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Cervical vestibular evoked myogenic potential asymmetry, but not amplitude, differentiates vestibular migraine during prolonged unidirectional visual motion
(Frontiers Media SA, 2026-03-17)
Elvira Cortese
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Huseyin Nezih Ozdemir
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Anca-Diana Grigore
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CASTRO ABARCA, PATRICIA BERNARDITA
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Nehzat Koohi
<jats:sec> <jats:title>Introduction</jats:title> <jats:p>Vestibular migraine (VM) is the leading cause of episodic vestibular complaints. It arises from altered brain states that disrupt sensory processing. A reliance on clinical history for diagnosis highlights the need for bedside biomarkers, particularly in emergency settings where misdiagnosis is common.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p> In this cross-sectional study, 30 VM patients (median-age = 40.5; 27 females) from University College London vestibular clinics and 30 age-gender matched healthy controls (median-age = 32.5; 27 females) were recruited, between May 2024 and October 2025. Cervical Vestibular Evoked Myogenic Potential (cVEMP) responses were measured before and after a <jats:italic>Unidirectional Visual Motion Stimuli</jats:italic> delivered via virtual reality goggles. </jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p> Mixed linear modeling (MLM) showed no significant effects of group, condition or ear on cVEMP amplitude (all <jats:italic>p</jats:italic>  &gt; 0.05). MLM on asymmetry revealed a significant effect of group, <jats:italic>F</jats:italic> (1, 57.21) = 11.89, <jats:italic>p</jats:italic>  = 0.001 and condition, <jats:italic>F</jats:italic> (1, 56.53) = 14.47, <jats:italic>p</jats:italic>  = &lt;0.001; but no significant group × condition interaction, <jats:italic>F</jats:italic> (1, 56.53) = 1.57, <jats:italic>p</jats:italic>  = 0.215. Spearman correlations showed no association between cVEMP delta amplitude and DHI. VM patients scored higher on all symptom’s measures compared with controls (All <jats:italic>p</jats:italic>  &lt; 0.001). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Prolonged unidirectional visual stimulation does not significantly affect cVEMP amplitude responses in VM, limiting its value as a differential diagnostic tool. The need to further explore asymmetry and interaural/interhemispheric sensory integration in VM is underscored.</jats:p> </jats:sec>
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Romberg test: Differentiating vestibular from somatosensory ataxia
(Springer Science and Business Media LLC, 2026-01-24)
Sofia Mermelstein
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Lucia Joffily
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Toby J. Ellmers
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Isaac Bocai
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Márcia Jardim
1
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Chronic dizziness in older adults: Disrupted sensorimotor EEG beta oscillations during postural instability
(Elsevier BV, 2025-06)
Toby J. Ellmers
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Richard Ibitoye
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CASTRO ABARCA, PATRICIA BERNARDITA
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Elmar C. Kal
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Diego Kaski
Scopus© Citations 2 1
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Towards an explanation for ‘unexplained’ dizziness in older people
(2024)
CASTRO ABARCA, PATRICIA BERNARDITA
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Richard Ibitoye
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Toby Ellmers
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Diego Kaski
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Qadeer Arshad
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Subjective unsteadiness or dizziness, usually without increase in body sway, is common in older people. The absence of mechanistic understanding of such symptoms renders clinical management difficult. Here, we explore the mechanisms behind such idiopathic dizziness (ID), focusing on postural control abnormalities.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Thirty patients with ID and 30 age-matched controls stood on a moving platform. Platform oscillations were randomly delivered at different velocities (from 0 to 0.2 m/s). Markers of postural control, including objective sway (trunk sway path, recorded via a sensor attached to vertebrae C7), stepping responses, subjective instability and anxiety ratings were obtained. MRI scans were available for correlations with levels of cerebral small vessel disease in 28 patients and 24 controls.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>We observed a significant relationship between objective and subjective instability in all groups. The slope of this fit was significantly steeper for patients than controls, indicating greater perceived instability for the same body sway. Stepwise linear regression showed that the slopes of this objective–subjective instability relationship were best explained by concerns about falling (Falls Efficacy Scale-International), clinical physical functioning (Short Physical Performance Battery) and, to some degree, by neuroimaging markers of cerebral small vessel disease. In addition, patients had a reduced stepping threshold, suggesting an overly cautious postural response.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The distorted perception of instability and subtle impairments in balance control, including abnormal and overly cautious stepping responses, underlies the emergence of ID. It appears to relate to changes in postural performance, psychological functioning and disruption of postural brain networks associated with cerebral small vessel disease.</jats:p> </jats:sec>
Scopus© Citations 7 1
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Multisensory contribution in visuospatial orientation: an interaction between neck and trunk proprioception
(2021)
Jason McCarthy
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CASTRO ABARCA, PATRICIA BERNARDITA
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Rachael Cottier
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Joseph Buttell
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Qadeer Arshad
<jats:title>Abstract</jats:title><jats:p>A coherent perception of spatial orientation is key in maintaining postural control. To achieve this the brain must access sensory inputs encoding both the body and the head position and integrate them with incoming visual information. Here we isolated the contribution of proprioception to verticality perception and further investigated whether changing the body position without moving the head can modulate visual dependence—the extent to which an individual relies on visual cues for spatial orientation. Spatial orientation was measured in ten healthy individuals [6 female; 25–47 years (SD 7.8 years)] using a virtual reality based subjective visual vertical (SVV) task. Individuals aligned an arrow to their perceived gravitational vertical, initially against a static black background (10 trials), and then in other conditions with clockwise and counterclockwise background rotations (each 10 trials). In all conditions, subjects were seated first in the upright position, then with trunk tilted 20° to the right, followed by 20° to the left while the head was always aligned vertically. The SVV error was modulated by the trunk position, and it was greater when the trunk was tilted to the left compared to right or upright trunk positions (<jats:italic>p</jats:italic> < 0.001). Likewise, background rotation had an effect on SVV errors as these were greater with counterclockwise visual rotation compared to static background and clockwise roll motion (<jats:italic>p</jats:italic> < 0.001). Our results show that the interaction between neck and trunk proprioception can modulate how visual inputs affect spatial orientation.</jats:p>
5Scopus© Citations 9
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Case Report: Acute Onset Fear of Falling and Treatment With “Cognitive Physical Therapy”
(2021)
CASTRO ABARCA, PATRICIA BERNARDITA
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Shree Vadera
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Matthew James Bancroft
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Joseph Buttell
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Diego Kaski
<jats:p>Fear of falling (FoF) is prevalent in older adults, especially those with previous falls, and typically starts insidiously. We present a 78-year-old woman with an abrupt onset FoF and no history of falls, balance problems, vertigo, oscillopsia, psychiatric or psychological issues to account for this. These cognitive changes led to a behavioural alteration of her gait that became slow and wide-based, with her gaze fixed on the floor. She began a tailored program of “Cognitive Physical Therapy (CPT)” combining cognitive behavioural therapy (CBT) and physical rehabilitation. 1 month later her 6 m walk time and steps were reduced by a 25 and 35%, respectively, and the stride length increased by 34%, with further improvement 2 months later. We postulate that the abrupt onset of symptoms triggered a central shift toward postural hypervigilance and anxiety, suppression of anticipatory (feed forward) postural adjustments (APA) leading to FoF. CPT improved objective gait parameters related to FoF and reduced postural anxiety suggesting that early diagnosis and prompt treatment may avoid chronic symptoms and social isolation.</jats:p>
Scopus© Citations 11 1
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Head shaking does not alter vestibulo ocular reflex gain in vestibular migraine
(2022)
Priyani Patel
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CASTRO ABARCA, PATRICIA BERNARDITA
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Nehzat Koohi
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Qadeer Arshad
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Lucia Gargallo
<jats:p>Vestibular Migraine (VM) is the most common cause of non-positional episodic vestibular symptoms. Patients with VM commonly report increased motion sensitivity, suggesting that vestibular responses to head movement may identify changes specific to VM patients. Here we explore whether the vestibulo-ocular reflex (VOR) gain alters in response to a clinical “headshake” maneuver in patients with VM. Thirty patients with VM in the inter-ictal phase, 16 patients with Benign Positional Paroxysmal Vertigo (BPPV) and 15 healthy controls were recruited. Patients responded to the question “Do you feel sick reading in the passenger seat of a car?” and completed a validated motion sickness questionnaire as a measure of motion sensitivity. Lateral canal vHIT testing was performed before and after headshaking; the change in VOR gain was calculated as the primary outcome. Baseline VOR gain was within normal limits across all participants. There was no significant change in VOR gain after headshaking in any group (<jats:italic>p</jats:italic> = 0.264). Patients were 4.3 times more likely to be in the VM group than in the BPPV group if they reported nausea when reading in the passenger seat of a car. We postulate that a headshake stimulus may be insufficient to disrupt cortical interactions and induce a change in VOR gain. Alternatively, changes in VOR gain may only be apparent in the acute phase of VM. Reading in the passenger seat of a car was considered uncomfortable in all VM patients suggesting that this specific question may be useful for the diagnosis of VM.</jats:p>
Scopus© Citations 2 2
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Visuospatial orientation: Differential effects of head and body positions
(2022)
CASTRO ABARCA, PATRICIA BERNARDITA
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Shahvaiz Hussain
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Omer G. Mohamed
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Diego Kaski
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Qadeer Arshad
8Scopus© Citations 3
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Priming overconfidence in belief systems reveals negative return on postural control mechanisms
(2022)
CASTRO ABARCA, PATRICIA BERNARDITA
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Efstratia Papoutselou
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Sami Mahmoud
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Shahvaiz Hussain
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Constanza Fuentealba Bassaletti
3Scopus© Citations 9
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Dissociated motor learning and de-adaptation in patients with functional gait disorders
(2020)
Denise Lin
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CASTRO ABARCA, PATRICIA BERNARDITA
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Amy Edwards
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Akila Sekar
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Mark J Edwards
<jats:title>Abstract</jats:title> <jats:p>Walking onto a stationary platform that had been previously experienced as moving generates a locomotor after-effect—the so-called ‘broken escalator’ phenomenon. The motor responses that occur during locomotor after-effects have been mapped theoretically using a hierarchal Bayesian model of brain function that takes into account current sensory information that is weighted according to prior contextually-relevant experiences; these in turn inform automatic motor responses. Here, we use the broken escalator phenomenon to explore motor learning in patients with functional gait disorders and probe whether abnormal postural mechanisms override ascending sensory information and conscious intention, leading to maladaptive and disabling gait abnormalities. Fourteen patients with functional gait disorders and 17 healthy control subjects walked onto a stationary sled (‘Before’ condition, five trials), then onto a moving sled (‘Moving’ condition, 10 trials) and then again onto the stationary sled (‘After’ condition, five trials). Subjects were warned of the change in conditions. Kinematic gait measures (trunk displacement, step timing, gait velocity), EMG responses, and subjective measures of state anxiety/instability were recorded per trial. Patients had slower gait velocities in the Before trials (P &lt; 0.05) but were able to increase this to accommodate the moving sled, with similar learning curves to control subjects (P = 0.87). Although trunk and gait velocity locomotor after-effects were present in both groups, there was a persistence of the locomotor after-effect only in patients (P &lt; 0.05). We observed an increase in gait velocity during After trials towards normal values in the patient group. Instability and state anxiety were greater in patients than controls (P &lt; 0.05) only during explicit phases (Before/After) of the task. Mean ‘final’ gait termination EMG activity (right gastrocnemius) was greater in the patient group than controls. Despite a dysfunctional locomotor system, patients show normal adaptive learning. The process of de-adaptation, however, is prolonged in patients indicating a tendency to perpetuate learned motor programmes. The trend to normalization of gait velocity following a period of implicit motor learning has implications for gait rehabilitation potential in patients with functional gait disorders and related disorders (e.g. fear of falling).</jats:p>
20Scopus© Citations 24

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