Objective and quantitative equilibriometric evaluation of individual locomotor behaviour in schizophrenia: Translational and clinical implications.

Psychiatry is the only medical specialty that lacks clinically applicable biomarkers for objective evaluation of the existing pathology at a single-patient level. On the basis of an original translational equilibriometric method for evaluation of movement patterns, we have introduced in the everyday clinical practice of psychiatry an easy-to-perform computerized objective quantification of the individual locomotor behaviour during execution of the Unterberger stepping test. For the last 20 years, we have gradually collected a large database of more than 1000 schizophrenic patients, their relatives, and matched psychiatric, neurological, and healthy controls via cross-sectional and longitudinal investigations. Comparative analyses revealed transdiagnostic locomotor similarities among schizophrenic patients, high-risk schizotaxic individuals, and neurological patients with multiple sclerosis and cerebellar ataxia, thus suggesting common underlying brain mechanisms. In parallel, intradiagnostic dissimilarities were revealed, which allow to separate out subclinical locomotor subgroups within the diagnostic categories. Prototypical qualitative (dysmetric and ataxic) locomotor abnormalities in schizophrenic patients were differentiated from 2 atypical quantitative ones, manifested as either hypolocomotion or hyperlocomotion. Theoretical analyses suggested that these 3 subtypes of locomotor abnormalities could be conceived as objectively measurable biomarkers of 3 schizophrenic subgroups with dissimilar brain mechanisms, which require different treatment strategies. Analogies with the prominent role of locomotor measures in some well-known animal models of mental disorders advocate for a promising objective translational research in the so far over-subjective field of psychiatry. Distinctions among prototypical, atypical, and diagnostic biomarkers, as well as between neuromotor and psychomotor locomotor abnormalities, are discussed. Conclusions are drawn about the translational and clinical implications of the new approach and its future perspectives.

International Clinical Protocol on Vestibular Disorders (Dizziness).

26-28 May at 43 Congress of Neurootological and Equilibriometric Society (Budapest, Hungary) International Clinical Protocol on Vestibular Disorders (Dizziness) being discussed and accepted as Consensus Document. Cochrane reports estimates that dizziness has prevalence of 22.9% in the last 12 months and an incidence of 3.1%. Only 1.8% of adults consulted a physician in the last 12 months. Cochrane reviews suggest that the evidence base for dizziness evaluation is weak, thus necessitates the creation of evidence-based document. Protocol is based at the new concept of vestibular system, which involves the vestibular peripheral sensors, space orientation tetrad, vestibular presentations in the brain cortex and vestibular effectory projections in the brain. Labyrinth consists of sensors, for which six modalities are adequate: 1. acceleration, 2. gravitation, 3. low frequency whole-body vibration, 4. Infrasound, 5. magnetic impulse, 6. metabolic changes. Vestibular system from rhomboid fosse gets the inputs from visual, acoustic, somatosensory organs, integrating them and forming space perception and orientation. Interaction with space is realized through sensory, motor, vegetative and limbic projections. So, vestibular disturbances may manifest as paropsia, tinnitus, numbness. Vestibular evoked potentials (not VEMP) and craniocorpography have highest sensitivity (90% and more). As vestibular dysfunction has recurrent character patients need monitoring.

Monocular electronystagmographic analysis of caloric nystagmus.

We compared the horizontal component of nystagmus of the right and left eyes using monocular recording of electronystagmography. We examined the eye movements of 135 patients during bithermal caloric testing and those of 50 patients during the rotation test. We measured the number of nystagmic beats, the slow-phase velocities, and the amplitudes during 10 seconds of the culmination phase of caloric response. We also measured the number of nystagmic beats during the first 30 seconds in postrotatory nystagmus. The eye on the cold-irrigated side moved significantly more strongly than did the eye on the nonirrigated side, whereas a warm irrigation did not induce a significant difference between the irrigated and nonirrigated eyes. The summated activities of each eye during the four different stimulations under bithermal caloric testing did not show any significant differences. The activities of postrotatory nystagmus were almost equal in both eyes in 50 patients. We concluded that the inhibitory effect of cold caloric stimulation is probably transmitted more intensively to the eye on the irrigated side.

Neurootological aspects of juvenile vertigo.

Pathologies from childhood to adolescence carry physical, cognitive, motor, linguistic, perceptual, social, emotional, and neurosensory characteristics. The ages between 8 and 14 or 15 especially carry very special traits of a rollover in data processing with respect to balance regulation. Data acquisition of neurootological function provides us with a network of information about the sensory status of our young patients. Major neurootological complaints leading to functional neurootological investigations are vertigo (including giddiness), dizziness, and nausea. These complaints may occur acutely but also are present in some patients at a young age as longer-lasting complaints. Physiological and clinical vertigo syndromes are commonly found as a combination of four principal phenomena: perceptual (vertigo), oculomotor (nystagmus), postural (dystaxia), and vegetative (nausea, vomiting). These four cardinal manifestations of vertigo are related to different levels of the vestibular analyzer and require different methods of investigation. The focus of our study is the phase of restructuring of equilibrium regulation in children between the ages of 8 and 15 years.

Comparing neurootological complaints in patients at the end of their professional lives (51-60 years) with those during the first phase of retirement (61-70 years).

Geriatrics defines the branch of medicine that treats all problems peculiar to old age and the aging, including the clinical problems of senescence and senility. In the full chain of years of the human life, a special period is humans' last decade of professional life (i.e., 51-60 years) and their first decade of retirement (i.e., 61-70 years). For this study aimed at comparing neurootological complaints of persons in this period of their lives, we examined large samples of European neurootological patients: Group A consisted of 1,965 persons aged 51-60 years, and group B consisted of 1,032 persons aged 61-70 years. Of the 11 vertigo and nausea symptoms evaluated, group A demonstrated 2.68 signs and group B 2.49 signs per individual. Acoustic subjective symptoms of tinnitus were exhibited in 55.42% of group A patients, and hearing loss was present in 63.92% of these patients. In group B, 52.62% of patients exhibited tinnitus, and 68.31% of patients had hearing loss. Our experimental neurootometric investigations exhibited the following rates of abnormal test findings in group A: butterfly calorigrams, 71.86%; stepping craniocorpography, 72.01%; and pure-tone audiometry of bone conduction, 37.66% in the right and 47.07% in the left ear. Among group B patients, abnormal test findings were noted as follows: butterfly calorigrams, 69.86%; stepping craniocorpography, 74.03%; and pure-tone audiometry of bone conduction, 44.57% in the right and 55.43% in the left ear.

Depressive disorders in relation to neurootological complaints.

Depression is a state of depressed mood characterized by feelings of sadness, despair, and discouragement. Depression ranges from normal feelings of "the blues" through dysthymia to major depression. Endogenous depression has been identified with a specific symptom complex: psychomotor retardation, early morning awakening, weight loss, excessive guilt, and lack of reactivity to the environment. Reactive depression is precipitated by a stressful life event. In the field of depression, we found an overlapping activity between psychiatry and neurootology. Our sample comprises 134 patients (53 [39.55%] male, 81 [60.45%] female) who were classified either by psychiatrists or by neurologists as suffering from depression. By evaluating our neurootological history data bank (Neurootological Data Evaluation-Claussen [NODEC]) as regards 6 important vertigo symptoms, we found that patients presented with a frequency of 2.10 signs per patient. When we extended the list to 11 vertigo and nausea signs, we found 2.93 signs per patients. All patients underwent an objective and quantitative neurootometric analysis. The following rates of abnormal findings were observed: butterfly calorigram of polygraphic electronystagmography, 69.40%; stepping craniocorpograms, 69.40%; and bone-conduction pure-tone audiometry of the right ear, 28.36%, and of the left ear, 36.57%.

Neurosensory deficits after myocardial infarction.

Cardiovascular diseases are extremely widespread and often cause vestibular system dysfunctions. They are related mainly to organic lesions of the brain. To investigate neurootological functional changes, we compared two samples from among our patients, of whom those in group A (42 persons: 92.86% male, 7.14% female) had experienced myocardial infarction within 1 year before our neurootometric investigation and those in group B had undergone infarction 1 year or more before examination (104 patients: 81.73% male, 18.27% female). Considering only the six most important vertigo symptoms experienced by patients, we found 1.48 symptoms per patient in group A and 2.02 symptoms per patient in group B. As regards acoustic symptoms, 45.24% of patients in group A experienced tinnitus and 52.38% reported hearing loss. In patients in group B, 48.08% were affected with tinnitus and 58.65% with hearing loss. Abnormalities in the neurootometric measurements were revealed as follows: in group A, butterfly calorigrams, 80.95%; stepping-test craniocorpography (CCG), 64.29%; and bone conduction audiometry on the right side, 40.48%, and on the left side, 52.38%; in group B, butterfly calorigrams, 78.85%; stepping-test CCG, 61.54%; bone conduction audiometry on the right side, 28.85%, and on the left side, 41.35%.

Vertigo, dizziness, and tinnitus after otobasal fractures.

Some 15% of temporal bone fractures are produced by blows to the occiput. The fracture line begins in the posterior fossa, at or near the foramen magnum, and crosses the petrous ridge through the internal auditory canal or the otic capsule. Thus, it is called a transverse fracture. In cases of transverse fractures of the temporal bone, due to automobile accidents or other causes of head injury, the labyrinth is involved more frequently than in longitudinal fractures. Severe vertigo with severe or total hearing loss is not uncommon in such injuries. In milder injuries, labyrinthine "concussion" may occur, with transitory auditory-vestibular symptoms. The force that causes the fracture is so great that it not only fractures the base of the skull but may cause a lesion of the brainstem, resulting in a combined peripheral and central lesion. We evaluated 61 patients (50 [81.97%] male, 11 [18.03%] female) with neurootological complaints of sequelae of otobasal fractures. Of these, 40.98% complained of tinnitus and 52.82% of hearing loss. Reviewing our experimental neurootometric investigations, we identified pathological processes on 75.41% of the butterfly calorigrams and 72.13% of the stepping craniocorpograms, as well as in 32.79% and 39.34% of subjects on right- and left-ear bone-conduction audiometry, respectively.

Computerized ultrasonographic craniocorpography and abnormal psychomotor activity in psychiatric patients.

A new version of craniocorpography (CCG), called computerized ultrasonographic CCG (Comp-USCCG), has been clinically applied for objective recording, documentation, and quantitative evaluation of abnormal psychomotor activity in psychiatric patients. Implications of this completely new approach to psychopathology are discussed. An original representation of Comp-USCCG data (introducing the time dimension as a new CCG parameter) is used to illustrate better the atypical abnormal stepping Comp-USCCG movement patterns in psychotic patients, some of which have not been described in neurootological patients to date. These atypical abnormal stepping Comp-USCCG movement patterns are prolonged longitudinal or shortened or backward longitudinal displacement; dysrhythmic longitudinal or lateral sway; and longitudinal or lateral directional changes. Reflecting the abnormal psychomotor activity, Comp-USCCG also provides for possible indirect evaluation of the underlying subjective psychotic experience. The contribution of the approach could be defined as an application of a known neurootological method into a new field of medicine (psychiatry) with a new purpose (to record and measure abnormal psychomotor activity). Our conclusion is that Comp-USCCG could become the first objective and quantitative method available for use in the field of clinical psychiatry.