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Journal of Neurology

Open Access 09-05-2024 | Original Communication

Low-intensity vestibular noise stimulation improves postural symptoms in progressive supranuclear palsy

Authors: Max Wuehr, Daniela Peto, Urban M. Fietzek, Sabrina Katzdobler, Georg Nübling, Mirlind Zaganjori, Matthias Brendel, Johannes Levin, Günter U. Höglinger, Andreas Zwergal

Published in: Journal of Neurology

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Abstract

Background

Postural imbalance and falls are an early disabling symptom in patients with progressive supranuclear palsy (PSP) of multifactorial origin that may involve abnormal vestibulospinal reflexes. Low-intensity noisy galvanic vestibular stimulation (nGVS) is a non-invasive treatment to normalize deficient vestibular function and attenuate imbalance in Parkinson’s disease. The presumed therapeutic mode of nGVS is stochastic resonance (SR), a mechanism by which weak sensory noise stimulation can enhance sensory information processing.

Objective

To examine potential treatment effects of nGVS on postural instability in 16 patients with PSP with a clinically probable and [18F]PI-2620 tau-PET-positive PSP.

Methods

Effects of nGVS of varying intensity (0–0.7 mA) on body sway were examined, while patients were standing with eyes 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

We found nGVS-induced reductions of body sway compatible with SR in 9 patients (56%) with optimal improvements of 31 ± 10%. In eight patients (50%), nGVS-induced sway reductions exceeded the minimal clinically important difference (improvement: 34 ± 5%), indicative of strong SR.

Conclusion

nGVS yielded clinically relevant reductions in body sway compatible with the exhibition of SR in vestibular sensorimotor pathways in at least half of the assessed patients. Non-invasive vestibular noise stimulation may be thus a well-tolerated treatment strategy to ameliorate postural symptoms in PSP.
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Metadata
Title
Low-intensity vestibular noise stimulation improves postural symptoms in progressive supranuclear palsy
Authors
Max Wuehr
Daniela Peto
Urban M. Fietzek
Sabrina Katzdobler
Georg Nübling
Mirlind Zaganjori
Matthias Brendel
Johannes Levin
Günter U. Höglinger
Andreas Zwergal
Publication date
09-05-2024
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-024-12419-9