Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders

Objective: We are still lacking a pathophysiological mechanism for functional disorders explaining the emergence and manifestation of characteristic, severely impairing bodily symptoms like chest pain or dizziness. A recent hypothesis based on the predictive coding theory of brain function suggests that in functional disorders, internal expectations do not match the actual sensory body states, leading to perceptual dysregulation and symptom perception. To test this hypothesis, we investigated the account of internal expectations and sensory input on gaze stabilization, a physiologically relevant parameter of gaze shifts, in functional dizziness. Methods: We assessed gaze stabilization in eight functional dizziness patients and 11 healthy controls during two distinct epochs of large gaze shifts: during a counter-rotation epoch (CR epoch), where the brain can use internal models, motor planning, and resulting internal expectations to achieve internally driven gaze stabilization; and during an oscillation epoch (OSC epoch), where, due to terminated motor planning, no movement expectations are present, and gaze is stabilized by sensory input alone. Results: Gaze stabilization differed between functional patients and healthy controls only when internal movement expectations were involved [F(1,17) = 14.63, p = 0.001, and partial η(2) = 0.463]: functional dizziness patients showed reduced gaze stabilization during the CR (p = 0.036) but not OSC epoch (p = 0.26). Conclusion: While sensory-driven gaze stabilization is intact, there are marked, well-measurable deficits in internally-driven gaze stabilization in functional dizziness pointing at internal expectations that do not match actual body states. This experimental evidence supports the perceptual dysregulation hypothesis of functional disorders and is an important step toward understanding the underlying pathophysiology

Evidence for a robust, transdiagnostic marker in functional disorders: erroneous sensorimotor processing in functional dizziness and functional movement disorder

Project depository for a study on mechanisms underlying functional disorders as part of the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie (grant no. 956673

Distributed coding of duration in rodent prefrontal cortex during time reproduction

As we interact with the external world, we judge magnitudes from sensory information. The estimation of magnitudes has been characterized in primates, yet it is largely unexplored in nonprimate species. Here, we use time interval reproduction to study rodent behavior and its neural correlates in the context of magnitude estimation. We show that gerbils display primate-like magnitude estimation characteristics in time reproduction. Most prominently their behavioral responses show a systematic overestimation of small stimuli and an underestimation of large stimuli, often referred to as regression effect. We investigated the underlying neural mechanisms by recording from medial prefrontal cortex and show that the majority of neurons respond either during the measurement or the reproduction of a time interval. Cells that are active during both phases display distinct response patterns. We categorize the neural responses into multiple types and demonstrate that only populations with mixed responses can encode the bias of the regression effect. These results help unveil the organizing neural principles of time reproduction and perhaps magnitude estimation in general

Post-COVID symptoms in the absence of organic deficit - Lessons from diseases we know

Given the increasing number of patients suffering severe physical symptoms after SARS-CoV-2 infection for which there is no conclusive organic explanation, it is important to remember a phenomenon well known in medicine: the authenticity and significance of symptoms does not necessarily depend on organic impairment. Rather, the same symptoms and their intensity can occur when structure is intact, but body signals are misinterpreted and incorrectly processed in the brain. For breathlessness, fatigue and dizziness there are already established experimental paradigms to measure such dysfunctions in the absence of organic impairment. Here, we describe these paradigms and explain how they could help to better understand persistent and debilitating symptoms after COVID-19