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Journal of Neurology
Published in: Journal of Neurology 3/2024

Open Access 16-11-2023 | Bilateral Vestibulopathy | Original Communication

Mechanisms underlying treatment effects of vestibular noise stimulation on postural instability in patients with bilateral vestibulopathy

Authors: Max Wuehr, Josefine Eder, Silvy Kellerer, Tamara Amberger, Klaus Jahn

Published in: Journal of Neurology | Issue 3/2024

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Abstract

Background

Previous studies indicate that imbalance in patients with bilateral vestibulopathy (BVP) may be reduced by treatment with low-intensity noisy galvanic vestibular stimulation (nGVS).

Objective

To elucidate the potential mechanisms underlying this therapeutic effect. In particular, we determined whether nGVS-induced balance improvements in patients are compatible with stochastic resonance (SR)—a mechanism by which weak noise stimulation can paradoxically enhance sensory signal processing.

Methods

Effects of nGVS of varying intensities (0–0.7 mA) on body sway were examined in 19 patients with BVP standing with eye closed on a posturographic force plate. We assumed a bell-shaped response curve with maximal sway reductions at intermediate nGVS intensities to be indicative of SR. An established SR curve model was fitted on individual patient outcomes, and three experienced human raters had to judge whether responses to nGVS were consistent with the exhibition of SR.

Results

nGVS-induced reductions of body sway compatible with SR were found in 12 patients (63%) with optimal improvements of 31 ± 21%. In 10 patients (53%), nGVS-induced sway reductions exceeded the minimally important clinical difference (optimal improvement: 35 ± 21%), indicative of strong SR. This beneficial effect was more likely in patients with severe vestibular loss (i.e. lower video head impulse test gain; R = 0.663; p = 0.002) and considerable postural imbalance (baseline body sway; R = 0.616; p = 0.005).

Conclusions

More than half of the assessed patients showed robust improvements in postural balance compatible with SR when treated with nGVS. In particular, patients with a higher burden of disease may benefit from the non-invasive and well-tolerated treatment with nGVS.
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Metadata
Title
Mechanisms underlying treatment effects of vestibular noise stimulation on postural instability in patients with bilateral vestibulopathy
Authors
Max Wuehr
Josefine Eder
Silvy Kellerer
Tamara Amberger
Klaus Jahn
Publication date
16-11-2023
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 3/2024
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-023-12085-3

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