Clinical Evaluation Of Vestibular Rehabilitation In Patients With Vestibular Migraine And Study Of Functional Magnetic Resonance Imaging

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CLINICAL EVALUATION OF VESTIBULAR REHABILITATION IN PATIENTS WITH VESTIBULAR MIGRAINEObjective:The purpose of this study was to evaluate the clinical efficacy of vestibular rehabilitation(VR)in the treatment of vestibular migraine(VM),and to explore the impact of vestibular rehabilitation on the quality of life and psychological status of patients with VM.Methods:1.According to inclusion and exclusion criteria,we included patients with VM who were admitted to the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University and the Fifth People's Hospital of Chongqing from January 2018 to January 2019.Patient demographic characteristics and detailed cases data were collected.2.Patients with VM were randomly divided into an experimental group and a control group.The experimental group was given VR combined with drug therapy,and the control group was given simple drug therapy.At baseline,Week 4 and Week 8 after the intervention,the Dizziness handicap inventory(DHI),Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)were used to evaluate the impact on the quality of life and psychological status of patients.The comparison of scale scores at different time points was performed by repeated measurement analysis of variance,and the comparison between the two groups was performed by independent sample t test,with P <0.05 having statistical significance.Results:1.A total of 46 patients were included in the study,21 in the experimental group and 25 in the control group.There was no statistically significant difference in the general data between the two groups.2.Repeated measurement analysis of variance was used to compare the DHI scores of the two groups of patients at different time points.The results showed that the P value of time effect was less than 0.001,the P values of the interaction effect and grouping effect were all less than 0.05,and there was significant difference between the two groups.The independent sample t test was used for comparison between the two groups.The results showed that there was no statistically significant difference in DHI scores between the two groups at baseline.At week 4(P = 0.007)and week 8(P=0.001)after the intervention,the DHI scores of the experimental group were significantly lower than that of the control group.3.Repeated measurement analysis of variance was used to compare the HAMA scores of the two groups of patients at different time points.The results showed that the P value of the time effect was less than 0.001,and the P values of the interaction effect and the grouping effect were greater than 0.05.There was no significant difference between the two groups.The independent sample t test was used for comparison between the two groups,and the results showed that there was no statistically significant difference in HAMA scores between the two groups at baseline and Week 4 after the intervention.At week 8(P=0.01),the HAMA scores of the experimental group were significantly lower than that of the control group.4.Repeated measurement analysis of variance was used to compare the HAMD scores of the two groups of patients at different time points.The results showed that the P value of the time effect was less than 0.001,and the P values of the interaction effect and the grouping effect were greater than 0.05.There was no significant difference between the two groups.The independent sample t test was used for comparison between the two groups.The results showed that there was no statistically significant difference in HAMD scores between the two groups at baseline,week 4 and week 8 after the intervention.Conclusion:1.Simple drug therapy and VR combined with drug therapy can improve the dizziness symptoms and the quality of life in patients with VM.Combined therapy is superior to simple drug therapy.2.Simple drug therapy and VR combined with drug therapy can improve the psychological status of patients with VM,and there is no significant difference in clinical efficacy between the two treatments methods.PART ? REGIONAL HOMOGENEITY STUDY OF THE RESTING-STATE FUNCTIONAL MAGNETIC RESONANCE IMAGING IN PATIENTS WITH VESTIBULAR MIGRAINEObjective:The regional homogeneity method of resting state functional magnetic resonance imaging(rs-f MRI)was used to explore the local characteristics of spontaneous brain activity in patients with vestibular migraine(VM),and it provided clues to the pathophysiological mechanism of VM.Methods:1.We included twenty patients with VM who were admitted to the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University and the Fifth People's Hospital of Chongqing from January 2018 to January 2019.Twenty healthy controls with education,age and gender matching were recruited to participate in the study.The dizziness handicap inventory(DHI)was used to evaluate the degree of vertigo in VM patients.2.The regional homogeneity(Re Ho)method of rs-f MRI was used to analyze the activity of the local brain regions of the subjects.REST software was used to perform independent sample t test on the Re Ho map of the two groups of subjects,and Alpha Sim method was used for multiple comparison correction.The statistical threshold was set to P <0.05,and the cluster volume was greater than 27 voxels.Pearson correlation coefficient was used to analyze the correlation between DHI scores and Re Ho values of brain regions with statistical differences in univariate analysis,with P<0.05 having statistical significance.Results:1.Compared with the healthy control group,the bilateral anterior cerebellar lobe,left superior frontal gyrus and middle frontal gyrus,bilateral inferior frontal gyrus,and right anterior cingulate gyrus showed increased regional homogeneity in VM group.Compared with the healthy control group,the right middle temporal gyrus,right lingual gyrus/anterior cuneiform lobe,left lingual gyrus,left inferior parietal lobule,and left anterior central gyrus/paracentral lobule showed reduced regional homogeneity in VM group.2.Correlation analysis results showed that there was no significant correlation between the DHI score and the Re Ho values of the dysfunctional brain area of VM patients.Conclusions:This study revealed that the patients with vestibular migraine have abnormal regional homogeneity of the brain network composed of multiple interacting brain regions.These brain areas mainly involved multiple cortical areas of somatosensory,somatic movement,emotional processing,cognition and vestibular information processing.It can be seen that the abnormal function of the cortical regions dealing with vestibular and nociceptive information.The abnormalities in the multisensory vestibular cortical area may be the pathophysiological features of VM.PART ? EFFECT OF VESTIBULAR REHABILITATION ON SPONTANEOUS BRAIN ACTIVITY IN PATIENTS WITH VESTIBULAR MIGRAINE: A RESTING-STATE FUNCTIONAL MAGNETIC RESONANCE IMAGING STUDYObjective:The changes of spontaneous brain activity in patients with VM after VR were studied by the amplitude of low-frequency fluctuations(ALFF)method of rs-f MRI,and the possible mechanism of VR was explored.Methods:1.According to the inclusion and exclusion criteria,we included patients with VM who were admitted to the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University and the Fifth People's Hospital of Chongqing from October 2017 to October 2018.Patient demographic characteristics and detailed cases data were collected.2.The patients with VM received vestibular rehabilitation training for one month.Clinical evaluation was conducted at baseline and one month after vestibular rehabilitation.The degree of vertigo was assessed by the DHI,the quality of life was assessed by the 36 items short form health survey(SF-36),the state of anxiety was assessed by the HAMA,and the state of depression was assessed by the HAMD.The paired t-test was used for statistical analysis(P < 0.05).3.The spontaneous brain activity of the subjects was analyzed by using the ALFF method of rs-f MRI.VM patients were examined by f MRI before and after VR treatment.Paired sample t test was performed on the ALFF map using REST software,and Gaussian random field(GRF)was used for multiple comparison correction(P < 0.001,Z > 2.65).In addition,the correlation analysis of DHI scores and ALFF values of brain areas with statistical differences before and after VR treatment was performed,with P<0.05 having statistical significance.Results:1.During the study period,14 patients were diagnosed with VM(9female/5 male,43.86±11.61 years,range 25-60 years).The mean age of migraine and vertigo onset was 20.21±8.11 and 22.14±10.08 years respectively.Vertigo attacks always associated with migraine was reported in 8 patients(57%).The most common type of vertigo was spontaneous vertigo(86%),followed by head motion-induced vertigo(29%).Frequency of vertigo attacks was between 1 and 6 days per month(2.86±2.18days/month).Most vertigo episodes lasted from 5 minutes to 24 hours.Six(43%)patients had vertigo episodes lasting 5-60 minutes.Five(36%)patients had vertigo attacks in the range of 1 to 24 hours.Family history of migraine was reported in 8(57%)patients and vertigo in first-degree relatives was in 4(29%)patients.2.The clinical evaluation of the subjects was completed before and after VR treatment,including DHI,HAMA,HAMD scores,and analysis scores of 8 domains in SF36.The results showed that the DHI scores(P =0.03)and HAMA scores(P = 0.02)decreased significantly and there was no significant difference in the HAMD scores before and after VR.The SF36 results showed that the role-physical(P = 0.037)and role-emotional(P = 0.047)scores were significantly higher in patients after VR than that at baseline.There were no significant differences in the aspects of physical functioning,social functioning,mental health,vitality,bodily pain or general health.3.The results of ALFF before and after VR showed that the ALFF values of the left posterior cerebellum in patients with VM increased significantly after VR(GRF corrected: P < 0.001,Z > 2.65).In addition,the correlation analysis revealed a negative correlation between the ALFF values in the left posterior cerebellum and the DHI scores in the patients with VM(r =-0.611,P = 0.020).Conclusions:1.The increased spontaneous activity of the left posterior cerebellar of VM patients after VR treatment may be a may be a central compensation for vestibular dysfunction in patients with VM.2.The mechanism of VR may be mainly to accelerate the occurrence of vestibular compensation through the cerebellum,but there is asymmetry,and the left cerebellum is dominant.3.With a further understanding of VM brain dysfunction,cerebellar abnormalities may be involved in the pathogenesis of VM,providing ideas for future treatment.