Asymmetry of balance responses to monaural galvanic vestibular stimulation in subjects with vestibular schwannoma

ObjectiveWe investigated the potential of galvanic vestibular stimulation (GVS) to quantify lateralised asymmetry of the vestibulospinal pathways by measuring balance responses to monaural GVS in 10 subjects with vestibular schwannoma and 22 healthy control subjects.MethodsSubjects standing without vision were stimulated with 3 s, 1 mA direct current stimuli delivered monaurally. The mean magnitude and direction of the evoked balance responses in the horizontal plane were measured from ground-reaction forces and from displacement and velocity of the trunk. Vestibular-evoked myogenic potentials (VEMPs) to 500 Hz air and bone-conducted tones were also recorded.ResultsIn healthy subjects, the magnitudes of the force, velocity and displacement responses were not significantly different for left compared to right ear stimulation. Their individual asymmetry ratios were always <30%. Subjects with vestibular schwannoma had significantly smaller force, velocity and displacement responses to stimulation of the affected compared with non-affected ear. Their mean asymmetry ratios were significantly elevated for all three measures (41.2 ± 10.3%, 40.3 ± 15.1% and 21.9 ± 14.6%).ConclusionsAsymmetry ratios of balance responses to monaural GVS provide a quantitative and clinically applicable lateralising test of the vestibulospinal pathways.SignificanceThis method offers a more clinically relevant measure of standing balance than existing vestibular function tests which assess only vestibuloocular and vestibulocollic pathways.     

Responses of primary vestibular neurons to galvanic vestibular stimulation (GVS) in the anaesthetised guinea pig

Previous studies in humans and animals which have shown that DC galvanic vestibular stimulation (GVS) induces horizontal and torsional eye movements have been interpreted as being due to a preferential activation of primary vestibular afferents innervating the horizontal semicircular canals and otoliths by GVS. The present study sought to determine in guinea pigs whether GVS does indeed selectively activate primary horizontal canal and otolith afferents. Constant-current GVS was passed between electrodes implanted in the tensor-tympani muscle of each middle ear or between electrodes on the skin over the mastoid. During this stimulation, responses from single primary vestibular neurons were recorded extracellularly by glass microelectrodes in Scarpa's ganglion. Afferents from all vestibular sensory regions were activated by both surface and tensor-tympani galvanic stimulation. Tensor tympani GVS was approximately 10 times more effective than surface GVS. At larger current intensities irregularly discharging afferents showed an asymmetrical response: cathodal stimulation resulted in a larger change in firing (increase) than anodal stimulation (decrease), whereas regularly discharging afferents responded symmetrically to the two polarities of GVS. Across all afferents tuned for different types of natural vestibular stimulation, neuronal sensitivity for GVS was found to increase with discharge variability (as indexed by CV*). Anterior canal afferents showed a slightly higher sensitivity than afferents from other vestibular sensory regions. Hence, the present study concluded that GVS activates primary vestibular afferents innervating all sensory regions in a uniform fashion. Therefore, the specific pattern of GVS-induced eye movements reported in previous studies are not due to differential sensitivity between different vestibular sensory regions, but are likely to reflect an involvement of central processing.     

Effect of noisy galvanic vestibular stimulation on center of pressure sway of static standing posture

Background

The vestibular system is involved in the control of standing balance. Galvanic vestibular stimulation (GVS) is a noninvasive technique that can stimulate the vestibular system. In recent years, noisy GVS (nGVS) using noise current stimulation has been attempted, but it has not been clarified whether it affects postural sway in open-eye standing.

The effect of galvanic vestibular stimulation on postural response of Down syndrome individuals on the seesaw

In order to better understand the role of the vestibular system in postural adjustments on unstable surfaces, we analyzed the effects of galvanic vestibular stimulation (GVS) on the pattern of muscle activity and joint displacements (ankle knee and hip) of eight intellectually normal participants (control group - CG) and eight control group individuals with Down syndrome (DS) while balancing on seesaws of different heights. The CG individuals adopted a pattern of muscle activation characterized by alternation between ankle agonist and antagonist muscles. The individuals with DS adopted a pattern of muscle co-contraction. The GVS affected neither the ability of CG individuals to maintain balance nor their pattern of muscle contraction. On the other hand, the individuals with DS showed greater sensitivity to GVS while balancing on a seesaw and were not able to select the appropriate motor strategy to efficiently balance and compensate the effects of GVS. These increased vestibular sensitivities observed in individuals with DS can reflect deficits in the proprioceptive system.     

The primal role of the vestibular system in determining musical rhythm

Previous studies have indicated that physical movement on either every second or on every third beat of an unaccented auditory rhythm pattern can disambiguate whether it is perceived in duple time as a march or in triple time as a waltz. Here we demonstrate that this disambiguation can also be accomplished by direct galvanic stimulation of the vestibular system. The galvanically induced sensation, without any actual movement, that the head moved from side to side on either every second or on every third beat of the ambiguous auditory rhythm pattern strongly biased whether adults perceived it as being in duple or in triple time. These results imply that the vestibular system plays a primal role in the perception of musical rhythm.     

Ocular torsion responses to electrical vestibular stimulation in vestibular schwannoma

Objectives

We determined if eye movements evoked by Electrical Vestibular Stimulation (EVS) can be used to detect vestibular dysfunction in patients with unilateral vestibular schwannoma (VS).

Control of the body vertical by vestibular and proprioceptive inputs

The study examines the influence of vestibular and leg proprioceptive cues on the maintenance of the body vertical in human stance. Vestibular body orientation cues were changed by applying bipolar currents to both mastoid bones (cosine-bell wave form of 3.3 s duration, 1 mA current intensity). Proprioceptive input was modified by vibrating the tibialis anterior muscle (at F = 90 Hz, step of 5 s duration and 1 mm amplitude). Furthermore, the vestibular stimulus was paired with the muscle vibration using three different temporal relationships between the stimuli. Body lean responses were analyzed in terms of sway trajectories of the center of foot pressure on the body support surface (horizontal plane). With the anode on the right mastoid, vestibular body lean response was essentially straight towards the right side, and with the anode on left mastoid towards the left side. Vibration of right tibialis anterior muscle induced an almost straight body lean forward and to the right. Upon combined stimulation, responses with complex trajectory resulted, which depended on the stimulus interval. These responses reflected a superposition of the individual vestibular and proprioceptive effects. The results show that the body vertical is under the continuous control of leg proprioceptive and vestibular inputs, which sum linearly. We present a concept according to which these inputs are used for establishing a reference system for the control of the body vertical.     

Perception of the vertical in patients with right hemispheric lesion: effect of galvanic vestibular stimulation

Patients with right-brain injury present, more frequently in the acute phase, with a deviation of the subjective vertical (SV) contralateral to the lesion. The aim of this study was to investigate the influence of galvanic vestibular stimulation (GVS) on this disorder. Twelve patients presenting with a right hemispheric lesion, seven with neglect (N+) and five without (N-) were compared to eight control subjects. They had to orient vertically a luminous rod in darkness, in three galvanic stimulation (1.5 mA) conditions: cathode left, cathode right and no stimulation (baseline). Without stimulation, the patients' SV, and especially that of N+, showed an anticlockwise deviation. In comparison with baseline values, GVS induced a deviation toward the side opposite to the cathode in the three groups. In the patients, the deviation was of larger amplitude and appeared greater for left than for right cathodic stimulation. In conclusion, we showed an influence of vestibular stimulation on the SV of right brain-injured patients, especially when spatial neglect was present. As left cathodic stimulation can reduce the SV deviation associated with spatial neglect, such a tool could be introduced in rehabilitation.     

Transient and steady-state responses to mechanical stimulation of different fingers reveal interactions based on lateral inhibition

Objective

Simultaneous tactile finger stimulation evokes transient ERP responses that are smaller than the linear summation of ERP responses to individual stimulation. Occlusion and lateral inhibition are two possible mechanisms responsible for this effect. The present study disentangles these two effects using steady-state somatosensory evoked potentials (SSSEP). Simultaneous stimulation on adjacent and distant finger pairs with the same and different stimulation frequencies are compared.

Methods

The index finger (IF), middle finger (MF) and little finger (LF) were mechanically stimulated with a frequency of 18, 22 or 26 Hz, respectively. Stimulation was applied for each finger separately, and for the IF (18 Hz) in combination with either the MF or LF for 22 and 26 Hz, respectively. A measure for interaction (IR) was calculated for the P60 component and the SSSEP amplitude.

Results

Significant interactions were found in both the P60 response and in the SSSEP response. Stimulation of adjacent finger combinations caused more interaction than distant finger combinations. No difference was found between stimulation of two fingers with the same or a different frequency.

Conclusions

Our results indicate that lateral inhibition is mainly responsible for the interaction effect.

Significance

These observations provide further insight in the mechanisms behind interaction between somatosensory inputs.     

Changes in somatosensory evoked responses by repetition of the median nerve stimulation

OBJECTIVE: We investigate the synaptic factor for the recovery function of evoked responses using a repetitive stimulation technique. METHODS: Somatosensory evoked cortical magnetic field (SEF) was recorded following stimulation of the median nerve using single to 6-train stimulation in 8 healthy subjects. The SEF responses after each stimulus in the train stimulation were extracted by subtraction of the waveforms. RESULTS: An attenuation of the SEF components was recognized after the second of the stimuli, but there was no significant attenuation with the third or later stimulations. The root mean square (RMS) of the 1M (peak latency at 20 ms after stimulation) and 4M (70 ms) components were smaller than that of the single stimulation during the train stimulation, while the 2M (30 ms) and 3M (45 ms) components were not attenuated, but the 3M was facilitated at the fourth to sixth stimulation. CONCLUSION: The synaptic factor was not responsible for the attenuation of the SEF components during repetitive stimulation in healthy subjects. The SEF change disclosed a functional difference among the SEF components during the train stimulation, especially among the later components.     

Postural and muscle responses to galvanic vestibular stimulation reveal a vestibular deficit in adolescents with idiopathic scoliosis

One of the most appealing hypotheses around the aetiopathogenesis of adolescent idiopathic scoliosis attributes the development of the spine deformity to an imbalance in the descending vestibulospinal drive to the muscles resulting in a differential mechanical pull on the spine during the early life stages. In this study, we explored this hypothesis by examining postural and muscle responses to binaural bipolar galvanic vestibular stimulation (GVS) of randomly alternating polarity. Adolescents diagnosed with idiopathic scoliosis (n = 12) and healthy age‐matched controls (n = 12) stood quietly with feet together (stance duration 66–102 s), eyes closed and facing forward, while 10 short (2s), transmastoidal, bipolar square wave GVS pulses (0.3–2.0 mA) of randomly alternating polarity were delivered at varying time intervals. Responses depicted in the electromyographic (EMG) activity of bilateral axial and appendicular muscles, vertical reaction forces and segment kinematics were recorded and analysed. Scoliotic patients demonstrated smaller ankle muscle responses and a delayed postural shift to the right relative to controls during anode right/cathode left GVS. When GVS polarity was reversed, patients had a greater soleus short‐latency response on the left anodal side, while the rest of the muscle and postural responses were similar between groups. Vestibular stimulation also evoked greater head and upper trunk sway in scoliotic compared with healthy adolescents irrespective of stimulus polarity. Results provide new preliminary evidence for a vestibular imbalance in adolescents with idiopathic scoliosis that is compensated by somatosensory, load‐related afferent feedback from the lower limbs during the latter part of the response.     

Effects of galvanic vestibular stimulation on resting state brain activity in patients with bilateral vestibulopathy

We examined the effect of galvanic vestibular stimulation (GVS) on resting state brain activity using fMRI (rs‐fMRI) in patients with bilateral vestibulopathy. Based on our previous findings, we hypothesized that GVS, which excites the vestibular nerve fibers, (a) increases functional connectivity in temporoparietal regions processing vestibular signals, and (b) alleviates abnormal visual–vestibular interaction. Rs‐fMRI of 26 patients and 26 age‐matched healthy control subjects was compared before and after GVS. The stimulation elicited a motion percept in all participants. Using different analyses (degree centrality, DC; fractional amplitude of low frequency fluctuations [fALFF] and seed‐based functional connectivity, FC), group comparisons revealed smaller rs‐fMRI in the right Rolandic operculum of patients. After GVS, rs‐fMRI increased in the right Rolandic operculum in both groups and in the patients' cerebellar Crus 1 which was related to vestibular hypofunction. GVS elicited a fALFF increase in the visual cortex of patients that was inversely correlated with the patients' rating of perceived dizziness. After GVS, FC between parietoinsular cortex and higher visual areas increased in healthy controls but not in patients. In conclusion, short‐term GVS is able to modulate rs‐fMRI in healthy controls and BV patients. GVS elicits an increase of the reduced rs‐fMRI in the patients' right Rolandic operculum, which may be an important contribution to restore the disturbed visual–vestibular interaction. The GVS‐induced changes in the cerebellum and the visual cortex were associated with lower dizziness‐related handicaps in patients, possibly reflecting beneficial neural plasticity that might subserve visual–vestibular compensation of deficient self‐motion perception.     

Systemically administered cocaine alters stimulus-evoked responses of thalamic somatosensory neurons to perithreshold vibrissae stimulation

Previous studies have shown that systemically administered cocaine can transiently alter responses of primary somatosensory cortical neurons to threshold level stimulation of peripheral receptive fields. The goal of the present investigation was 2-fold: (1) characterize the effects of systemic cocaine on stimulus-evoked responses of the ventral posterior medial (VPM) thalamic neurons which relay somatosensory information to the cortex and (2) determine the time course and magnitude of changes in monoamine levels within the somatosensory thalamus following systemic administration of cocaine. Extracellularly recorded responses of single VPM thalamic neurons to whisker stimulation were monitored before and after cocaine administration in halothane anaesthetized rats. Each cell was first characterized by assessing its response profile to a range of perithreshold level deflections of the optimal whisker on the contralateral face. Drug effects on stimulus-response curves, response magnitude and latency were determined from quantitative analysis of spike train data. The results indicate that cocaine elicits a predictable augmentation or attenuation of the sensory response magnitude, with the direction of the change inversely related to the initial magnitude of the stimulus-evoked discharge. In addition, cocaine consistently reduced the response time of somatosensory thalamic neurons to peripheral receptive field stimulation. At the same dose and over the same time period, cocaine also produced marked elevation of norepinephrine and serotonin levels within the ventrobasal thalamus, as determined by in vivo microdialysis. These results suggest that cocaine-induced increases in norepinephrine and serotonin are responsible for drug-related modulation of the transfer of sensory signals through primary thalamocortical relay circuits.     

Magnetoencephalographic responses to painful impact stimulation

Magnetoencephalographic (MEG) field recordings are unique to detect current dipoles in SI and SII. Few devices are available for painful mechanical stimulation in magnetically shielded MEG rooms. The aim of the present MEG (dual 37-channel biomagnetometer) study was to investigate the location of the cortical generators evoked by painful impact stimuli of different intensities. An airgun was placed outside the shielded MEG room, and small plastic bullets were fired at the arm and trunk of the subjects in the room. The velocity of the bullet was measured and related to the evoked pain intensity. Stimuli were delivered for each of the following three conditions: strong pain intensity elicited from the upper arm and upper trunk; weak pain intensity elicited from the upper trunk. The evoked MEG responses had a major component with the characteristically polarity-reversal deflections indicating a dipole located beneath the coils. The response could be estimated by a single current dipole. When the estimated locations of the dipoles were superimposed on the individual magnetic resonance images (MRIs), consistent bilateral activation of areas corresponding to the secondary sensory cortices (SII) was found.     

Postural responses to low‐intensity,short‐duration,galvanic vestibular stimulation as a possible differential diagnostic procedure

Rinalduzzi S, Cipriani AM, Capozza M, Accornero N. Postural responses to low‐intensity, short‐duration, galvanic vestibular stimulation as a possible differential diagnostic procedure.
Acta Neurol Scand: 2011: 123: 111–116.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Objectives – In this study we investigated the effect of polarity‐related differences in short‐duration very low‐intensity galvanic vestibular stimulation (GVS), not perceived by the subject, by evaluating the minimal postural sway responses in healthy people. We also verified its possible usefulness as a differential diagnostic tool in patients with postural instability disturbances related to polyneuropathy or peripheral vertigo. Methods – We applied bimastoid opposite polarity direct current GVS (0.7 mA for 1 s) and recorded the induced postural response with an electromagnetic head position tracker. Latency, amplitude, velocity and an asymmetry index were measured between two reverse polarity sessions. Results – The postural response was easily recorded and was statistically wider in amplitude and velocity in the polyneuropathy group than in the other groups. Postural responses were asymmetric only in the group with mild peripheral vertigo. Conclusion – These findings suggest that even weak GVS affects vestibular excitability: cathodal polarization increases whereas anodal GVS decreases excitability. Symmetry and amplitude or velocity of the postural responses, particularly in the eyes closed condition, can differentiate the three groups of subjects tested.     

Somatosensory cortex responses to median nerve stimulation: fMRI effects of current amplitude and selective attention.

OBJECTIVES: The aim of this study was to localize and to investigate response properties of the primary (SI) and the secondary (SII) somatosensory cortex upon median nerve electrical stimulation. METHODS: Functional magnetic resonance imaging (fMRI) was used to quantify brain activation under different paradigms using electrical median nerve stimulation in healthy right-handed volunteers. In total 11 subjects were studied using two different stimulus current values in the right hand: at motor threshold (I(max)) and at I(min) (1/2 I(max)). In 7 of these 11 subjects a parametric study was then conducted using 4 stimulus intensities (6/6, 5/6, 4/6 and 3/6 I(max)). Finally, in 10 subjects an attention paradigm in which they had to perform a counting task during stimulation with I(min) was done. RESULTS: SI activation increased with current amplitude. SI did not show significant activation during stimulation at I(min). SII activation did not depend on current amplitude. Also the posterior parietal cortex appeared to be activated at I(min). The I(min) response in SII significantly increased by selective attention compared to I(min) without attention. At I(max) significant SI activity was observed only in the contralateral hemisphere, the ipsilateral cerebellum, while other areas possibly showed bilateral activation. CONCLUSIONS: Distributed activation in the human somatosensory cortical system due to median nerve stimulation was observed using fMRI. SI, in contrast to SII, appears to be exclusively activated on the contralateral side of the stimulated hand at I(max), in agreement with the concept of SI's important role in processing of proprioceptive input. Only SII remains significantly activated in case of lower current values, which are likely to exclusively stimulate the sensible fibres mediating cutaneous receptor input. Selective attention only enhances SII activity, indicating a higher-order role for SII in the processing of somatosensory input.     

Paradigms for restoration of somatosensory feedback via stimulation of the peripheral nervous system

The somatosensory system contributes substantially to the integration of multiple sensor modalities into perception. Tactile sensations, proprioception and even temperature perception are integrated to perceive embodiment of our limbs. Damage of somatosensory networks can severely affect the execution of daily life activities. Peripheral injuries are optimally corrected via direct interfacing of the peripheral nerves. Recent advances in implantable devices, stimulation paradigms, and biomimetic sensors enabled the restoration of natural sensations after amputation of the limb. The refinement of stimulation patterns to deliver natural feedback that can be interpreted intuitively such to prescind from long-learning sessions is crucial to function restoration. For this review, we collected state-of-the-art knowledge on the evolution of stimulation paradigms from single fiber stimulation to the eliciting of multisensory sensations. Data from the literature are structured into six sections: (a) physiology of the somatosensory system; (b) stimulation of single fibers; (c) restoral of multisensory percepts; (d) closure of the control loop in hand prostheses; (e) sensory restoration and the sense of embodiment, and (f) methodologies to assess stimulation outcomes. Full functional recovery demands further research on multisensory integration and brain plasticity, which will bring new paradigms for intuitive sensory feedback in the next generation of limb prostheses.     

A long-lasting improvement of tactile extinction after galvanic vestibular stimulation: two Sham-stimulation controlled case studies

Sensory extinction is frequent and often persistent after brain damage. Previous studies have shown the transient influence of sensory stimulation on tactile extinction. In the present two case studies we investigated whether subliminal galvanic vestibular stimulation (GVS) modulates tactile extinction. GVS induces polarity-specific changes in cerebral excitability in the vestibular cortices and adjacent cortical areas in the temporo-parietal cortex via polarization of the vestibular nerves. Two patients (DL, CJ) with left-sided tactile extinction due to chronic (5 vs. 6 (1/2) years lesion age) right-hemisphere lesions (right fronto-parietal in DL, right frontal and discrete parietal in CJ) were examined. Both showed normal tactile sensitivity to light touch and yielded 90-100% correct identifications in unilateral tactile stimulations for both hands. In Baseline investigations without GVS and Sham-GVS both showed stable left-sided tactile extinction rates of 40-55% (DL) and 49-72% (CJ). In contrast, one session of right-cathodal GVS (intensity: 0.6 mA, duration: 20 min) permanently improved tactile identification of identical stimuli, while a second session with left-cathodal GVS significantly reduced left-sided extinction rates for different stimuli in DL. Patient CJ's left-sided tactile extinction was significantly improved by left-cathodal GVS (0.5 mA, 20 min) for different stimuli, while right-cathodal GVS induced a significant reduction for identical materials. In contrast, Sham-stimulation was ineffective. Improvements remained stable for at least 1 year (DL) resp. 3 weeks (CJ). Control experiments ruled out improvements in tactile extinction merely by retesting. In conclusion, chronic tactile extinction may be permanently improved by GVS in a polarity-specific way.     

Postural responses to combined vestibular and hip proprioceptive stimulation in man

Vestibular-proprioceptive interaction in human postural control in the frontal plane was studied by analysing the lateral body sway evoked in a standing subject by a weak, near-threshold galvanic vestibular stimulation combined with a balanced, bilateral vibration of the medial gluteus muscles. The intensities of the stimuli were adjusted so that none of them produced a consistent postural response when delivered alone. The pattern of the lateral body sway evoked by the combined stimulation was compared with postural responses to suprathreshold vestibular stimulation and asymmetric (unilateral) vibration of the hip abductors. During the vestibular stimulation alone the head movement started earlier and was larger than movement of the hip. During unilateral vibration the head movement was delayed with respect to the hip movement and the amplitude of head deviation was less than that of the hip. The pattern of postural response to combined vestibular stimulation and balanced vibration resembled that observed under unbalanced, unilateral vibration in terms of both the latencies and amplitudes of deviation of the body segments from their respective baseline positions. It is suggested that the asymmetric vestibular signal provided by galvanic stimulation of the labyrinth introduces a bias into the reference frame for central interpretation of proprioceptive signals so that a symmetric proprioceptive input gives rise to a lateral body sway when referenced to an asymmetric vestibular input.     

Modulation of the soleus H‐reflex following galvanic vestibular stimulation and cutaneous stimulation in prone human subjects

There is evidence to suggest that vestibular and somatosensory inputs may interact when they are processed by the central nervous system, although the nature of the individual sensory contributions to this interaction is unknown. We examined the effects of a combined vestibular and cutaneous conditioning stimulus on the motoneuron pool that supplies the soleus muscle via the Hoffman reflex (H‐reflex). We applied galvanic vestibular stimulation (GVS; bipolar, binaural, 500 ms, 2.5‐mA square‐wave pulse) and cutaneous stimulation (medial plantar nerve; 11 ms, three‐pulse train, 200 HZ ) to prone human subjects and examined changes in the amplitude of the H‐reflex. GVS alone caused facilitation (approximately 20%) of the H‐reflex, whereas ipsilateral cutaneous stimulation alone caused a 26% inhibition. Paired GVS and cutaneous stimulation resulted in a linear summation of the individual conditioning effects. H‐reflex amplitudes observed after paired conditioning with GVS and cutaneous stimulation could be predicted from the amplitudes observed with individual conditioning. These results suggest that in the prone position, when the muscles are not posturally engaged, vestibular and somatosensory information appear to sum in a linear fashion to influence the reflex response of lower limb motoneurons. Muscle Nerve 40: 213–220, 2009