Recent advances in the diagnosis and treatment of balance disorders

  title={Recent advances in the diagnosis and treatment of balance disorders},
  author={Klaus Jahn and Marianne Dieterich},
  journal={Journal of Neurology},
  • K. JahnM. Dieterich
  • Published 27 October 2011
  • Medicine, Psychology, Biology
  • Journal of Neurology
Here we summarize the recent progress made in the diagnosis and treatment of balance and gait disorders. Focusing on work published in the Journal of Neurology in 2010 and 2011, we have found evidence for the following clinically relevant statements: (1) the exclusion of stroke in acute vestibular syndromes is based on the bedside clinical findings; (2) the risk of developing secondary somatoform vertigo is predictable; it is especially high in patients with vestibular migraine; (3) postural… 

Investigating the effect of rivastigmine on postural control in Parkinson's disease dementia

Improvements in clinical and posturographic measures of balance control were observed with donepezil monotherapy and, to a minimal extent, with the addition of selegeline.

[Vestibular vertigo].

It is noted that the cause of vertigo is often misdiagnosed with vertebral-basilar insufficiency, discirculatory encephalopathy, cervical spine pathology; at the same time, BPPV, Meniere's disease, vestibular neuritis or Vestibular migraine is diagnosed less often.

Can 4-aminopyridine modulate dysfunctional gait networks in Parkinson's disease?

Vertigo and dizziness in children.

Pediatricians and neuro-otologists should be aware of the full spectrum of causes of vertigo and dizziness in children and adolescents and take specific approaches for somatoform vertigo, the most frequent diagnosis in adolescent girls.

Referral and Final Diagnoses of Patients Assessed in an Academic Vertigo Center

In particular, BPPV, multisensory dizziness, and vestibular migraine are under-diagnosed by referring physicians, and calls for better education of primary care takers in the field of neuro-otology.

Vertigo and dizziness in children.

  • K. Jahn
  • Medicine
    Handbook of clinical neurology
  • 2016

Health services utilization of patients with vertigo in primary care: a retrospective cohort study

The results emphasize the need for establishing systematic training to improve oto-neurological skills in primary care services not specialized on the treatment of dizzy patients.

Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness

Almost half of patients with vertigo/dizziness suffer from a psychiatric comorbidity, and these patients show more severe psychosocial impairment compared with patients without psychiatric disorders.

Acute dizziness in rural practice: Proposal of a diagnostic procedure

A practical concept is presented to clarify most frequent acute dizziness syndromes using clinical and low budget methods.

Can Gait Signatures Provide Quantitative Measures for Aiding Clinical Decision-Making? A Systematic Meta-Analysis of Gait Variability Behavior in Patients with Parkinson's Disease

A clear functional threshold for monitoring treatment efficacy in patients with Parkinson's disease is defined and quantification of specific functional deficits could well provide a basis for locating the source and extent of the neurological damage, and therefore aid clinical decision-making for individualizing therapies.



Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus

Although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many Vestibular and ocular motor disorders, including betahistine for Ménière’s disease, oxcarbazepine for vestibULAR paroxysmia, or metoprolol for vestIBular migraine.

Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit

While the study is small, classification of AVS in the stroke unit is reliable and the sensitivity and specificity of bedside ocular motor testing are comparable to those previously reported by expert neuro-otologists.

Combined stimulation of the substantia nigra pars reticulata and the subthalamic nucleus is effective in hypokinetic gait disturbance in Parkinson’s disease

A novel stimulation paradigm of simultaneous stimulation on distant electrode contacts located in the STN and the caudal border zone between the STn and substantia nigra pars reticulata (SNr) in a patient with a severe hypokinetic gait disturbance is described.

Unilateral pedunculopontine stimulation improves falls in Parkinson's disease.

It is suggested that pedunculopontine nucleus deep-brain stimulation may be effective in preventing falls in patients with advanced Parkinson's disease but that further evaluation of this procedure is required.

Postural imbalance and falls in PSP correlate with functional pathology of the thalamus

The new and clinically relevant finding of this study is that imbalance and falls in PSP are closely associated with thalamic dysfunction.

HINTS to Diagnose Stroke in the Acute Vestibular Syndrome: Three-Step Bedside Oculomotor Examination More Sensitive Than Early MRI Diffusion-Weighted Imaging

A 3-step bedside oculomotor examination (HINTS: Head-Impulse—Nystagmus—Test-of-Skew) appears more sensitive for stroke than early MRI in AVS.

4-Aminopyridine improves gait variability in cerebellar ataxia due to CACNA 1A mutation

Patients with cerebellar ataxia typically walk with a broadened base of support, decreased step length and increased gait variability, which is a critical parameter in the assessment of patients with gait disorders.

Vestibular dysfunction in migraine: effects of associated vertigo and motion sickness

Patients with MV/MD showed increased VOR time constant (TC) and greater suppression of the post-rotatory nystagmus with forward head tilt, suggesting that innate hypersensitivity of the vestibular system may be an underlying mechanism of motion sickness and increased TC in MD/MV.

Falls and the falls efficacy scale in Parkinson’s disease

The lack of fear of falling but frequent falls in this small subgroup of patients with idiopathic Parkinson’s disease may suggest that special techniques to instill suitable caution to prevent falls are necessary, or may make training of these patients impossible.

Gait variability in Parkinson’s disease: an indicator of non-dopaminergic contributors to gait dysfunction?

Different characteristics explain the two measures of gait variability, pointing to different control mechanisms.