Electrical vestibular stimulation in humans: a narrative review

Background: In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/ or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electrical vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular function. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear implant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing. Summary: Vestibular co-stimulation with a CI is based on “spread of excitation,” which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular costimulation can be functionally used in patients with bilateral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activation of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implanted electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspecific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to induce a more unspecific stimulation. Although all three applications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicability and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the patient population who serves to gain from such technologies

The rationale of opportunistic bilateral salpingectomies (OBS) during benign gynaecological and obstetric surgery : a consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG)

Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro’s and the con’s of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS

A re-investigation of the role of utricular asymmetries in space motion sickness

During the first days of spaceflight, about 50-70% of the astronauts experience symptoms of Space Motion Sickness (SMS). It has been proposed that an asymmetry between the left and right otolith organs contributes to an astronaut's individual susceptibility. A recently developed test to measure unilateral utricular function enabled us to re-investigate this so-called otolith asymmetry hypothesis, while using the paradigm of sustained centrifugation as a ground based model for SMS. This latter paradigm has been shown to elicit symptoms similar to those of SMS and is referred to as Sickness Induced by Centrifugation (SIC). In 15 healthy subjects unilateral utricular function was assessed by recording ocular counter rolling during a unilateral centrifugation paradigm. In addition, saccular function was assessed by recording Vestibular Evoked Myogenic Potentials (VEMPs), and horizontal semicircular canal function was assessed using bithermal caloric stimulation. SIC-susceptible subjects showed a marginally higher degree of utricular asymmetry, utricular sensitivity and semicircular canal sensitivity (p < 0.1) than the non-susceptible group. Interestingly, a logistic regression model using both utricular and semicircular canal parameters led to a correct classification of 91% of the subjects. As such, these results suggest that otolith asymmetry is at most one factor - and not present in all susceptible subjects - in defining susceptibility to SMS and SIC. Both the utricular and the canal system might be involved as well. © 2011 - IOS Press and the authors. All rights reserved

Effects of specific drugs against G-level transition induced spatial disorientation on the otolith-ocular reflex and the otolith asymmetry

Space motion sickness (SMS) remains a persistent problem in human spaceflight since up to 60 of all astronauts suffer from SMS during the first 72 hours of spaceflight and during transitions from different gravitational environments. To date, there are no effective drug countermeasures that are able to combat SMS while preserving the full cognitive function of the astronaut. It was first suggested by Von Baumgarten Thumler in 1979 that an asymmetry between the left and right otoliths might contribute to susceptibility to SMS in astronauts. To determine the level of asymmetry, a test that enables the unilateral evaluation of both utricles is needed. The unilateral centrifugation test allows such a side-by-side investigation. During this test, the subject is rotated about an earth-vertical axis at high rotation speeds (e.g. 400°/s) and translated along an interaural axis to consecutively align the axis of rotation with the left and the right utricle. The combined rotation and translation induces ocular counter rolling (OCR), which is measured using 3-D video-oculography. A recent refinement of the stimulation paradigm and an improved model to analyse the test results have enabled a more detailed extraction of the otolith characteristics such as otolith asymmetry, gain and bias. In addition, characteristics of the semicircular canals such as the cupular time constant and the velocity storage component can be determined. This detailed analysis allows us to evaluate the effects of drugs on the different characteristics of the vestibular system. Hereto, a double blind placebo controlled pharmacological ESA study investigating the effects of four different drugs (baclofen, meclizine, cinnarizine in combination with dimenhydrinate and promethazine in combination with dextro-amphetamine) on the different parts of the vestibular and cardiovascular system was performed in 20 healthy, male subjects. The effects of the different medications on the otolith-ocular reflex and the level of otolith asymmetry will be presented