@misc{AubeleGrillEggertetal., author = {Aubele, Maria and Grill, Eva and Eggert, Thomas and Schneider, Erich and Strobl, Ralf and Jahn, Klaus and M{\"u}ller, Martin and Holle, Rolf and Linkohr, Birgit and Heier, Margit and Ladwig, Karl-Heinz and Lehnen, Nadine}, title = {Symptoms in unilatral vestibular hypofunction are associated with number of catch-up saccades and retinal errors: results from the population-based KORA FF4study}, series = {Frontiers in Neurology}, volume = {2023}, journal = {Frontiers in Neurology}, number = {14}, issn = {1664-2295}, pages = {8}, abstract = {Objective: The presence and intensity of symptoms vary in patients with unilateral vestibular hypofunction. We aimed to determine which saccadic and vestibulo-ocular reflex parameters best predict the presence of symptoms in unilateral vestibular hypofunction in order to better understand vestibular compensation and its implications for rehabilitation therapy. Methods: Video head impulse test data were analyzed from a subpopulation of 23 symptomatic and 10 currently symptom-free participants with unilateral vestibular hypofunction, embedded in the KORA (Cooperative Health Research in the Region of Augsburg) FF4 study, the second follow-up of the KORA S4 population-based health survey (2,279 participants). Results: A higher number of catch-up saccades, a higher percentage of covert saccades, and a larger retinal error at 200 ms after the onset of the head impulse were associated with relevant symptoms in participants with unilateral vestibular hypofunction (p = 0.028, p = 0.046, and p = 0.038, respectively). After stepwise selection, the number of catch-up saccades and retinal error at 200 ms remained in the final logistic regression model, which was significantly better than a null model (p = 0.014). Age, gender, saccade amplitude, saccade latency, and VOR gain were not predictive of the presence of symptoms. Conclusion: The accuracy of saccadic compensation seems to be crucial for the presence of symptoms in unilateral vestibular hypofunction, highlighting the role of specific gaze stabilization exercises in rehabilitation. Early saccades, mainly triggered by the vestibular system, do not seem to compensate accurately enough, resulting in a relevant retinal error and the need for more as well as more accurate catch-up saccades, probably triggered by the visual system.}, language = {en} } @misc{MichailidouKordaWyssetal., author = {Michailidou, Efterpi and Korda, Athanasia and Wyss, Thomas and Bardins, Stanislav and Schneider, Erich and Morrison, Miranda and Wagner, Franca and Caversaccio, Marco Domenico and Mantokoudis, Georgios}, title = {The value of saccade metrics and VOR gain in detecting a vestibular stroke}, series = {Journal of Vestibular Research}, volume = {34}, journal = {Journal of Vestibular Research}, number = {1}, issn = {1878-6464}, doi = {10.3233/VES-230083}, pages = {49 -- 61}, abstract = {Objective: A normal video Head Impulse Test is the gold standard in the emergency department to rule-in patients with an acute vestibular syndrome and a stroke. We aimed to compare the diagnostic accuracy of vHIT metrics regarding the vestibulo-ocular reflex gain and the corrective saccades in detecting vestibular strokes. Methods: Prospective cross-sectional study (convenience sample) of patients presenting with acute vestibular syndrome in the emergency department of a tertiary referral centre between February 2015 and May 2020. We screened 1677 patients and enrolled 76 patients fulfilling the inclusion criteria of acute vestibular syndrome. All patients underwent video head impulse test with automated and manual data analysis. A delayed MRI served as a gold standard for vestibular stroke confirmation. Results: Out of 76 patients, 52 were diagnosed with acute unilateral vestibulopathy and 24 with vestibular strokes. The overall accuracy of detecting stroke with an automated vestibulo-ocular reflex gain was 86.8\%, compared to 77.6\% for cumulative saccade amplitude and automatic saccade mean peak velocity measured by an expert and 71\% for cumulative saccade amplitude and saccade mean peak velocity measured automatically. Gain misclassified 13.1\% of the patients as false positive or false negative, manual cumulative saccade amplitude and saccade mean peak velocity 22.3\%, and automated cumulative saccade amplitude and saccade mean peak velocity 28.9\% respectively. Conclusions: We found a better accuracy of video head impulse test for the diagnosis of vestibular strokes when using the vestibulo-ocular reflex gain than using saccade metrics. Nevertheless, saccades provide an additional and important information for video head impulse test evaluation. The automated saccade detection algorithm is not yet perfect compared to expert analysis, but it may become a valuable tool for future non-expert video head impulse test evaluations.}, language = {en} }