Brain, Vol 120, Issue 9 1659-1673, Copyright © 1997 by Oxford University Press
V Sakellari, AM Bronstein, S Corna, CA Hammon, S Jones and CJ Wolsley
The effect of hyperventilation on postural balance was investigated.
Voluntary hyperventilation increased body sway in normal subjects,
particularly in the sagittal plane. The possibility that this
hyperventilation-induced unsteadiness is due to interference with lower
limb somatosensory input, vestibular reflexes or cerebellar function was
assessed. (i) The effect of hyperventilation on peripheral compound sensory
action potentials (SAPs) and somatosensory evoked potentials (SEPs)
(recorded centrally, from the scalp) elicited by electrical stimulation of
the sural nerve was measured in six normal adults. A reduction in the scalp
SEP amplitude and an increase in the peripheral SAP amplitude were observed
during hyperventilation, which reversed during the recovery period. These
changes indicate increased peripheral neural excitability which could lead
to a higher level of ectopic activity; the latter would interfere with
central reception of peripheral input. (ii) The click-evoked
vestibulo-collic reflex was recorded to study the effect of
hyperventilation on vestibulo-spinal activity. EMG recordings from both
sternocleidomastoid muscles of six healthy subjects were made in response
to loud clicks presented to either ear. Neither the amplitude nor the
latency of the response were altered significantly by hyperventilation.
(iii) Eye-movement recordings were obtained in the six normal subjects to
assess the effect of hyperventilation on the vestibulo-ocular reflex and
its visual suppression, the latter being a function largely mediated by the
cerebellum; no changes were detected. (iv) Three-dimensional eye- movement
recordings and body-sway measurements were obtained in six patients with
longstanding unilateral vestibular loss in order to evaluate if
hyperventilation disrupts vestibular compensation. In all patients, a
horizontal nystagmus either appeared or was significantly enhanced for >
or = 60 s after voluntary hyperventilation. Sway was also enhanced by
hyperventilation in these patients, particularly in the frontal plane. This
study suggests that hyperventilation disrupts mechanisms mediating
vestibular compensation. The increase in sway may be, at least partly,
mediated by deranged peripheral and central somatosensory signals from the
lower limbs. Hyperventilation seems to spare vestibular reflex activity and
cerebellar-mediated eye movements.
ARTICLES
The effects of hyperventilation on postural control mechanisms
MRC Human Movement and Balance Unit (Section of Neuro-otology), National Hospital for Neurology and Neurosurgery, London, UK.
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