The integration of multisensory motion stimuli is impaired in vestibular migraine patients
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The integration of multisensory motion stimuli is impaired in vestibular migraine patients Maurizio Versino1,2 · Marco Mandalà3 · Silvia Colnaghi2,4 · Giampietro Ricci5 · Mario Faralli5 · Stefano Ramat6 Received: 20 June 2019 / Revised: 7 May 2020 / Accepted: 9 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Vestibular migraine (VM) is a relatively recently acknowledged vestibular syndrome with a very relevant prevalence of about 10% among patients complaining of vertigo. The diagnostic criteria for VM have been recently published by the Bárány Society, and they are now included in the latest version of the International Classification of Headache Disorders, yet there is no instrumental test that supports the diagnosis of VM. Objective In the hypothesis that the integration of different vestibular stimuli is functionally impaired in VM, we tested whether the combination of abrupt vestibular stimuli and full-field, moving visual stimuli would challenge vestibular migraine patients more than controls and other non-vestibular migraineurs. Methods In three clinical centers, we compared the performance in the functional head impulse test (fHIT) without and with an optokinetic stimulus rotating in the frontal plane in a group of 44 controls (Ctrl), a group of 42 patients with migraine (not vestibular migraine, MnoV), a group of 39 patients with vestibular migraine (VM) and a group of 15 patients with vestibular neuritis (VN). Results The optokinetic stimulation reduced the percentage of correct answers (%CA) in all groups, and in about 33% of the patients with migraine, in as many as 87% of VM patients and 60% of VN patients, this reduction was larger than expected from controls’ data. Conclusions The comparison of the fHIT results without and with optokinetic stimulation unveils a functional vestibular impairment in VM that is not as large as the one detectable in VN, and that, in contrast with all the other patient groups, mainly impairs the capability to integrate different vestibular stimuli. Keywords Vestibular migraine · International classification of headache disorders · Functional head impulse test · Vestibular ocular reflex · Optokinetic stimulation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-09905-1) contains supplementary material, which is available to authorized users. * Stefano Ramat [email protected]
1
Neurology Unit, ASST Settelaghi, Insubria University, DMC, Varese, Italy
Maurizio Versino maurizio.versino@asst‑settelaghi.it
2
Neuro‑Otology and Neuro‑Ophthalmology Lab, IRCCS Mondino Foundation, Pavia, Italy
Marco Mandalà [email protected]
3
Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
Silvia Colnaghi [email protected]
4
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
Giampietro Ricci [email protected]
5
Depart
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