Brain, Vol 121, Issue 4 677-685, Copyright © 1998 by Oxford University Press
M Strupp, V Arbusow, M Dieterich, W Sautier and T Brandt
Afferent cervical somatosensory input may substitute for absent vestibular
information as part of central vestibular compensation after unilateral
peripheral vestibular deficit. In order to determine the particular
contribution of neck muscle spindles to the perception of body orientation
and to the oculomotor system, we measured (i) the subjective visual
straight ahead (SVA) by psychophysical tests and (ii) the changes in eye
position by video-nystagmography during unilateral stimulation of the
posterior neck muscles by vibration (100 Hz). Twenty- five patients with
subacute unilateral vestibular lesion (vestibular neuritis) and 25 controls
participated in the study. Vibration elicited a horizontal displacement of
SVA towards the side of stimulation in all subjects. Mean displacement (+/-
SD) was 3.28 +/- 2.96 degrees for right-side and 3.45 +/- 2.93 degrees for
left-side stimulation in controls. Muscle stimulation on the patients'
lesion side induced a significantly higher displacement (11.51 +/- 6.63
degrees) than contralateral stimulation (3.04 +/- 2.95 degrees, P <
0.01, paired Student's t test). The mean difference during stimulation
between the two sides in the patients was 8.02 +/- 5.52 degrees; in the
controls, however, it was only 0.74 +/- 0.47 degree (P < 0.001,
Student's t test). This asymmetry increased gradually in patients over a
period of weeks, reaching a maximum at days 60-80 and declining thereafter.
Videonystagmography revealed that ipsilateral stimulation in patients
induced large horizontal eye deviations of up to 25 degrees towards the
side of the lesion (9.1 +/- 7.6 degrees, n = 18). Contralateral stimulation
induced only small shifts, which were within the range of controls. The
correlation coefficient between displacement of the SVA and change in eye
position was high (r = 0.94, P < 0.0001), indicating that the shift of
SVA is the perceptual correlate of the directional change of gaze in space.
This interpretation was supported by two control experiments in which the
subject was required to (i) indicate the subjective straight ahead by
finger-pointing with the eyes closed and (ii) adjust SVA when looking
through horizontally reversing prisms. Vibration of neck muscles caused
almost no displacement of the SVA when it was indicated by pointing with
the eyes closed, but reversed the direction of the displacement if the
subject wore reversing prisms. In summary, our data showed: (i) an increase
in muscle spindle input following unilateral vestibular lesion; (ii) this
increase is asymmetrical, restricted to the affected side, and gradually
builds up over weeks; and (iii) the perceived effects during vibration are
secondary to changes in eye position rather than changes in cortical
representation of body orientation. This is the first study to demonstrate
a unilateral increase in somatosensory weight, which substitutes for
missing vestibular input.
ARTICLES
Perceptual and oculomotor effects of neck muscle vibration in vestibular neuritis. Ipsilateral somatosensory substitution of vestibular function
Department of Neurology, University of Munich, Klinikum Grosshadern, Germany.
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