Search Results (1,068)

Pediatric episodic vestibular syndrome (pEVS) is a frequent source of diagnostic uncertainty because recurrent vertigo, dizziness, and unsteadiness in children may arise from disorders with markedly different mechanisms, prognostic implications, and management pathways. Symptom descriptions are often imprecise, interictal examination may be normal, and similar recurrent attack patterns may reflect spontaneous, triggered, neurologic, autonomic, audiovestibular, or extravestibular conditions. This Perspective proposes a clinician-oriented, phenotype-first framework for the practical evaluation of pEVS, grounded in the International Classification of Vestibular Disorders and Bárány Society consensus criteria where available. The proposed approach begins with structured history taking and focused bedside examination, emphasizing the core symptom category, attack duration, trigger profile, and associated migraine, auditory, autonomic, and neurologic features. Recurrent attacks are then organized into clinically recognizable phenotypes, including spontaneous non-migraine and migraine-related presentations, auditory phenotypes, ultrabrief stereotyped attacks, trigger-related attacks, orthostatic/autonomic phenotypes, motion- or visually-triggered dizziness, episodic vertigo with transient neurologic signs, and anxiety-related presentations. Rather than providing an exhaustive etiologic review, this framework is intended to support bedside classification, guide selective ancillary testing, and facilitate longitudinal reassessment, as diagnostic reclassification may occur over time. A phenotype-driven approach may improve diagnostic reasoning, support more rational use of ancillary testing, and facilitate earlier recognition of both common and less frequent but clinically important disorders. Full article

Background/Objective: In late adulthood, the increasing prevalence of diabetes overlaps with the highest prevalence of postural instability. A cross-sectional study was designed to explore the combined influence of age, gender, history of COVID-19 quadriceps strength, and Body Mass Index (B.M.I.) on the postural stability of adults with/without diabetes, under a variety of sensory conditions. Methods: A total of 263 adults aged 21 to 82 years old accepted to participate, 99 with and 164 without diabetes. They had no history of vestibular/otology/neurology/autoimmune/orthopedic disease or proliferative retinopathy/severe renal dysfunction/traumatic injury. After clinical and vestibular evaluations, postural sway was recorded on hard/soft surface, eyes open/closed, and without/with 30° neck extension. Bivariate analysis and repeated measures multivariate analysis of covariance were performed with 0.05 significance. Results: In the two groups, two thirds of the participants had excess weight and almost half had history of COVID-19. Overall conditions, gender and diabetes were the main factors contributing to sway area (multiple R = 0.28–0.31, p ≤ 0.001) and to sway length (multiple R = 0.34–0.47, p ≤ 0.00001). Compared to adults without diabetes, in those with diabetes, the age was not related to sway measurements; with contribution to sway from history of COVID-19 and quadriceps strength, and decreased contribution of the study variables to both the anterior–posterior position of the center of pressure and ankle movement (velocity as a function of the anterior–posterior position of the center of pressure) (p > 0.05). Conclusions: Diabetes may interfere with the influence of individual cofactors contributing to postural sway, including decreased influence of age and reduced ankle movement. A history of mild–moderate COVID-19 may have influence on postural control in varied sensory conditions. Full article

Cerebellar Ataxia, Neuropathy and Bilateral Vestibular Areflexia Syndrome (CANVAS) is a progressive multisystem disorder characterized by cerebellar ataxia, sensory neuropathy and bilateral vestibular failure. Although intensive rehabilitation is commonly recommended, the actual effectiveness and the most appropriate physiotherapeutic strategy for CANVAS have not been clearly established. Background/Objectives: To evaluate the effects of an integrated rehabilitation program combining neurocognitive therapeutic exercise and focal muscle vibration (FMV) on clinical and instrumental measures of gait, balance and postural stability in a CANVAS patient. Methods: A structured protocol consisting of neurocognitive therapeutic exercise and FMV was administered. Clinical measures included the Berg Balance Scale, Tinetti, SARA and SF-36. The instrumental evaluations included stabilometry and gait analysis. Results: The intervention produced improvements in balance scores associated with a reduction in fall risk. Stabilometry revealed reduction in oscillation area. Conclusions: FMV combined with neurocognitive therapeutic exercise may promote clinical and biomechanical improvements in CANVAS. Full article

Background: Migraine in older adults represents an increasingly relevant yet underrecognized clinical challenge in aging societies, where multimorbidity, frailty, and polypharmacy complicate both diagnosis and management. Although traditionally considered a disorder of younger individuals, migraine frequently persists or presents after the age of 60 with atypical features, contributing to diagnostic uncertainty. Methods: This narrative review, conducted in accordance with the SANRA principles, aims to provide a comprehensive overview of the epidemiology, clinical presentation, pathophysiology, and management of migraine in older adults, with particular emphasis on age-related complexities, therapeutic challenges, and unmet clinical needs. Results: Migraine in this population often presents with atypical or misleading features, such as aura without headache, vestibular symptoms, or overlap with cerebrovascular conditions, leading to delayed or incorrect diagnoses. The burden of disease is substantial, affecting physical function, mobility, cognition, emotional well-being, and social participation, and is further amplified by comorbid conditions including cardiovascular and metabolic disorders, mood disturbances, and chronic pain syndromes. Aging-related neurobiological changes, such as impaired pain modulation, endothelial dysfunction, and neuroinflammation, may influence disease expression and treatment response. Therapeutic management is challenged by contraindications, increased susceptibility to adverse drug effects, and the complexity of polypharmacy, highlighting the importance of individualized and non-pharmacological approaches. Conclusions: Migraine in older adults is a significant but often overlooked contributor to disability and reduced quality of life. Improved recognition of its unique clinical features and age-specific vulnerabilities is essential to optimize patient-centered care. Future research should prioritize the inclusion of older populations and the development of tailored, safe, and effective management strategies. Full article

Virtual reality (VR) has been increasingly adopted as a digital tool in rehabilitation for balance training, coordination improvement, and motor recovery, yet the literature remains dispersed across clinical rehabilitation, exercise-based interventions, and broader motor-related applications. This fragmentation makes it difficult to determine how the field has evolved and where research emphasis has shifted. This study mapped the research landscape and thematic evolution of VR for balance, coordination, and motor rehabilitation using bibliometric analysis and topic modeling. A total of 1258 articles indexed in the Web of Science Core Collection from 2011 to 2025 were analyzed. Only English language articles and reviews relevant to VR-based balance, coordination, or motor rehabilitation research were included, yielding a final dataset of 1258 publications. CiteSpace and VOSviewer were used to examine keyword co-occurrence, clustering patterns, and temporal trends, while Latent Dirichlet Allocation (LDA) was applied to identify latent themes and their temporal dynamics. The field has moved beyond early feasibility testing toward a more differentiated landscape shaped by distinct clinical targets, population groups, and training purposes. Seven recurring themes were identified, including vestibular rehabilitation and immersive training, post-stroke upper-limb rehabilitation, efficacy and adverse-effect assessment, balance and gait training interventions, evidence synthesis and review-based evaluation, elderly exercise and cognitive interventions, and skill-oriented virtual task training with recent expansion toward broader population groups and task-specific applications beyond traditional rehabilitation settings. VR research on balance, coordination, and motor rehabilitation has evolved into a more thematically differentiated field rather than remaining a single rehabilitation-oriented domain. By combining bibliometric mapping with topic modeling, this study clarifies where evidence is concentrated and which thematic directions are gaining visibility, providing a clearer basis for future evidence synthesis and more comparable intervention reporting. Full article

Objective: This study aims to analyze the characteristics of vestibular evoked myogenic potentials (VEMPs) and evaluate specific vestibular nerve pathway impairments in children with Attention Deficit Hyperactivity Disorder (ADHD) compared to typically developing (TD) children. Methods: Forty-five children with ADHD and 34 TD children were recruited. All participants underwent comprehensive acoustic (ACS) and galvanic (GVS) VEMP examinations. To account for within-subject correlation, statistical analyses were performed at the subject level. Results: Children with ADHD exhibited prolonged P13 and N23 latencies in both ACS-cVEMP and GVS-cVEMP compared to TD children. For oVEMP, the N1 latency of ACS-oVEMP was significantly shorter in the ADHD group, and the interval was prolonged. Additionally, the absolute amplitude of ACS-cVEMP was significantly and markedly higher in children with ADHD. Conclusions: Children with ADHD exhibit functional abnormalities in both the saccule inferior vestibular nerve pathway (reflected by cVEMP) and the utricle superior vestibular nerve pathway (reflected by oVEMP). These impairments are primarily characterized by altered neural conduction latencies and hyperactive amplitude responses, providing valuable electrophysiological insights into vestibular dysfunction in ADHD. Full article

Background: In the last few decades, a growing body of evidence has confirmed that vestibular rehabilitation (VR) can improve the symptoms of many unilateral and bilateral vestibular disorders, by facilitating vestibular compensation mechanisms, such as adaptation, substitution, and habituation. However, the usefulness of the vestibular rehabilitation approach in Persistent Postural–Perceptual Dizziness (PPPD) is currently highly debated and unclear. The aim of the present study was to evaluate the efficacy of VR using computerized dynamic posturography in PPPD patients as a single treatment and without other associated psychological or pharmacological therapies. Results were compared with patients with unilateral and bilateral vestibular disfunction, in order to define the role of our rehabilitation model within a framework of personalized therapy for different disorders. Methods: We evaluated 44 patients (23 F, 21 M; ranged from 28 to 82 years; mean age 63.72) affected by unilateral vestibular vestibulopathy (UVP) (n = 19), bilateral vestibular vestibulopathy (BVP) (n = 10) and PPPD (n = 15). For each patient, a comprehensive clinical bedside vestibular assessment was carefully performed by expert clinicians, as well as Bithermal caloric tests with videonystagmography (VNG), Video Head Impulse Test (vHIT) and Computed Dynamic Posturography (CDP). The impact of dizziness on quality of life (QoL) was assessed by the Italian Dizziness Handicap Inventory (DHI). All subjects evaluated in this study underwent five rehabilitative therapy sessions in our centre, once a week for 45 min and exercised daily for 30 min at home. All the exercises progressively became more difficult each week. Results: Our study showed that vestibular rehabilitation improved quality of life and reduced the level of self-perceived handicap in patients affected by unilateral and bilateral vestibular dysfunction, with significant improvement in DHI total score and posturographic parameters. In PPPD patients, rehabilitation did not significantly modify posturographic performances and the improvement in total DHI score did not reach statistical significance, although a significant change was observed in the functional sub-score. Conclusions: Vestibular rehabilitation confirmed its effectiveness in unilateral and bilateral peripheral vestibulopathies. In patients with PPPD, rehabilitation performed with computerized dynamic posturography may reduce subjective handicap and improve some aspects of daily functioning, although the small sample size and the absence of a control group do not allow definitive conclusions about its efficacy. Full article

Background: Vestibular schwannoma (VS) stereotactic radiosurgery (SRS) requires high target conformality and rapid dose falloff to spare adjacent organs at risk (OARs), particularly the brainstem. HyperArc (HA) is an automated noncoplanar volumetric-modulated arc therapy (VMAT) approach designed to standardize and streamline cranial SRS planning and delivery. We compared CyberKnife (CK) with HA for single-fraction VS SRS and evaluated the impact of multileaf collimator (MLC) leaf width. Methods: Fifteen VS cases previously treated with single-fraction CK SRS (12.5 Gy) were retrospectively replanned using HA. HA plans used four preconfigured noncoplanar partial arcs and were created with either a standard 5.0 mm MLC (HA-SMLC) or a 2.5 mm high-definition MLC (HA-HDMLC). HA plans were normalized to match the prescription dose target coverage of the corresponding CK plan for each of the patients. Endpoints included planning target volume (PTV) dosimetric statistics (Dmean, Dmin, Dmax, D98%), Paddick conformity index (PCI), Paddick gradient index (GI), ICRU Report 83 homogeneity index (HI), brain V12Gy, and brainstem Dmax. Because plans were generated for the same patients, paired comparisons were performed using two-sided Wilcoxon signed-rank tests (p < 0.05). Results: Both HA techniques achieved a higher near-minimum target dose than CK, with significantly higher PTV D98% (CK 12.35 ± 0.52 Gy; HA-SMLC 12.54 ± 0.28 Gy; HA-HDMLC 12.57 ± 0.35 Gy; p < 0.05). HA reduced target hotspots, with lower PTV Dmax than CK (CK 15.25 ± 0.32 Gy; HA-SMLC 14.70 ± 0.39 Gy; HA-HDMLC 14.73 ± 0.32 Gy; p < 0.05), and improved homogeneity and dose falloff as reflected by HI and GI (p < 0.05). CK achieved the highest conformity by PCI (p < 0.05), while HA-HDMLC improved PCI compared with HA-SMLC (p < 0.05). Brain V12Gy and brainstem Dmax were low and did not differ significantly among techniques. Conclusions: HA provides dosimetric performance comparable to CK for single-fraction VS SRS, with improved near-minimum PTV dose, reduced hotspots, and steeper dose gradients. Although CK showed the highest PCI overall, conformity improved with HA when a high-definition MLC was used. Overall, these findings support HA, particularly HA-HDMLC, as an efficient and clinically practical option for VS SRS treatment planning. Full article

Background: Vestibular symptoms and objective vestibular dysfunction have been reported in patients with autoimmune and rheumatologic diseases, but available evidence remains fragmented and methodologically heterogeneous. Previous studies have often addressed audiovestibular involvement as a combined entity, limiting disease-specific interpretation of vestibular outcomes. Methods: A PRISMA 2020-based systematic review was conducted using predefined eligibility criteria targeting vestibular outcomes in autoimmune and systemic rheumatologic diseases. Observational studies reporting vestibular symptoms and/or objective vestibular test results were included. Vestibular data were extracted even when studies reported combined audiovestibular outcomes. Certainty of evidence was assessed using the GRADE approach. Results: Twenty-seven studies were included in the qualitative synthesis, comprising 14 primary observational studies and 13 reviews. Vestibular involvement was reported across multiple diseases, including systemic sclerosis, giant cell arteritis, ankylosing spondylitis, psoriatic arthritis, Behçet disease, primary Sjögren syndrome, rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and vasculitic disorders. Objective vestibular abnormalities were most frequently identified using caloric testing, balance integration measures, videonystagmography, and video head impulse testing. Systemic sclerosis and giant cell arteritis showed more consistently reported vestibular findings, although heterogeneity in assessment methods precluded quantitative synthesis. Conclusions: Vestibular involvement occurs across autoimmune and systemic inflammatory diseases, but overall certainty of evidence remains limited. Standardized vestibular assessment and longitudinal studies are needed to better define disease-specific vestibular phenotypes. Full article

Background/Objectives: This systematic review synthesizes MRI evidence to characterize neuromorphological alterations in somatosensory and vestibular brain regions among adolescents with idiopathic scoliosis (AIS). Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines. We systematically searched five databases from inception to January 2026 for case–control MRI studies comparing AIS patients (10–18 years) with healthy controls. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Newcastle–Ottawa Scale. Results: Across 15 studies (1270 participants), AIS patients demonstrated consistent neuromorphological alterations: (1) lower cerebellar tonsil position (0.9–2.8 mm below baseline), with ectopia incidence correlating with curve severity; (2) cortical thickening in bilateral medial regions but thinning in left paracentral areas; (3) left-dominant white matter volume increases and impaired microstructure in the corpus callosum; and (4) left-sided vestibular morphological changes, including a more vertical semicircular canal. Conclusions: AIS is associated with consistent neuromorphological alterations in key somatosensory and vestibular regions, supporting a potential neuroanatomical basis for impaired sensorimotor integration in its pathogenesis. It should be noted that substantial heterogeneity among the included studies prevented a meta-analysis, and the cross-sectional design limits causal interpretations Registration: This systematic review was registered in PROSPERO (CRD42024577195). Full article

Background: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic vestibular disorder that has been receiving more research attention lately. Nonetheless, there is a lack of systematic bibliometric overviews tracing the conceptual evolution, knowledge structure, and emerging research frontiers within this field. The utilization of bibliometric and visualization analyses can enhance the understanding of trends and central themes in PPPD research, offering valuable insights for future studies. Methods: Data were retrieved from the Web of Science Core Collection, yielding a final dataset of 370 bibliographic records (“DATA”). We employed CiteSpace, HistCite, the Alluvial Generator, and R software to conduct multi-dimensional statistical and visualization analyses on publication trends, collaborative networks (countries/institutions/authors), disciplinary distribution, citation bursts, and the evolution of keyword clusters. Results: Starting from 2005, there has been a notable increase in publication volume, reaching its peak in 2024. The United States and Germany are at the forefront of national collaboration, with the University of Munich and the Mayo Clinic being key research institutions. The research focus has transitioned from a primary emphasis on Psychiatry to a broader scope encompassing Neurosciences, Otorhinolaryngology, and General Medicine. Keyword analysis reveals a shift towards standardized terminology, transitioning from “phobic postural vertigo” to “diagnostic criteria” and “consensus documents”. Current research trends are centered around comorbidity mechanisms like “vestibular migraine”, therapeutic approaches such as “vestibular rehabilitation”, and quality of life assessments using the “dizziness handicap inventory”. The 2017 consensus document by the Bárány Society is highlighted as a pivotal publication with significant citation impact. Conclusions: The intellectual structure of the field, as revealed by this bibliometric analysis, has transitioned from a phenomenological description to a conceptual unification. The bibliometric analysis indicates that the field is currently in a conceptually stabilized stage characterized by a research focus on refining diagnostic precision and comorbidity exploration, while scholarly attention remains biologically exploratory regarding objective biomarkers and pathophysiological mechanisms. Full article

Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease characterized by immune dysregulation, microvascular damage, and progressive fibrosis affecting multiple organs. While cardiopulmonary, renal, and gastrointestinal manifestations have been extensively investigated, involvement of the vestibular system remains insufficiently explored and is likely underrecognized in clinical practice. Vestibular symptoms such as dizziness, vertigo, imbalance, and postural instability may significantly affect quality of life and functional independence in patients with SSc. The pathophysiology of vestibular involvement in SSc is presumed to be multifactorial, involving microangiopathy of the inner ear, immune-mediated damage to vestibular end organs, fibrotic changes affecting inner ear homeostasis, and, in some cases, central nervous system involvement. This narrative review provides a comprehensive and critical synthesis of the current literature on vestibular alterations in systemic sclerosis. We discuss underlying mechanisms, clinical manifestations, diagnostic strategies, associations with common vestibular disorders, and the role of vestibular rehabilitation. By consolidating existing evidence and identifying knowledge gaps, this review aims to promote a more systematic and multidisciplinary approach to the evaluation and management of vestibular dysfunction in SSc. Full article

Vulvodynia is a chronic gynecological condition characterized by unexplained vulvar pain, which may significantly impact every aspect of women’s quality of life, encompassing physical, psychological, and social well-being. Due to its heterogeneous clinical presentation and associated comorbidities, vulvodynia is often misdiagnosed and/or not adequately treated. This descriptive observational study was conducted using an anonymous questionnaire, which was distributed through social media channels and included 29 questions (25 multiple-choice and four open-ended questions) and aimed to investigate participants’ most frequent symptoms, comorbidities, impact on quality of life, and treatment efficacy and costs. Analyzing a total of 221 answers, we found that burning (85%) and abrasion/irritation sensation (73%) are the most common symptoms, and they are most frequently localized in the vestibular area, while irritable bowel syndrome (35%) is the most common comorbidity. A significant negative effect on individual functioning was confirmed, also due to a noticeable diagnostic delay (4.5 years on average) and treatments’ prohibitive costs potentially impairing participants’ compliance. Our study provides valuable insights into self-reported aspects of women affected by vulvodynia, raising healthcare professionals’ awareness of this issue. Better knowledge of peculiar aspects of vulvodynia may help improve its diagnosis and promote a more personalized and efficient therapeutic approach. Full article

Postural control relies on the integration of visual, vestibular, and somatosensory inputs under biomechanical constraints. Conventional Romberg testing provides limited quantitative insight, particularly regarding directional control and sensory dependence. Wearable inertial measurement units (IMUs) enable portable, multidimensional assessment of postural sway. Thirty healthy adults (15 females, 15 males) completed a modified Romberg protocol with systematic manipulation of stance (normal, tandem), visual condition (eyes open, eyes closed), and arm position (arms at sides, arms forward), including both left and right leading foot during tandem stance. Whole-body kinematics were recorded using a full-body IMU system comprising 17 wireless sensors. Center-of-mass (CoM) trajectories were derived from a 23-segment biomechanical model, and linear, spatial, and nonlinear sway metrics were computed. Statistical analyses were conducted using repeated-measures ANOVA, with significance set at p < 0.05. Visual deprivation significantly increased sway path length, mean sway velocity, and sway area across all stance conditions (p < 0.001). Tandem stance elicited greater mediolateral sway than normal stance (p < 0.001). Romberg ratios exceeded unity for all metrics and were significantly higher in tandem stance (p < 0.01). Arm position effects were negligible in normal stance but showed significant Vision × Arm interactions during tandem stance (p < 0.05). Leading foot position had no significant main effects. Combining a modified Romberg protocol with full-body IMU-based CoM analysis enables sensitive characterization of sensory dependence and directional postural control. Tandem stance with visual deprivation increases mediolateral postural demands under reduced base-of-support conditions, providing a more challenging context for evaluating directional postural control. Full article

Background/Objective: Dizziness is managed using various therapies, including lifestyle changes, nutritional supplementation, pharmaceutical therapies, and physical therapy, each offering differing efficacy. With legalization of cannabis in Canada, patients are exploring its use in treating their dizziness and related symptoms. Limited knowledge exists regarding usage patterns, forms, doses, and effects on these symptoms. The current study aims to examine cannabis use in patients experiencing dizziness. Methods: We conducted a cross-sectional study at the Ottawa Hospital outpatient neuro-otology clinic. Eligible participants included new patients presenting with a primary complaint of dizziness and follow-up patients reporting new-onset dizziness. Participants completed a questionnaire capturing demographic data, dizziness and related symptoms, attitudes toward cannabis use, consumption patterns, and its perceived effects on their symptoms. Results: Of 154 participants, 118 (77%) expressed willingness to consider cannabis for dizziness and 78 (51%) reported previous cannabis use. Of those patients, 44 (56%) consumed it recreationally, largely via smoking (29/78, 37%). Approximately 21% of these patients reported a moderate–large subjective relief from dizziness after use of cannabis. The most common diagnoses amongst cannabis users were migraine/vestibular migraine (24%), persistent postural perceptive dizziness (22%), and benign paroxysmal positional vertigo (17%). Other related symptoms relieved by cannabis included sleep (28/78, 36%), emotional difficulties (17/78, 22%), neck pain/stiffness (14/78, 18%) and headaches/migraines (9/78, 12%). Conclusions: There is generally a positive attitude towards cannabis use in treating dizziness amongst patients, with a subset of patients reporting a subjective improvement of dizziness and its related symptoms, such as sleep and emotional difficulties. Full article