) is an anti-oxidant and mucolytic effective against bacterial biofilms, making it useful in the treatment of chronically discharging ears that are unresponsive to traditional treatment methods. The objective of this study was to evaluate the otologic safety of intratympanic NAC combined with Ciprodex® in an animal model. Baseline distortion product otoacoustic emissions (DPOAE) and auditory brainstem response (ABR) measurements were performed for both ears on thirteen guinea pigs from the animal care research facilities of the McGill University Health Center. This was followed by intratympanic administration of control solution (Ciprofloxacin 0.3%/Dexamethasone 0.1%) to the left ear and experimental solution (1.25% NAC/Ciprofloxacin 0.3%/Dexamethasone 0.1%) to the right ear. Three additional intratympanic injections were performed over the next fourteen days. DPOAE and ABR measurements were repeated 3–4 weeks after the initial procedure. Outcome measures included differences in DPOAE and ABR thresholds after intervention, clinical evidence of vestibular dysfunction and histological evidence of ototoxicity. There were no significant differences in the ABR thresholds and DPOAE results of the control and experimental ears at baseline and after intervention. There was neither clinical manifestation of vestibular dysfunction nor histological evidence of ototoxicity. Our study suggests that intratympanic 1.25% NAC with ciprofloxacin and dexamethasone is safe in guinea pigs and support its potential use in the treatment of chronically discharging ears. Further studies in humans are required to analyze its efficacy relative to conventional treatments. Animal Research. • 1.25% N-acetylcysteine with Ciprofloxacin 0.3%/Dexamethasone 0.1% was instilled to the middle ear of thirteen guinea pigs. • There was no significant change in the hearing, and no signs of vestibular dysfunction after four instillations of the experimental solution. • 1.25% N-acetylcysteine is safe in guinea pigs and can be potentially used to treat chronically discharging ears. [ABSTRACT FROM AUTHOR]

• Video Head Impulse tests of the vestibulo-ocular reflex (VOR) provided the best separation of vestibular neuritis (VN) from posterior circulation stroke (PCS). • Refixation saccade-analysis complemented VOR gain measures in differentiating VN from PCS. • Ocular VEMP (oVEMP) asymmetry demonstrated low sensitivity but high specificity as a marker of VN. To separate vestibular neuritis (VN) from posteriorcirculation stroke (PCS) using quantitative tests of canal and otolith function. Video Head-Impulse tests (vHIT) were used to assess all three semicircular canal pairs; vestibulo-ocular reflex (VOR) gain and saccade metrics were examined. Cervical and ocular-Vestibular-Evoked Myogenic Potentials (c- and oVEMP) and Subjective Visual Horizontal (SVH) were used to assess otolith function. For controls (n = 40), PCS (n = 22), and VN (n = 22), mean horizontal-canal VOR-gains were 0.96 ± 0.1, 0.85 ± 0.3 and 0.40 ± 0.2, refixation-saccade prevalence was 71.9 ± 41, 90.7 ± 57, 209.2 ± 62 per 100 impulses and cumulative-saccade amplitudes were 0.9 ± 0.4°, 2.4 ± 2.2°, 8.0 ± 3.5°. Abnormality-rates for cVEMP, oVEMP and SVH were 38%, 9%, 72% for PCS, and 43%, 50%, 91% for VN. A gain ≤0.68, refixation-saccade prevalence of ≥135% and cumulative-saccade amplitudes ≥5.3° separated VN from PCS with sensitivities of 95.5%, 95.5%, and 81.8%, and specificities of 68.2%, 86.4% and 95.5%. VOR-gain and saccade prevalence when combined, separated VN from PCS with a sensitivity and specificity of 90.9%. Abnormal oVEMP asymmetry-ratios were of low sensitivity (50%) but high specificity (90.9%) for separating VN from PCS. vHIT provided the best separation of VN from PCS. VOR-gain, refixation-saccade prevalence and amplitude were effective discriminators of VN from PCS. vHIT and oVEMP could assist early identification of the aetiology of Acute Vestibular Syndrome in the Emergency Room. [ABSTRACT FROM AUTHOR]

• There is a quantifiable vestibulo-ocular reflex suppression (VORS) measured using video head impulse test devices. • Visually enhanced vestibulo-ocular reflex and VORS test responses depend on head oscillation frequency. • Participant concentration during VORS testing has significant effect VORS magnitude. To investigate the main effects of some testing and analysis variables on clinically quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) results using video head impulse test. This prospective observational clinical study included 19 healthy participants who underwent the VVOR and VORS tests. The effect of demographic variables, head oscillation frequency, rotation direction, visual acuity and analysis time window width and location of the recorded tests on the quantified results of both VVOR and VORS were evaluated. And specifically, for the VORS test the effect of cognitive reinforcement of the participant during testing was evaluated. A statistically significant difference was observed among the VVOR, non-reinforced VORS, and reinforced VORS tests for mean gain values of 0.91 ± 0.09, 0.6 ± 0.15, and 0.57 ± 0.16, respectively (p < 0.001). The optimized linear mixed-effect model showed a significant influence of frequency on the gain values for the reinforced and non-reinforced VORS tests (p = 0.01 and p = 0.004, respectively). Regarding the gain analysis method, statistically significant differences were found according to the short time interval sample location of the records for the initial location of the VVOR test (p < 0.006) and final location of the reinforced VORS test (p < 0.023). Significant differences were observed in the gain values according to VVOR and VORS testing. Head oscillation frequency is a significant factor that affects the gain values, especially in VORS testing. Moreover, in VORS testing, participant concentration has a significant effect on the test for obtaining suppression gain values. When a short time interval sample is considered for VVOR and VORS testing, intermediate time samples appear the most adequate for both tests. The quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) tests have recently been added to the assortment of available clinical vestibular tests. However, despite the clinical validity of these quantified tests that appear to be of increasing clinical interest, the effects of most of the clinical testing methods and mathematical variables are not well defined. In this research we describe what are the main collecting and analysis variables that could influence to the VVOR and VORS tests. Specially for VORS test, participant concentration on test tasks will have positive effect on the measured vestibulo-ocular reflex (VOR) suppression. [ABSTRACT FROM AUTHOR]

A 55-year-old woman reported blurred vision while walking, numbness and tingling, contact allodynia, and gait imbalance. Visual acuity was 20/20 in both eyes, but there was a loss of 4 lines with horizontal dynamic visual acuity testing. Ocular motility examination demonstrated spontaneous downbeat nystagmus that increased in lateral gaze with a torsional component and impaired smooth pursuits. Head impulse test was positive, and electromyography demonstrated a sensory neuropathy/neuronopathy. Vestibular testing confirmed both central ocular motor pathway and bilateral peripheral vestibular system involvement. The constellation of clinical findings and paraclinical testing was consistent with a recently recognized neurodegenerative disorder termed cerebellar ataxia with neuropathy and vestibular areflexia syndrome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate whether the insertion of an implant into the cochlea is accompanied by a deterioration in otolith function. Cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) and linear vestibulo-ocular reflex (lVOR) during eccentric rotation were assessed before and after cochlear implantation (CI) to evaluate otolith function.Methods: Twelve patients with bilateral severe sensorineural hearing loss who had undergone CI surgery in our hospital between May 2016 and November 2017 were included in this study. cVEMP and oVEMP were assessed using the asymmetry ratio (AR), calculated with the following formula: [(peak-to-peak amplitude calculated as the sum of the p13 and n23 amplitudes in the non-operated side) - (that in the operated side)]/[(that in the non-operated side) + (that in the operated side)]. The ratio of VOR gain during eccentric rotation against VOR gain during center rotation was used to assess lVOR. For eccentric rotation, patients were rotated while displaced from the axis of rotation. At the same time, linear acceleration stimulated the utricle and induced lVOR. All patients underwent cVEMP and oVEMP tests and center and eccentric rotation tests before and about 30days after CI surgery.Results: Three patients with absent cVEMP responses before surgery were excluded, leaving pre-surgery cVEMP results for 9/12 patients. In five of these patients, the AR of cVEMP increased after CI, indicating that saccular function, as evaluated by cVEMP, did not deteriorate significantly postoperatively. One patient with an absent oVEMP response before CI was excluded, leaving pre-surgery oVEMP results for 11/12 patients. In 10 of these patients, the AR of oVEMP increased after CI surgery, indicating that utricular function, as evaluated by oVEMP, deteriorated significantly postoperatively. However, because the ratio of VOR gain during eccentric rotation against VOR gain during center rotation did not become worse after CI, utricular function, as evaluated by lVOR, did not deteriorate significantly postoperatively. Symptoms of vertigo became worse after CI in two of the 12 patients.Conclusion: CI does not cause a deterioration in saccular function, as evaluated by cVEMP. Although CI does cause a deterioration in utricular function in oVEMP tests, this is not consistent in lVOR tests. These results indicate that CI causes a slight deterioration in utricular function that is insufficient to cause vertigo or deterioration of lVOR. [ABSTRACT FROM AUTHOR]

• Cervical and ocular vestibular evoked myogenic potentials (cVEMPs, oVEMPs) in almost all cases of vestibular involvement can help both in diagnosis and in prognosis. • More research is needed to understand the applications of both c- and oVEMPs, especially the latter. • A significant percentage of published data have neglected one or more vital VEMP parameters. Cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs respectively) are now used by an increasing number of laboratories to evaluate otolith inner ear function and their pathways through the central nervous system. However, the literature is incomplete or unclear as to what information both c- and oVEMPs can add beyond what a good clinical examination can provide, and what other paramedical tests can provide also, and the present review aims to clarify what is known so far. The following review will describe what is known with regards to both c- and oVEMPs and their use. MEDLINE (accessed by PubMed, years 1994–2018) was searched with the following string: ("vestibular evoked myogenic potentials" [all fields]). Only articles published in English were evaluated. Both c- and oVEMPs are useful not only for confirming the presence of superior semicircular canal dehiscence (SSCD), but also for confirming the presence of acoustic neuromas when MRI is not available, bilateral vestibulopathies, inferior vestibular neuritis and vestibular dysfunction in inherited neuropathies. Further work is required, especially with respect to oVEMPs. The usefulness of both c- and oVEMPs goes beyond the confirmation of SSCDs, and is useful in many clinical cases. [ABSTRACT FROM AUTHOR]

• The eye simulation model is proposed by combining vestibule-ocular reflex and optokinetic reflex model. • The proposal eye simulation model works well with voluntary eye movement. • The cognitive distraction can estimate by using the mean square error between the simulated and observed eye movement. With the aim of developing a method for evaluating driver distraction based on the difference between simulated and observed eye movements, we integrated a vestibulo–ocular reflex (VOR) model and an optokinetic reflex (OKR) model. On the basis of 2 × 2 factorial design analysis (VOR model only and VOR+OKR model; with and without visual stimulus), we confirmed that the VOR+OKR model showed a better performance than the VOR model, with a smaller mean-square error. We also conducted an experiment that used an n -back task to simulate mental workload while driving. The mean-square error between the simulated and observed eye movement became larger in the presence of mental workload. This result suggests that the VOR+OKR model could be applied in the evaluation of driver distraction. [ABSTRACT FROM AUTHOR]

• Kennedy patients exhibit severe balance deficits in conditions of absent vision. • Horizontal vestibulo-ocular reflex function is preserved. • The balance impairment stems from a diminished somatosensory input. • Some Kennedy patients face difficulties in producing fast eye movements. Spinal and bulbar muscular atrophy (Kennedy's disease) has been associated with balance dysfunction and falls. However, postural control has not been studied quantitatively. Here, we quantified upright stance and aimed to disentangle the role of vestibular, proprioceptive and oculomotor deficits. Static balance was assessed in Kennedy patients (n = 7) during quiet stance on a force platform under different visual and proprioceptive feedback conditions. Vestibular function was assessed with the video head impulse test. Sural nerve neurography was employed to evaluate the severity of peripheral neuropathy. Also, horizontal saccades were recorded and quantified by the main sequence relationship. Posturographic analyses revealed significantly increased body sway, more pronounced in conditions with closed eyes, which was also reflected in the calculated Romberg indices. Horizontal vestibulo-ocular reflex gains were normal, i.e. > 0.75. In contrast, compound sensory nerve action potentials were markedly decreased in all patients (mean = 2.4 μV). Two patients showed slow saccades with increased exponential main sequence constants. We conclude that Kennedy patients exhibit severe deficits in quiet stance. Postural instability is greatest in conditions of absent vision with reduced proprioception being the main determinant of unsteadiness. Some patients show slowed saccadic eye movements suggesting a nuclear abducens neuronopathy. [ABSTRACT FROM AUTHOR]

• Repetitive oVEMPs reliably differentiate MG patients from controls. • Inferior oblique muscle recordings at 30 Hz were most sensitive and specific. • At higher repetition rates, the decrement occurred with later stimulus repetitions. To determine the most effective stimulation parameters for the diagnosis of ocular myasthenia gravis (MG) using repetitive ocular vestibular evoked myogenic potentials (oVEMP) for quantification of the extraocular muscle response decrement. Repetitive bone-conducted oVEMPs were elicited in 18 MG patients and 20 healthy subjects. We compared four different stimulus repetition rates (20 Hz, 30 Hz, 40 Hz, 50 Hz) and 100 Hz continuous stimulation, as well as recordings from the inferior oblique muscles and the lateral rectus muscles to determine the most sensitive and specific oVEMP parameters for decrement detection. Repetitive stimulation at all tested repetition rates with recordings from inferior oblique muscles allowed for effective differentiation between MG patients and healthy subjects. Among all repetition rates, 30 Hz showed a trend towards superiority, with a sensitivity of 71% and a specificity of 94% (area under the curve (AUC) 0.88) when using the smaller decrement of the two eyes and −10% as cutoff. Considering the larger decrement for analysis (−9% as cutoff), sensitivity increased to 82%, but specificity decreased to 78% (AUC 0.81). Our study demonstrates, that repetitive oVEMP stimulation elicits a robust decrement in the inferior oblique muscles of MG patients at repetition rates between 20 Hz and 50 Hz, with a probable optimum at 30 Hz. Repetitive inferior oblique oVEMP stimulation with optimal stimulus parameters facilitates early and accurate diagnosis of ocular MG. [ABSTRACT FROM AUTHOR]

• Participants were rotated with displacement from the axis of rotation. • Eye movements were analyzed three-dimensionally. • Recognition of the direction of centripetal acceleration was analyzed. This study was conducted to evaluate the linear vestibulo-ocular reflex (lVOR) mediated by the saccule, and to investigate the relationship between the lVOR and the ability to distinguish the direction of centripetal acceleration during centric and eccentric rotation. Participants sat on a chair in darkness, with the right ear facing downwards, either directly above the center of rotation, or with their nose out, nose in, right shoulder out, or left shoulder out against the center of rotation (eccentric rotation). Participants were given no information about the chair position, and were rotated sinusoidally at 0.1–0.7 Hz. Three-dimensional eye movements during rotation were analyzed. Participants were asked to describe the position of the chair after rotation. Correctly reporting the five possible chair positions requires recognition of the direction of centripetal acceleration. We analyzed the rate of correct answers to assess participants' ability to identify the direction of centripetal acceleration. lVOR mediated by the saccule was observed only at high rotational frequencies. The rate of correct answers was higher at high rotational frequencies than that at low rotational frequencies. These results indicate that high rotational frequency is important for both lVOR mediated by the saccule and distinguishing the direction of centripetal acceleration. [ABSTRACT FROM AUTHOR]

Locomotion involves complex combinations of translational and rotational head movements. For gaze stability, this necessitates the interplay of angular and linear vestibulo-ocular reflexes (VOR) as well as the integration of visual feedback about the desired viewing distance. Furthermore, gaze stabilizing systems must be able to cope with vast differences in head motion brought about by changing locomotor speeds and patterns (walking vs. running). The present study investigated horizontal and vertical angular VOR (aVOR) and linear gaze stabilization (lGS) as well as compensation for linear head movements by angular counter rotation of the head during treadmill walking and running at different velocities (0.4 to 2.4 m/s) while fixating either a close (0.5 m) or distant (2.0 m) target. In the horizontal plane, the aVOR predominated throughout all locomotor speeds, whereas the compensation of linear translations was highly variable and generally insufficient. In contrast, in the vertical plane, eye and angular head motion steadily became more in phase with increasing locomotor speed, which served to optimize linear motion compensation. Furthermore, the timing of the vertical aVOR became more automated and independent of visual feedback during faster locomotion. Thus, horizontal and vertical gaze stabilization strategies appear to be considerably different. Whereas horizontal gaze control is likely governed by passive sensorimotor reflexes throughout all locomotor speeds, vertical gaze stabilization switches to an automated feed-forward control at faster locomotion. This switch is presumably driven by efference copies from spinal locomotor commands that were previously shown to govern gaze stabilization in animal models during stereotypic locomotion. • Gaze stabilization during locomotion depends on locomotor speed, dimension, and target distance. • Gaze stabilization in the horizontal dimension is mediated by sensory feedback independent of locomotor speed. • In contrast, gaze stabilization in the vertical plane undergoes a major transformation from slow to fast locomotion. • These changes in vertical gaze stabilization are presumably governed by feed-forward signals from the locomotor command. [ABSTRACT FROM AUTHOR]

The orientation of human eyes is uniquely defined with respect to their gaze direction, known as Donders' law. Further, the manner in which the eyes follow Donders' law varies as a function of the situation. When the head is stationary, the Donders' surfaces are flat planes but they tilt when eye fixation distance changes. These planes also shift and rotate when head orientation changes with respect to the direction of gravito-inertial acceleration. When the head is free to rotate, the Donders' surfaces are twisted. In this paper, we present a systematic method to analyze the kinematics of the eye under different gaze situations utilizing the measurement of alignment between various coordinate frames. Kinematic equations are presented for various eye movements ranging from simple head-fixed monocular shifts of eye gaze to complex eye-head shifts of gaze. At each stage, we show that simulated eye orientations that derived from our equations are able to capture the variations of Donders' surfaces and they are comparable with experimental results in the literature. The final equations we propose provide the unified kinematics of head-upright far gaze, head-upright binocular fixation, head static tilted monocular gaze and head-free monocular gaze. [ABSTRACT FROM AUTHOR]

Abstract Objective We aimed to describe vestibular/oculomotor function of 7–12-year-old children with CP, Gross Motor Function Classification System (GMFCS) levels (I-III), in comparison to an age-matched control group to understand the effect of the vestibular system on activities and participation of children with CP. Methods Vestibular, oculomotor and balance function were tested in children with CP. Central and peripheral vestibular function was examined using an enclosed rotary chair and infrared video goggles (100 Hz) that measured eye movements. Oculomotor tests included smooth pursuit and optokinetic nystagmus (OKN). Vestibulo-Ocular Reflex (VOR) tests, done in complete darkness, included step rotation (STEP), sinusoidal harmonic acceleration (SHA) test, VOR cancellation and enhancement, and subjective visual vertical and horizontal (SVV/SVH). The integrity of the saccule was tested with the Cervical Vestibular Evoked Myogenic Potential. If able, the participants' balance abilities were examined using the Sensory Organization Test (SOT) to determine ability to maintain standing balance during six conditions that challenged the visual, somatosensory and vestibular systems. Independent t-tests and Mann-Whitney U tests were used to compare results between groups. Results Forty-one children with CP (mean age = 9.44 years, SD = 1.66; 23F/18M; Gross Motor Function Classification System levels: I (n = 19), II (n = 7), III (n = 15) and thirty-three typically developing (TD) children (mean age = 10.16 years, SD = 1.6; 13F/20M) were recruited from the Birmingham, AL community. There was no significant difference between children with CP and TD children in saccular function (i.e. C-VEMP test), and peripheral vestibular end organ (i.e. SHA test and STEP test), VOR enhancement, or OKN gain. Velocity gain for horizontal smooth pursuit was significantly worse in children with CP (p = 0.009), compared to TD children. Poor mediation of central vestibular function were that evident with significantly higher VOR cancellation gain in children with CP (p < 0.0001), compared to TD children and significantly higher SVV variance (p = 0.002), SVH mean (p = 0.001), and SVH variance (p < 0.0001) in children with CP compared to TD children. Compromised balance abilities in children with CP was evident with significantly lower composite scores (p < 0.0001), vestibular ratio (p < 0.0001), and visual ratio (p = 0.021). The somatosensory ratio (p = 0.798) of children with CP was similar to children with TD. Conclusions Although peripheral vestibular function was intact, children with CP had difficulty coupling eye and head movement (VOR cancellation), using the vestibular system for postural control (SOT), demonstrated poor perception of upright (SVV/SVH), and had difficulty following a slow moving target (smooth pursuit eye movement). These results implicate a central vestibular and oculomotor function impairment the severity of which corresponded with severity of the level of CP. [ABSTRACT FROM AUTHOR]

Highlights • Surgery-free VOR measurement that allows screen for genes and drugs affecting vestibular function has been enabled. • Daily-progression profile of the vestibular impairment caused by IDPN at different dose levels has been obtained. • Mice with homozygous mutations of Lhfpl5 and Cdh23 have been identified based on their reduced VOR-response levels. Abstract Vestibulo-ocular reflex (VOR) responding to acceleration stimuli is originated from the vestibular apparatuses and thus widely used as an in vivo indicator of the vestibular function. We have developed a vestibular function testing (VFT) system that allows to evaluate VOR response with improved efficiency. The previously required surgical procedure has been avoided by using a newly designed animal-immobility setup. The efficacy of our VFT system was demonstrated on the mice with vestibular abnormalities caused by either genetic mutations (Lhfpl5−/− or Cdh23−/−) or applied vestibulotoxicant (3,3′-iminodipropionitrile, IDPN). Daily longitudinal inspection of the VOR response in the IDPN-administered mice gives the first VOR-based daily-progression profile of the vestibular impairment. The capability of VOR in quantifying the severity of toxicant-induced vestibular deficits has been also demonstrated. The acquired VOR-measurement results were validated against the corresponding behavioral-test results. Further validation against immunofluorescence microscopy was applied to the VOR data obtained from the IDPN-administered mice. We conclude that the improved efficiency of our surgery-free VFT system, firstly, enables the characterization of VOR temporal dynamics and quantification of vestibular-impairment severity that may reveal useful information in toxicological and/or pharmaceutical studies; and, secondly, confers our system promising potential to serve as a high-throughput screener for identifying genes and drugs that affect vestibular function. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Trial-to-trial VOR variability increased with chair velocities between ∼1°/s and 65°/s. • Trial-to-trial VOR variability exhibited a stimulus-independent range below ∼1°/s. • VOR and perceptual imprecision were similar over a range of stimulus velocities. • Velocity was the salient cue for VOR variability for our range of motion stimuli. Abstract The vestibular system enables humans to estimate self-motion, stabilize gaze and maintain posture, but these behaviors are impacted by neural noise at all levels of processing (e.g., sensory, central, motor). Despite its essential importance, the behavioral impact of noise in human vestibular pathways is not completely understood. Here, we characterize the vestibular imprecision that results from neural noise by measuring trial-to-trial vestibulo-ocular reflex (VOR) variability and perceptual just-noticeable differences (JNDs) in the same human subjects as a function of stimulus intensity. We used head-centered yaw rotations about an Earth-vertical axis over a broad range of motion velocities (0–65°/s for VOR variability and 3–90°/s peak velocity for JNDs). We found that VOR variability increased from approximately 0.6°/s at a chair velocity of 1°/s to approximately 3°/s at 65°/s; it exhibited a stimulus-independent range below roughly 1°/s. Perceptual imprecision ("sigma") increased from 0.76°/s at 3°/s to 4.7°/s at 90°/s. Using stimuli that manipulated the relationship between velocity, displacement and acceleration, we found that velocity was the salient cue for VOR variability for our motion stimuli. VOR and perceptual imprecision both increased with stimulus intensity and were broadly similar over a range of stimulus velocities, consistent with a common noise source that affects motor and perceptual pathways. This contrasts with differing perceptual and motor stimulus-dependent imprecision in visual studies. Either stimulus-dependent noise or non-linear signal processing could explain our results, but we argue that afferent non-linearities alone are unlikely to be the source of the observed behavioral stimulus-dependent imprecision. [ABSTRACT FROM AUTHOR]

Highlights • Brainstem neural circuits for horizontal and vertical saccades. • Reciprocity between upward and its contralateral downward saccade systems. • Similarity of well-known vestibuloocular and saccade generating pathways. • The saccade system and the VOR system share common semicircular canal coordinate. • Commissural inhibition of two superior colliculi supports canal coordinate hypothesis. Abstract Sensory signals for eye movements (visual and vestibular) are initially coded in different frames of reference but finally translated into common coordinates, and share the same final common pathway, namely the same population of extraocular motoneurons. From clinical studies in humans and lesion studies in animals, it is generally accepted that voluntary saccadic eye movements are organized in horizontal and vertical Cartesian coordinates. However, this issue is not settled yet, because neural circuits for vertical saccades remain unidentified. We recently determined brainstem neural circuits from the superior colliculus to ocular motoneurons for horizontal and vertical saccades with combined electrophysiological and neuroanatomical techniques. Comparing well-known vestibuloocular pathways with our findings of commissural excitation and inhibition between both superior colliculi, we proposed that the saccade system uses the same frame of reference as the vestibuloocular system, common semicircular canal coordinate. This proposal is mainly based on marked similarities (1) between output neural circuitry from one superior colliculus to extraocular motoneurons and that from a respective canal to its innervating extraocular motoneurons, (2) of patterns of commissural reciprocal inhibitions between upward saccade system on one side and downward system on the other, and between anterior canal system on one side and posterior canal system on the other, and (3) between the neural circuits of saccade and quick phase of vestibular nystagmus sharing brainstem burst neurons. In support of the proposal, commissural excitation of the superior colliculi may help to maintain Listing's law in saccades in spite of using semicircular canal coordinate. [ABSTRACT FROM AUTHOR]

Background: Individuals with Rett syndrome (RTT) are notoriously reliant on the use of eye gaze as a primary means of communication. Underlying an ability to communicate successfully via eye gaze is a complex matrix of requirements, with an intact oculomotor system being just one element. To date, the underlying neural and motor pathways associated with eye gaze are relatively under-researched in RTT.Purpose: This study was undertaken to plug this gap in knowledge and to further the understanding of RTT in one specific area of development and function, namely oculomotor function.Material and Methods: The eye movements of 18 girls and young women with RTT were assessed by electronystagmography (ENG). This tested their horizontal saccadic and smooth pursuit eye movements as well as optokinetic nystagmus and vestibulo-ocular reflex. Their results were compared with normative data collected from 16 typically developing children and teenagers.Results: Overall, the individuals with RTT demonstrated a range of eye movements on a par with their typically developing peers. However, there were a number of difficulties in executing the ENG testing with the RTT cohort which made quantitative analysis tricky, such as reduced motivation and attention to test materials and low-quality electrode signals.Conclusions: This study suggests that individuals with RTT have an intact oculomotor system. However, modifications should be made to the ENG assessment procedure to combat problems in testing and add strength to the results. Further investigation into these testing difficulties is warranted in order to inform such modifications. [ABSTRACT FROM AUTHOR]

Background and purpose Lateral medullary infarction (LMI) sometimes causes long-lasting dizziness. Although the precise mechanism of chronic post-LMI dizziness is unknown, a cerebellar control disorder of the vestibulo-ocular reflex (VOR) has been reported in such patients. We conducted a proof-of-principle cohort study to assess the potential efficacy of cerebellar repetitive transcranial magnetic stimulation (rTMS) as treatment for chronic post-LMI dizziness. Methods We first applied cerebellar rTMS in healthy volunteers (n = 11) and showed that cerebellar intermittent theta burst stimulation (iTBS) affected vestibulocerebellar neural activity. Then, between September and December 2015, we enrolled six patients (aged≥20 years) with chronic post-LMI dizziness (duration≥6 months), applied cerebellar rTMS (iTBS for 5 days), and followed these patients up for up to 25 months for clinical symptoms (Dizziness Handicap Inventory [DHI]), signs (nystagmus), and VOR gain. Results Four of the six patients completed the study without complications. After rTMS, DHI scores were reduced (mean pre-rTMS DHI score minus post-rTMS DHI score was 13.0 [P = 0.036]) with disappearance of the ipsilesional nystagmus characteristic of the post-LMI dizziness. Reduction in the absolute VOR gain (mean pre- rTMS gain minus post-rTMS gain in the ipsilesional direction was 0.135 [P = 0.036] and that in the contralesional direction was 0.137 [P = 0.031]) were also associated with reduced DHI scores. Relative cerebellar blood flow to the brainstem was increased in four of five patients. The effects of cerebellar rTMS did not always persist, and three of four patients elected to undergo more than one rTMS series. The repeat cerebellar rTMS treatments had same beneficial effects. Conclusion Our study showed, for the first time, the potential efficacy of cerebellar rTMS for treatment of chronic post-LMI dizziness. The short duration of the cerebellar rTMS effects can be compensated for by repeating the rTMS treatment every few months. Further large-scale randomized studies are warranted to confirm our findings. [ABSTRACT FROM AUTHOR]

P2X 2 receptors are ligand-gated cation channels activated by extracellular ATP that modulate neural transmission in various neuronal systems. Although the function and distribution of P2X 2 receptors in the cochlea portion of the inner ear are well established, their physiological role in the vestibular portion is still not understood. Therefore, we investigated P2X 2 receptor localization in the peripheral vestibular portion, and assessed their physiological function in vivo using P2X 2 receptor knock out (P2X 2 -KO) mice. Histological analysis revealed that P2X 2 receptors were localized on the epithelial surface of supporting and transitional cells of the vestibular end organs. To examine vestibular function in P2X 2 -KO mice, we conducted behavioral tests and tested the vestibulo-ocular reflex (VOR) during sinusoidal rotations. P2X 2 -KO mice exhibited significant motor balance impairment in the balance beam test. VOR gain in P2X 2 -KO mice was significantly reduced, with no decrease in the optokinetic response. In conclusion, we showed that P2X 2 receptors are mainly localized in the supporting cells of the vestibular inner ear, and the loss of P2X 2 receptors causes mild vestibular dysfunction. Taken together, our findings suggest that the P2X 2 receptor plays a modulatory role in vestibular function. [ABSTRACT FROM AUTHOR]

Chronic occupational exposure to carbon disulfide (CS2) has debilitating motor and sensory effects in humans, which can increase the risk of falls. Although no mention of vestibulotoxic effects is contained in the literature, epidemiological and experimental data suggest that CS2 could cause low-frequency hearing loss when associated with noise exposure. Low-frequency noise might also perturb the peripheral balance receptor through an as-yet unclear mechanism. Here, we studied how exposure to a low-frequency noise combined with 250-ppm CS2 affected balance in rats. Vestibular function was tested based on post-rotary nystagmus recorded by a video-oculography system. These measurements were completed by behavioral tests and analysis of the cerebellum to measure expression levels for gene expression associated with neurotoxicity. Assays were performed prior to and following a 4-week exposure, and again after a 4-week recovery period. Functional measurements were completed by histological analyses of the peripheral organs.Nystagmus was unaltered by exposure to noise alone, while CS2 alone caused a moderate 19% decrease of the saccade number. In contrast, coexposure to 250-ppm CS2 and low-frequency noise decreased both saccade number and duration by 33% and 34%, respectively. After four weeks, recovery was only partial but measures were not significantly different from pre-exposure values. Real-time quantitative polymerase chain reaction (RT-qPCR) analysis of cerebellar tissue revealed a slight but significant modification in expression levels for two genes linked to neurotoxicity in CS2-exposed animals. However, neither histopathological changes to the peripheral receptor nor behavioral differences were observed. Based on all these results, we propose that the effects of CS2 were due to reversible neurochemical disturbance of the efferent pathways managing post-rotatory nystagmus. Because the nervous structures involving the vestibular function appear particularly sensitive to CS2, post-rotary nystagmus could be used as an early, non-invasive measurement to diagnose CS2 intoxication as part of an occupational conservation program. [ABSTRACT FROM AUTHOR]

Physiological methods that can be similarly recorded in humans and animals have a major role in sensory toxicology, as they provide a bridge between human sensory perception data and the molecular and cellular data obtained in animal studies. Vestibular toxicity research lags well behind other sensory systems in many aspects, including the availability of methods for functional assessment in animals that could be robustly translated to human significance. Here we review the methods available for the assessment of vestibular function in both humans and laboratory animals, with an emphasis on their similarity or divergence, to highlight their potential utility for the predictive assessment of vestibular toxicity. [ABSTRACT FROM AUTHOR]

Purpose Chronic tinnitus is a common symptom after cerebellopontine angle (CPA) tumor removal. Sometimes, the tinnitus is gaze-modulated. In that case, patients can change the loudness or pitch of their tinnitus by ocular movements. During tumor removal by a retrosigmoid craniotomy, the cerebellar flocculus is manipulated by the surgical approach to access the tumor. The flocculus has been associated with tinnitus in rats, and is involved in eye-gaze control. This suggests that the flocculus may have a role in gaze-modulated tinnitus after CPA tumor removal. In order to investigate this hypothesis, the relation between the flocculus volume and the characteristics of postoperative tinnitus was studied. Results A single-center cohort of 51 patients completed a questionnaire after CPA tumor removal. The questionnaire asked for the effect of eye movements on tinnitus and included the Tinnitus Functional Index (TFI). Tinnitus was present in 36 patients (71% of 51), of which 29 (81% of 36) described gaze-modulation. The median TFI was 22 (range 0–85). A postoperative MRI-scan of sufficient quality was available in 34 cases. The volumes of the (para)flocculi ipsilateral and contralateral to the surgery, and the ratio of these volumes were similar between patients with and without tinnitus. The TFI correlated with the volume of both ipsi- and contralateral (para)flocculus (r s (23) = .516, p  = .008 and r s (23) = .430, p  = .032). The ipsilateral-to-contralateral volume ratio of the (para)flocculi volumes was significantly lower in patients that could modulate the loudness of their tinnitus by eye gaze, compared to patients that could not ( t (23) = 3.337, p  = .003). Conclusions The lack of a relation between flocculus volumes and the presence of tinnitus, combined with the significant correlation between tinnitus severity and flocculus volumes, suggests that the flocculus may not be the primary source of tinnitus, but is likely to mediate tinnitus severity. The reduced ipsi-to-contralateral volume ratio in patients with gaze-modulated tinnitus suggests that atrophy of the flocculus on the surgery side triggers cross-modal interactions leading to modulation of tinnitus. [ABSTRACT FROM AUTHOR]

Objective: In this retrospective study the aim of the authors was to examine the effect of gentamicin on the individual semicircular canals after low dose, single injection intratympanal gentamicin therapy in Meniere's disease.Methods: Data of 32 patients treated between 2011 and 2015 were collected. The high frequency, high acceleration vestibuloocular reflex (VOR) gain was measured in the individual semicircular canals using video head impulse test immediately before the first intratympanal gentamicin instillation and approximately two months later.Results: In all cases 'AAO-HNS Class A' vertigo control could be attained at least for several months. In 13 cases only one instillation was necessary. In the other 19 cases the attacks returned after a few months. In 11 cases the injection had to be repeated a second time, in 4 cases 3 injections, in 2 cases 4, in 1 case 5 injections and in another 6 injections were necessary. The initial VOR gain was normal in all cases and two months after one injection it decreased in average by 40% in a highly significant manner. However, there were cases in which, although the patients became free of attacks, the gain values remained normal.Conclusion: It was possible to demonstrate a significant correlation between the gain decrease of the individual canals. There was no prognostic correlation between the initial gain decrease after the first injection and the necessity of further injections. Gain values also decreased slightly but significantly in the lateral and posteriors canals on the contralateral, untreated side, possibly because of the missing disfacilitation from the treated side. [ABSTRACT FROM AUTHOR]

Background Eye movements evoked by electrical vestibular stimulation (EVS) offer potential for diagnosing vestibular dysfunction. However, ocular recording techniques are often too invasive or impractical for routine clinical use. Furthermore, the kinematic nature of the EVS signal is not fully understood in terms of movement sensations. New method We apply sinusoidal EVS stimuli varying from 0.05 to 20 Hz, and record the eye in darkness using an infrared camera. Eye movement was measured offline using commercially available software to track iris striations. Response gain and phase were calculated separately for eye position, velocity and acceleration across all frequencies, to determine how the brain interprets the EVS signal. Results Ocular torsion responses were observed at the same frequency as the stimulus, for all frequencies, while lateral/vertical responses were minimal or absent. Response gain and phase resembled previously reported responses to natural rotation, but only when analysing eye velocity, not position or acceleration. Comparison with existing method(s) Our method offers a simple, affordable, reliable and non-invasive method for tracking the ocular response to EVS. It is more convenient than scleral coil recordings, or marking the sclera to aid video tracking. It also allows us to assess the torsional VOR at frequencies not possible with natural stimuli. Conclusions Ocular torsion responses to EVS can be readily assessed using sinusoidal stimuli combined with an infrared camera. Gain and phase analysis suggests that the central nervous system interprets the stimulus as head roll velocity. Future work will assess the diagnostic potential for patients with vestibular disorders. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the lateralization value of video head-impulse test (vHIT) for the diagnosis of vestibulopathy and to analyze cases showing dissociated results with caloric test.Methods: In total, 19 healthy volunteers and 92 dizzy patients who underwent both a caloric test and a vHIT were enrolled. Patients were divided into two groups depending on their fluctuating pattern of vertigo. The vestibulo-ocular reflex (VOR) gain and gain asymmetry (GA) of a vHIT as well as unilateral weakness (UW) and the sum of the slow-phase velocities (SPVs) of warm and cold irrigation of the same side were compared. A cutoff value of VOR gain of a vHIT was also calculated using a receiver-operating characteristic curve.Results: A VOR gain in an affected ear and GA of a vHIT showed a statistically significant correlation with UW in a caloric test. The cutoff value of a vHIT was determined to be 0.875, derived under the assumption that UW of a caloric test ≤25% is normal. However, the parameters of the two tests were dissociated in 18%.Conclusion: A VOR gain of vHIT is a valuable objective parameter with a lateralization value determining vestibular hypofunction. However, considering substantial dissociation between a vHIT and a caloric test, these tests can be complementary tools for the lateralization of vestibular impairment for the comprehensive evaluation of patients' VOR. [ABSTRACT FROM AUTHOR]