The Epidemiology of Vertigo, Dizziness, and Unsteadiness and Its Links to Co-Morbidities

Vertigo, dizziness, and unsteadiness (VDU) are common symptoms traditionally considered to result from different kinds of vestibular and non-vestibular dysfunctions. The epidemiology of each symptom and how they relate to each other and to migraine, agoraphobia, motion sickness susceptibility (MSS), vaso-vagal episodes (VVE), and anxiety-depression was the object of this population-based study in north-eastern France. A self-administered questionnaire was returned by 2987 adults (age span 18–86 years, 1471 women). The 1-year prevalence for vertigo was 48.3%, for unsteadiness 39.1%, and for dizziness 35.6%. The three symptoms were correlated with each other, occurred mostly (69.4%) in various combinations rather than in isolation, less than once per month, and 90% of episodes lasted ≤2 min. The three symptoms were similar in terms of female predominance, temporary profile of the episodes, and their link to falls and nausea. Symptom episodes of >1 h increase the risk of falls. VDU are much more common than the known prevalence of vestibular disorders. The number of drugs taken increase VDU even when controlling for age. Each VDU symptom was correlated with each co-morbidity in Chi-squared tests. The data suggest that the three symptoms are more likely to represent a spectrum resulting from a range of similar – rather than from different, unrelated – mechanisms or disorders. Logistic regressions controlling for each vestibular symptom showed that vertigo correlated with each co-morbidity but dizziness and unsteadiness did not, suggesting that vertigo is certainly not a more specific symptom than the other two. A logistic regression using a composite score of VDU, controlling for each co-morbidity showed a correlation of VDU to migraine and VVE but not to MSS and not to agoraphobia in men, only in women

Motion sickness diagnostic criteria: Consensus document of the classification committee of the Bárány society

We present diagnostic criteria for motion sickness, visually induced motion sickness (VIMS), motion sickness disorder (MSD), and VIMS disorder (VIMSD) to be included in the International Classification of Vestibular Disorders. Motion sickness and VIMS are normal physiological responses that can be elicited in almost all people, but susceptibility and severity can be high enough for the response to be considered a disorder in some cases. This report provides guidelines for evaluating signs and symptoms caused by physical motion or visual motion and for diagnosing an individual as having a response that is severe enough to constitute a disorder. The diagnostic criteria for motion sickness and VIMS include adverse reactions elicited during exposure to physical motion or visual motion leading to observable signs or symptoms of greater than minimal severity in the following domains: nausea and/or gastrointestinal disturbance, thermoregulatory disruption, alterations in arousal, dizziness and/or vertigo, headache and/or ocular strain. These signs/symptoms occur during the motion exposure, build as the exposure is prolonged, and eventually stop after the motion ends. Motion sickness disorder and VIMSD are diagnosed when recurrent episodes of motion sickness or VIMS are reliably triggered by the same or similar stimuli, severity does not significantly decrease after repeated exposure, and signs/symptoms lead to activity modification, avoidance behavior, or aversive emotional responses. Motion sickness/MSD and VIMS/VIMSD can occur separately or together. Severity of symptoms in reaction to physical motion or visual motion stimuli varies widely and can change within an individual due to aging, adaptation, and comorbid disorders. We discuss the main methods for measuring motion sickness symptoms, the situations conducive to motion sickness and VIMS, and the individual traits associated with increased susceptibility. These additional considerations will improve diagnosis by fostering accurate measurement and understanding of the situational and personal factors associated with MSD and VIMSD

Discussion about Visual Dependence in Balance Control: European Society for Clinical Evaluation of Balance Disorders

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesThe executive committee of the European Society for the clinical evaluation of balance disorders meets annually to address equilibrium problems that are not well understood. This is a review paper on discussions in the latest meeting we held. MATERIALS AND METHODS: Seeing patients with vestibular disorders who end up depending on visual information as part of their compensation process is a common clinical occurrence. However, this "visual dependence" can generate symptoms, which include nausea, sensations of imbalance, and anxiety. It is unclear how this develops, as symptoms can be widely variable from patient to patient. There are several triggering factors to this symptom set, and quantifying it in a given patient is extremely difficult Results: The committee agreed that the presence of this symptom set can be suggestive of vestibular pathology, but the pathology does not have to be present. As a result, there is no correlation between symptom severity and test results. CONCLUSION: Visual dependence can often be present in a patient, although little, if any, measurable pathology is present. It is important to emphasize that although we cannot accurately measure this with either standardized testing or pertinent questionnaires, "hypersensitive" patients have a genuine disease and their symptoms are not of psychiatric origin

The epidemiology of mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in community-living seniors: protocol of the MemoVie cohort study, Luxembourg

BACKGROUND: Cognitive impairment and Alzheimer’s disease (AD) are increasingly considered a major public health problem. The MemoVie cohort study aims to investigate the living conditions or risk factors under which the normal cognitive capacities of the senior population in Luxembourg (≥ 65 year-old) evolve (1) to mild cognitive impairment (MCI) – transitory non-clinical stage – and (2) to AD. Identifying MCI and AD predictors undeniably constitutes a challenge in public health in that it would allow interventions which could protect or delay the occurrence of cognitive disorders in elderly people. In addition, the MemoVie study sets out to generate hitherto unavailable data, and a comprehensive view of the elderly population in the country. METHODS/DESIGN: The study has been designed with a view to highlighting the prevalence in Luxembourg of MCI and AD in the first step of the survey, conducted among participants selected from a random sample of the general population. A prospective cohort is consequently set up in the second step, and appropriate follow-up of the non-demented participants allows improving the knowledge of the preclinical stage of MCI. Case-control designs are used for cross-sectional or retrospective comparisons between outcomes and biological or clinical factors. To ensure maximal reliability of the information collected, we decided to opt for structured face to face interviews. Besides health status, medical and family history, demographic and socio-cultural information are explored, as well as education, habitat network, social behavior, leisure and physical activities. As multilingualism is expected to challenge the cognitive alterations associated with pathological ageing, it is additionally investigated. Data relative to motor function, including balance, walk, limits of stability, history of falls and accidents are further detailed. Finally, biological examinations, including ApoE genetic polymorphism are carried out. In addition to standard blood parameters, the lipid status of the participants is subsequently determined from the fatty acid profiles in their red blood cells. The study obtained the legal and ethical authorizations. DISCUSSION: By means of the multidisciplinary MemoVie study, new insights into the onset of cognitive impairment during aging should be put forward, much to the benefit of intervention strategies as a whole

Age at onset as stratifier in idiopathic Parkinson’s disease – effect of ageing and polygenic risk score on clinical phenotypes

Several phenotypic differences observed in Parkinson’s disease (PD) patients have been linked to age at onset (AAO). We endeavoured to find out whether these differences are due to the ageing process itself by using a combined dataset of idiopathic PD (n = 430) and healthy controls (HC; n = 556) excluding carriers of known PD-linked genetic mutations in both groups. We found several significant effects of AAO on motor and non-motor symptoms in PD, but when comparing the effects of age on these symptoms with HC (using age at assessment, AAA), only positive associations of AAA with burden of motor symptoms and cognitive impairment were significantly different between PD vs HC. Furthermore, we explored a potential effect of polygenic risk score (PRS) on clinical phenotype and identified a significant inverse correlation of AAO and PRS in PD. No significant association between PRS and severity of clinical symptoms was found. We conclude that the observed non-motor phenotypic differences in PD based on AAO are largely driven by the ageing process itself and not by a specific profile of neurodegeneration linked to AAO in the idiopathic PD patients

The epidemiology of vertigo, dizziness and unsteadiness and its links to migraine, motion sickness susceptibility, anxiety-depression, vaso-vagal episodes and agoraphobia.

Le vertige (V), l'étourdissement (E) et l'instabilité (I) sont des symptômes fréquents, traditionnellement considérés comme ayant des étiologies vestibulaires et extra-vestibulaires différentes. La prévalence de chaque symptôme et la manière dont ils sont liés entre eux ainsi qu'avec la migraine, l'agoraphobie, la susceptibilité au mal des transports (SMT), le malaise vagal (MV), l'anxiété/dépression (AD) et la prise de médicaments, ont été l'objet de cette étude. Un questionnaire auto-administré a été complété par 2897 adultes de la population lorraine, âgés de 18 à 86 ans, dont 1471 femmes. La prévalence sur un an du V était de 48,3%, celle de l'I de 39,1% et celle de l'E de 35,6%. Les VEI étaient corrélés entre eux et apparaissaient en général en diverses combinaisons (69,4%) ; 90% des épisodes de VEI avaient une durée inférieure ou égale à 2 mn et une fréquence sexe féminin>VEI, pour la SMT : sexe féminin > AD > migraine. En ajustant sur les trois VEI entre eux, le V reste un facteur de risque significatif pour chaque co-morbidité, suggérant que le V est un symptôme aussi peu spécifique que les deux autres et que les VEI représentent un spectre de symptômes résultant de diverses causesVertigo (V), dizziness (D) and unsteadiness (U) are common symptoms traditionally considered to result from different kinds of vestibular and non-vestibular dysfunctions. The prevalence of each symptom and how they relate to each other and to migraine, agoraphobia, motion sickness susceptibility (MSS), vaso-vagal episodes (VVE) and anxiety-depression (AD) was the object of this population-based study in north-eastern France. A self-administered questionnaire was returned by 2987 adults (age span 18-86 years, 1471 women). The 1-year prevalence for V was 48.3%, for U 39.1% and for D 35.6%. The VDU symptoms were correlated with each other, occurred mostly (69.4%) in various combinations rather than in isolation, less than once per month, and 90% of episodes lasted 1 hour increased the risk of falls. The number of drugs taken increased VDU even when controlling for age. Each VDU symptom was correlated with each co-morbidity. The risk factors were for agoraphobia: AD>female gender>VDU; for MSS: female gender>AD>migraine. Logistic regressions controlling for each vestibular symptom showed that V correlated with each co-morbidity, suggesting that V is a symptom as unspecific as the other two and that the three symptoms represent a spectrum resulting from a range of mechanisms or disorder

Épidémiologie du vertige, de l'étourdissement et de l'instabilité, ainsi que leurs relations avec la migraine, le mal des transports, l'anxiété-dépression, le malaise vagal et l'agoraphobie

Vertigo (V), dizziness (D) and unsteadiness (U) are common symptoms traditionally considered to result from different kinds of vestibular and non-vestibular dysfunctions. The prevalence of each symptom and how they relate to each other and to migraine, agoraphobia, motion sickness susceptibility (MSS), vaso-vagal episodes (VVE) and anxiety-depression (AD) was the object of this population-based study in north-eastern France. A self-administered questionnaire was returned by 2987 adults (age span 18-86 years, 1471 women). The 1-year prevalence for V was 48.3%, for U 39.1% and for D 35.6%. The VDU symptoms were correlated with each other, occurred mostly (69.4%) in various combinations rather than in isolation, less than once per month, and 90% of episodes lasted 1 hour increased the risk of falls. The number of drugs taken increased VDU even when controlling for age. Each VDU symptom was correlated with each co-morbidity. The risk factors were for agoraphobia: AD>female gender>VDU; for MSS: female gender>AD>migraine. Logistic regressions controlling for each vestibular symptom showed that V correlated with each co-morbidity, suggesting that V is a symptom as unspecific as the other two and that the three symptoms represent a spectrum resulting from a range of mechanisms or disordersLe vertige (V), l'étourdissement (E) et l'instabilité (I) sont des symptômes fréquents, traditionnellement considérés comme ayant des étiologies vestibulaires et extra-vestibulaires différentes. La prévalence de chaque symptôme et la manière dont ils sont liés entre eux ainsi qu'avec la migraine, l'agoraphobie, la susceptibilité au mal des transports (SMT), le malaise vagal (MV), l'anxiété/dépression (AD) et la prise de médicaments, ont été l'objet de cette étude. Un questionnaire auto-administré a été complété par 2897 adultes de la population lorraine, âgés de 18 à 86 ans, dont 1471 femmes. La prévalence sur un an du V était de 48,3%, celle de l'I de 39,1% et celle de l'E de 35,6%. Les VEI étaient corrélés entre eux et apparaissaient en général en diverses combinaisons (69,4%) ; 90% des épisodes de VEI avaient une durée inférieure ou égale à 2 mn et une fréquence sexe féminin>VEI, pour la SMT : sexe féminin > AD > migraine. En ajustant sur les trois VEI entre eux, le V reste un facteur de risque significatif pour chaque co-morbidité, suggérant que le V est un symptôme aussi peu spécifique que les deux autres et que les VEI représentent un spectre de symptômes résultant de diverses cause

Épidémiologie du vertige, de l'étourdissement et de l'instabilité, ainsi que leurs relations avec la migraine, le mal des transports, l'anxiété-dépression, le malaise vagal et l'agoraphobie

Le vertige (V), l'étourdissement (E) et l'instabilité (I) sont des symptômes fréquents, traditionnellement considérés comme ayant des étiologies vestibulaires et extra-vestibulaires différentes. La prévalence de chaque symptôme et la manière dont ils sont liés entre eux ainsi qu'avec la migraine, l'agoraphobie, la susceptibilité au mal des transports (SMT), le malaise vagal (MV), l'anxiété/dépression (AD) et la prise de médicaments, ont été l'objet de cette étude. Un questionnaire auto-administré a été complété par 2897 adultes de la population lorraine, âgés de 18 à 86 ans, dont 1471 femmes. La prévalence sur un an du V était de 48,3%, celle de l'I de 39,1% et celle de l'E de 35,6%. Les VEI étaient corrélés entre eux et apparaissaient en général en diverses combinaisons (69,4%) ; 90% des épisodes de VEI avaient une durée inférieure ou égale à 2 mn et une fréquence sexe féminin>VEI, pour la SMT : sexe féminin > AD > migraine. En ajustant sur les trois VEI entre eux, le V reste un facteur de risque significatif pour chaque co-morbidité, suggérant que le V est un symptôme aussi peu spécifique que les deux autres et que les VEI représentent un spectre de symptômes résultant de diverses causesVertigo (V), dizziness (D) and unsteadiness (U) are common symptoms traditionally considered to result from different kinds of vestibular and non-vestibular dysfunctions. The prevalence of each symptom and how they relate to each other and to migraine, agoraphobia, motion sickness susceptibility (MSS), vaso-vagal episodes (VVE) and anxiety-depression (AD) was the object of this population-based study in north-eastern France. A self-administered questionnaire was returned by 2987 adults (age span 18-86 years, 1471 women). The 1-year prevalence for V was 48.3%, for U 39.1% and for D 35.6%. The VDU symptoms were correlated with each other, occurred mostly (69.4%) in various combinations rather than in isolation, less than once per month, and 90% of episodes lasted 1 hour increased the risk of falls. The number of drugs taken increased VDU even when controlling for age. Each VDU symptom was correlated with each co-morbidity. The risk factors were for agoraphobia: AD>female gender>VDU; for MSS: female gender>AD>migraine. Logistic regressions controlling for each vestibular symptom showed that V correlated with each co-morbidity, suggesting that V is a symptom as unspecific as the other two and that the three symptoms represent a spectrum resulting from a range of mechanisms or disordersMETZ-SCD (574632105) / SudocNANCY1-Bib. numérique (543959902) / SudocNANCY2-Bibliotheque electronique (543959901) / SudocNANCY-INPL-Bib. électronique (545479901) / SudocSudocFranceF

Management of vestibular migraine

Vestibular migraine is considered to be the second most common cause of vertigo and the most common cause of spontaneous episodic vertigo. The duration of attacks varies from seconds to days, usually lasting minutes to hours, and they mostly occur independently of headaches. Long-lasting individual attacks are treated with generic antivertiginous and antiemetic drugs. Specific antimigraine drugs are unlikely to be very effective for rescue. The mainstay of the management of vestibular migraine is prophylactic medication. To date, there are no controlled trials available; the body of knowledge builds on case series and retrospective or observational studies. Most drugs are also used for the prevention of migraine headaches. The choice of medication should be guided by its side effect profile and the comorbidities of patients. Betablockers such as propanolol or metoprolol are preferred in patients with hypertension but in the absence of asthma. Anticonvulsants include topiramate when patients are obese, valproic acid and lamotrigine. Lamotrigine is preferred if vertigo is more frequent than headaches. Calcium antagonists include verapamil and flunarizine. If patients have anxiety, tricyclic antidepressants such as amitryptiline or nortryptiline or SSRIs and benzodiazepines such as clonazepam are recommended. Acetazolamide is effective in rare genetic disorders related to migraine-like episodic ataxia; however, its place in vestibular migraine is still to be established. Nonpharmacological measures such as diet, sleep, hygiene and avoidance of triggers are recommended as they are for migraine. Vestibular rehabilitation might be useful when there are complications such as loss of confidence in balance or visual dependence

Towards personalized medicine in Ménière’s disease [version 1; referees: 3 approved]

Ménière’s disease (MD) represents a heterogeneous group of relatively rare disorders with three core symptoms: episodic vertigo, tinnitus, and sensorineural hearing loss involving 125 to 2,000 Hz frequencies. The majority of cases are considered sporadic, although familial aggregation has been recognized in European and Korean populations, and the search for familial MD genes has been elusive until the last few years. Detailed phenotyping and cluster analyses have found several clinical predictors for different subgroups of patients, which may indicate different mechanisms, including genetic and immune factors. The genes associated with familial MD are COCH, FAM136A, DTNA, PRKCB, SEMA3D, and DPT. At least two mechanisms have been involved in MD: (a) a pro-inflammatory immune response mediated by interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNFα), and IL-6, and (b) a nuclear factor-kappa B (NF-κB)-mediated inflammation in the carriers of the single-nucleotide variant rs4947296. It is conceivable that microbial antigens trigger inflammation with release of pro-inflammatory cytokines at different sites within the cochlea, such as the endolymphatic sac, the stria vascularis, or the spiral ligament, leading to fluid imbalance with an accumulation of endolymph. Computational integration of clinical and “omics” data eventually should transform the management of MD from “one pill fits all” to precise patient stratification and a personalized approach. This article lays out a proposal for an algorithm for the genetic diagnosis of MD. This approach will facilitate the identification of new molecular targets for individualized treatment, including immunosuppressant and gene therapy, in the near future