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Recent advances in the diagnosis and treatment of balance disorders

  • Medical Progress in the Journal of Neurology
  • Published:
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Abstract

Here we summarize the recent progress made in the diagnosis and treatment of balance and gait disorders. Focusing on work published in the Journal of Neurology in 2010 and 2011, we have found evidence for the following clinically relevant statements: (1) the exclusion of stroke in acute vestibular syndromes is based on the bedside clinical findings; (2) the risk of developing secondary somatoform vertigo is predictable; it is especially high in patients with vestibular migraine; (3) postural imbalance and falls in Parkinson syndromes are related to dysfunction of the cholinergic midbrain thalamic axis; (4) aminopyridines improve a variety of cerebellar parameters including central nystagmus and gait variability.

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Abbreviations

4-AP:

4-Aminopyridine

AVS:

Acute vestibular syndrome

EA-2:

Episodic ataxia type 2

MRI:

Magnetic resonance imaging

PD:

Parkinson’s disease

PSP:

Progressive supranuclear palsy

SSV:

Secondary somatoform vertigo

VM:

Vestibular migraine

References

  1. Ahn BY, Bae JW, Kim DH, Choi KD, Kim HJ, Kim EJ (2010) Pseudovestibular neuritis associated with isolated insular stroke. J Neurol 257:1570–1572

    Article  PubMed  Google Scholar 

  2. Baier B, Dieterich M (2011) Incidence and anatomy of gaze-evoked nystagmus in patients with cerebellar lesions. Neurol 76:361–365

    Article  Google Scholar 

  3. Bassani R, Della TS (2011) Positional nystagmus reversing from geotropic to apogeotropic: a new central vestibular syndrome. J Neurol 258:313–315

    Article  PubMed  Google Scholar 

  4. Brandt T, Strupp M, Novozhilov S, Krafczyk S (2011) Artificial neural network posturography detects the transition of vestibular neuritis to phobic postural vertigo. J Neurol 258(7):1385–1388

    Article  Google Scholar 

  5. Bronstein AM, Golding JF, Gresty MA, Mandala M, Nuti D, Shetye A, Silove Y (2010) The social impact of dizziness in London and Siena. J Neurol 257:183–190

    Article  PubMed  Google Scholar 

  6. Chen L, Lee W, Chambers BR, Dewey HM (2011) Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit. J Neurol 258:855–861

    Article  PubMed  CAS  Google Scholar 

  7. Cummins G, O’Hare A, Dunne R, Connolly S, O’Rourke K, Lynch T (2011) “Sixteen and a half”: a novel pontine neuro-ophthalmological syndrome. J Neurol 258:1347–1348

    Article  PubMed  CAS  Google Scholar 

  8. Dietz V (2011) Quadrupedal coordination of bipedal gait: implications for movement disorders. J Neurol 258:1406–1412

    Article  PubMed  Google Scholar 

  9. Ferraye MU, Debu B, Fraix V, Krack P, Charbardes S, Seigneuret E, Benabid AL, Pollak P (2011) Subthalamic nucleus versus pedunculopontine nucleus stimulation in Parkinson disease: synergy or antagonism? J Neural Transm 118:1469–1475

    Article  PubMed  CAS  Google Scholar 

  10. Flet L, Polard E, Guillard O, Leray E, Allain H, Javaudin L, Edan G (2010) 3, 4-diaminopyridine safety in clinical practice: an observational, retrospective cohort study. J Neurol 257:937–946

    Article  PubMed  CAS  Google Scholar 

  11. Goodman AD, Brown TR, Edwards KR, Krupp LB, Schapiro RT, Cohen R, Marinucci LN, Blight AR (2010) A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Ann Neurol 68:494–502

    Article  PubMed  CAS  Google Scholar 

  12. Griffin HJ, Greenlaw R, Limousin P, Bhatia K, Quinn NP, Jahanshahi M (2011) The effect of real and virtual visual cues on walking in Parkinson’s disease. J Neurol 258:991–1000

    Article  PubMed  CAS  Google Scholar 

  13. Hirano S, Shinotoh H, Shimada H, Aotsuka A, Tanaka N, Ota T, Sato K, Ito H, Kuwabara S, Fukushi K, Irie T, Suhara T (2010) Cholinergic imaging in corticobasal syndrome, progressive supranuclear palsy and frontotemporal dementia. Brain 133:2058–2068

    Article  PubMed  Google Scholar 

  14. Jeong SH, Oh SY, Kim HJ, Koo JW, Kim JS (2010) Vestibular dysfunction in migraine: effects of associated vertigo and motion sickness. J Neurol 257:905–912

    Article  PubMed  Google Scholar 

  15. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE (2009) HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 40:3504–3510

    Article  PubMed  Google Scholar 

  16. Kishi M, Sakakibara R, Nomura T, Yoshida T, Yamamoto M, Kataoka M, Ogawa E, Tateno F (2011) Lateral medullary infarction presenting as isolated vertigo and unilateral loss of visual suppression. Neurol Sci

  17. Lord S, Baker K, Nieuwboer A, Burn D, Rochester L (2011) Gait variability in Parkinson’s disease: an indicator of non-dopaminergic contributors to gait dysfunction? J Neurol 258:566–572

    Article  PubMed  Google Scholar 

  18. Mak MK, Pang MY (2010) Parkinsonian single fallers versus recurrent fallers: different fall characteristics and clinical features. J Neurol 257:1543–1551

    Article  PubMed  Google Scholar 

  19. Moro E, Hamani C, Poon YY, Al-Khairallah T, Dostrovsky JO, Hutchison WD, Lozano AM (2010) Unilateral pedunculopontine stimulation improves falls in Parkinson’s disease. Brain 133:215–224

    Article  PubMed  Google Scholar 

  20. Sander T, Sprenger A, Marti S, Naumann T, Straumann D, Helmchen C (2011) Effect of 4-aminopyridine on gravity dependence and neural integrator function in patients with idiopathic downbeat nystagmus. J Neurol 258:618–622

    Article  PubMed  CAS  Google Scholar 

  21. Schniepp R, Wuehr M, Ackl N, Danek A, Brandt T, Strupp M, Jahn K (2011) 4-Aminopyridine improves gait variability in cerebellar ataxia due to CACNA 1A mutation. J Neurol 258(9):1708–1711

    Article  PubMed  Google Scholar 

  22. Stamelou M, Knake S, Oertel WH, Hoglinger GU (2011) Magnetic resonance imaging in progressive supranuclear palsy. J Neurol 258:549–558

    Article  PubMed  CAS  Google Scholar 

  23. Strupp M, Kalla R, Claassen J, Adrion C, Mansmann U, Klopstock T, Freilinger T, Neugebauer H, Spiegel R, Dichgans M, Lehmann-Horn F, Jurkat-Rott K, Brandt T, Jen JC, Jahn K (2011) A randomized trial of 4-aminopyridine in EA2 and related familial episodic ataxias. Neurol 77:269–275

    Article  CAS  Google Scholar 

  24. Strupp M, Thurtell MJ, Shaikh AG, Brandt T, Zee DS, Leigh RJ (2011) Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. J Neurol 258:1207–1222

    Article  PubMed  CAS  Google Scholar 

  25. Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE (2011) Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 183:E571–E592

    Article  PubMed  Google Scholar 

  26. Thomas AA, Rogers JM, Amick MM, Friedman JH (2010) Falls and the falls efficacy scale in Parkinson’s disease. J Neurol 257:1124–1128

    Article  PubMed  Google Scholar 

  27. Tschan R, Best C, Beutel ME, Knebel A, Wiltink J, Dieterich M, Eckhardt-Henn A (2011) Patients’ psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease. J Neurol 258:104–112

    Article  PubMed  Google Scholar 

  28. Verghese J, Ambrose AF, Lipton RB, Wang C (2010) Neurological gait abnormalities and risk of falls in older adults. J Neurol 257:392–398

    Article  PubMed  Google Scholar 

  29. Weiss D, Breit S, Wachter T, Plewnia C, Gharabaghi A, Kruger R (2011) Combined stimulation of the substantia nigra pars reticulata and the subthalamic nucleus is effective in hypokinetic gait disturbance in Parkinson’s disease. J Neurol 258:1183–1185

    Article  PubMed  Google Scholar 

  30. Werner WG, Gentile AM (2010) Improving gait and promoting retention in individuals with Parkinson’s disease: a pilot study. J Neurol 257:1841–1847

    Article  PubMed  Google Scholar 

  31. Zwergal A, la FC, Lorenzl S, Rominger A, Xiong G, Deutschenbaur L, Linn J, Krafczyk S, Dieterich M, Brandt T, Strupp M, Bartenstein P, Jahn K (2011) Postural imbalance and falls in PSP correlate with functional pathology of the thalamus. Neurol 77:101–109

    Article  CAS  Google Scholar 

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Acknowledgment

The authors thank Judy Benson for copy editing the manuscript.

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Correspondence to Klaus Jahn.

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Jahn, K., Dieterich, M. Recent advances in the diagnosis and treatment of balance disorders. J Neurol 258, 2305–2308 (2011). https://doi.org/10.1007/s00415-011-6286-4

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  • DOI: https://doi.org/10.1007/s00415-011-6286-4

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