J Clin Neurol.  2019 Jul;15(3):339-346. 10.3988/jcn.2019.15.3.339.

No Evidence of a Contribution of the Vestibular System to Frequent Falls in Progressive Supranuclear Palsy

Affiliations
  • 1Department of Neurology, Ludwig Maximilians University, Munich, Germany. nicolina.goldschagg@med.uni-muenchen.de
  • 2German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.

Abstract

BACKGROUND AND PURPOSE
Conflicting results about vestibular function in progressive supranuclear palsy (PSP) prompted a systematic examination of the semicircular canal function, otolith function, and postural stability.
METHODS
Sixteen patients with probable PSP [9 females, age=72±6 years (mean±SD), mean disease duration=3.6 years, and mean PSP Rating Scale score=31] and 17 age-matched controls were examined using the video head impulse test, caloric testing, ocular and cervical vestibular evoked myogenic potentials (o- and cVEMPs), video-oculography, and posturography.
RESULTS
There was no evidence of impaired function of the angular vestibulo-ocular reflex (gain=1.0±0.1), and caloric testing also produced normal findings. In terms of otolith function, there was no significant difference between PSP patients and controls in the absolute peakto-peak amplitude of the oVEMP (13.5±7.2 µV and 12.5±5.6 µV, respectively; p=0.8) or the corrected peak-to-peak amplitude of the cVEMP (0.6±0.3 µV and 0.5±0.2 µV, p=0.3). The total root-mean-square body sway was significantly increased in patients with PSP compared to controls (eyes open/head straight/hard platform: 9.3±3.7 m/min and 6.9±2.1 m/min, respectively; p=0.032). As expected, the saccade velocities were significantly lower in PSP patients than in controls: horizontal, 234±92°/sec and 442±66°/sec, respectively; downward, 109±105°/sec and 344±72°/sec; and upward, 121±110°/sec and 348±78°/sec (all p<0.01).
CONCLUSIONS
We found no evidence of impairment of either high- or low-frequency semicircular function or otolith organ function in the examined PSP patients. It therefore appears that other causes such as degeneration of supratentorial pathways lead to postural imbalance and falls in patients with PSP.

Keyword

movement disorders; progressive supranuclear palsy; tauopathy; vestibular function; falls

MeSH Terms

Accidental Falls*
Caloric Tests
Female
Head Impulse Test
Humans
Movement Disorders
Otolithic Membrane
Reflex, Vestibulo-Ocular
Saccades
Semicircular Canals
Supranuclear Palsy, Progressive*
Tauopathies
Vestibular Evoked Myogenic Potentials
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