@misc{LehnenHeuserSağlametal., author = {Lehnen, Nadine and Heuser, Fabian and Sağlam, Murat and Schulz, Christian M. and Wagner, Klaus J. and Taki, Masakatsu and Kochs, Eberhard F. and Jahn, Klaus and Schneider, Erich}, title = {Opioid-induced nausea involves a vestibular problem preventable by head-rest}, series = {PLoS one}, volume = {10}, journal = {PLoS one}, number = {8}, issn = {1932-6203}, doi = {10.1371/journal.pone.0135263}, pages = {e0135263}, language = {en} } @misc{HeubergerSağlamToddetal., author = {Heuberger, Maria and Sağlam, Murat and Todd, Nicholas Sean and Jahn, Klaus and Schneider, Erich and Lehnen, Nadine}, title = {Covert anti-compensatory quick eye movements during head impulses}, series = {PLoS One}, volume = {9}, journal = {PLoS One}, number = {4}, issn = {1932-6203}, doi = {10.1371/journal.pone.0093086}, pages = {e93086}, language = {en} } @misc{HelmchenMachnerLehnenetal., author = {Helmchen, Christoph and Machner, Bj{\"o}rn and Lehnen, Nadine and Jahn, Klaus and Schneider, Erich}, title = {Current state of diagnostic management of acute vertigo: a survey of neurologists in Germany}, series = {Journal of Neurology}, volume = {261}, journal = {Journal of Neurology}, number = {8}, issn = {0340-5354}, doi = {10.1007/s00415-014-7405-9}, pages = {1638 -- 1640}, language = {en} } @misc{AgrawalSchubertMigliaccioetal., author = {Agrawal, Yuri and Schubert, Michael C. and Migliaccio, Americo A. and Zee, David S. and Schneider, Erich and Lehnen, Nadine}, title = {Evaluation of quantitative head impulse testing using search coils versus video-oculography in older individuals}, series = {Otology \& neurotology}, volume = {35}, journal = {Otology \& neurotology}, number = {2}, issn = {1537-4505}, doi = {10.1097/MAO.0b013e318287f343}, pages = {283 -- 288}, language = {en} } @misc{BartlLehnenKohlbecheretal., author = {Bartl, Klaus and Lehnen, Nadine and Kohlbecher, Stefan and Schneider, Erich}, title = {Head impulse testing using video-oculography}, series = {Annals of the New York Academy of Sciences}, volume = {1164}, journal = {Annals of the New York Academy of Sciences}, issn = {1749-6632}, doi = {10.1111/j.1749-6632.2009.03850.x}, pages = {331 -- 333}, language = {en} } @misc{HeuserSchulzSağlametal., author = {Heuser, Fabian and Schulz, Christian and Sağlam, Murat and Ramaioli, Cecilia and Heuberger, Maria and Wagner, Klaus J. and Jahn, Klaus and Schneider, Erich and Brandt, Thomas and Glasauer, Stefan and Lehnen, Nadine}, title = {Preventing opioid-induced nausea and vomiting: Rest your head and close your eyes?}, series = {PloS one}, volume = {12}, journal = {PloS one}, number = {3}, issn = {1932-6203}, doi = {10.1371/journal.pone.0173925}, pages = {e0173925}, language = {en} } @misc{LehnenRamaioliHenningsenetal., author = {Lehnen, Nadine and Ramaioli, Cecilia and Henningsen, Peter and Glasauer, Stefan}, title = {An experimental litmus test of the emerging hypothesis that persistent physical symptoms can be explained as perceptual dysregulation}, series = {Journal of Psychosomatic Research}, volume = {114}, journal = {Journal of Psychosomatic Research}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2018.08.007}, pages = {15 -- 17}, language = {en} } @misc{LehnenKellererKnorretal., author = {Lehnen, Nadine and Kellerer, Silvy and Knorr, Alexander G. and Schlick, Cornelia and Jahn, Klaus and Schneider, Erich and Heuberger, Maria and Ramaioli, Cecilia}, title = {Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy}, series = {Frontiers in Neurology}, volume = {9}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2018.00562}, pages = {6}, language = {en} } @misc{HeubergerGrillSaglametal., author = {Heuberger, Maria and Grill, Eva and Saglam, Murat and Ramaioli, Cecilia and M{\"u}ller, Martin and Strobl, Ralf and Holle, Rolf and Peters, Annette and Schneider, Erich and Lehnen, Nadine}, title = {Usability of the Video Head Impulse Test: Lessons from the Population-Based Prospective KORA Study}, series = {Frontiers in Neurology}, volume = {9}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2018.00659}, pages = {7}, language = {en} } @misc{LehnenSchroederHenningsenetal., author = {Lehnen, Nadine and Schr{\"o}der, Lena and Henningsen, Peter and Glasauer, Stefan and Ramaioli, Cecilia}, title = {Deficient head motor control in functional dizziness: Experimental evidence of central sensory-motor dysfunction in persistent physical symptoms}, series = {Progress in Brain Research}, volume = {249}, journal = {Progress in Brain Research}, issn = {1875-7855}, doi = {10.1016/bs.pbr.2019.02.006}, pages = {385 -- 400}, abstract = {Understanding the mechanisms of symptoms that are insufficiently explained by organic dysfunction remains challenging. Recently, it has been proposed that such "functional symptoms" are based on erroneous sensory processing in the central nervous system (CNS), with internal expectations dominating sensory inputs. In a pilot study, we used a head motor control set-up to assess the interplay between sensory input and expectation on the example of patients with functional dizziness. Eight patients and 11 age-matched healthy controls performed large active eye-head gaze shifts towards visual targets in the natural situation and with the head moment of inertia 3.3-fold increased. The latter induces head oscillations and the expected sensory outcome of the movement, estimated in the CNS, does not match the actual sensory input. Head oscillations were assessed in patients and in healthy subjects and compared to prior results from patients with organic disease (vestibular loss and cerebellar ataxia). Head oscillations in patients with functional dizziness were different from those of healthy subjects (F(1,17) = 27.26, P < 0.001, partial η2 = 0.62), and similar to those of patients with cerebellar ataxia, and with vestibular loss (F(2,19) = 0.56, P = 0.58). Even in the natural, unweighted, condition, head oscillations were higher in functional dizziness patients than in healthy subjects (P = 0.001). Since an extensive work-up failed to demonstrate any explanatory peripheral vestibular, motor, or cerebellar organic dysfunction, these motor control deficits are a first indication of erroneous interplay between expectations and sensory input in the CNS that could account for persistent physical symptoms.}, language = {en} } @misc{GlasauerLehnenRadziejetal., author = {Glasauer, Stefan and Lehnen, Nadine and Radziej, Katharina and Weigel, Angelika and K{\"a}nel, Roland von and Pitron, Victor and Van den Bergh, Omer and L{\"o}we, Bernd and Lehmann, Marco and Henningsen, Peter}, title = {Complementing conceptual models of persistent somatic symptoms with mathematical formalization}, series = {Psychosomatic Medicine}, journal = {Psychosomatic Medicine}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000801}, language = {en} } @misc{GrillHeubergerStrobletal., author = {Grill, Eva and Heuberger, Maria and Strobl, Ralf and Saglam, Murat and Holle, Rolf and Linkohr, Birgit and Ladwig, Karl-Heinz and Peters, Annette and Schneider, Erich and Jahn, Klaus and Lehnen, Nadine}, title = {Prevalence, determinants, and consequences of vestibular hypofunction. results from the kora-ff4 survey}, series = {Frontiers in Neurology}, volume = {9}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2018.01076}, pages = {8}, abstract = {Objective: Uni- or bilateral vestibular hypofunction (VH) impairs balance and mobility, and may specifically lead to injury from falls and to disability. The extent of this problem in the general population is still unknown and most likely to be underestimated. Objective of this study was to determine the prevalence, determinants, and consequences of VH in the general population. Methods: Data originates from the cross-sectional second follow-up (FF4) in 2013/14 of the KORA (Cooperative Health Research in the Region of Augsburg)-S4 study (1999-2001) from Southern Germany. This was a random sample of the target population consisting of all residents of the region aged 25-74 years in 1999. We included all participants who reported moderate or severe vertigo or dizziness during the last 12 months and a random sub-sample of participants representative for the general population without vertigo or dizziness during the last 12 months were tested. VH was assessed with the Video-Head Impulse Test (vHIT). Trained examiners applied high-acceleration, small-amplitude passive head rotations ("head impulses") to the left and right in the plane of the horizontal semicircular canals while participants fixated a target straight ahead. During head impulses, head movements were measured with inertial sensors, eye movements with video-oculography (EyeSeeCam vHIT). Results: A total of 2,279 participants were included (mean age 60.8 years, 51.6\% female), 570 (25.0\%) with moderate or severe vertigo or dizziness during the last 12 months. Of these, 450 were assessed with vHIT where 26 (5.8\%) had unilateral VH, and 16 (3.6\%) had bilateral VH. Likewise, 190 asymptomatic participants were tested. Of these 5 (2.6\%) had unilateral VH, and 2 (1.1\%) had bilateral VH. Prevalence of uni- or bilateral VH among tested symptomatic participants was 2.4\% in those < 48 years, and 32.1\% in individuals aged 79 and over. Age-adjusted prevalence was 6.7\% (95\% CI 4.8\%; 8.6\%). VH was associated with worse health, falls, hearing loss, hearing impairment, and ear pressure. Conclusion: VH may affect between 53 and 95 million adults in Europe and the US. While not all affected persons will experience the full spectrum of symptoms and consequences, adequate diagnostic and therapeutic measures should become standard of care to decrease the burden of disease.}, language = {en} } @misc{RegnathBiersackJaegeretal., author = {Regnath, Franziska and Biersack, Katharina and J{\"a}ger, Nina and Glasauer, Stefan and Lehnen, Nadine}, title = {Not a general, symptom-unspecific, transdiagnostic marker for functional symptoms: sensorimotor processing of head control is intact in chronic pain}, series = {Frontiers in Neurology}, volume = {14}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2023.1294702}, abstract = {Introduction: Functional disorders are prevalent in all medical fields and pose a tremendous public health problem, with pain being one of the most common functional symptoms. Understanding the underlying, potentially unifying mechanism in functional (pain) disorders is instrumental in facilitating timely diagnosis, stigma reduction, and adequate treatment options. Neuroscientific models of perception suggest that functional symptoms arise due to dysregulated sensorimotor processing in the central nervous system, with brain-based predictions dominating the eventual percept. Experimental evidence for this transdiagnostic mechanism has been established in various functional symptoms. The goal of the current study was to investigate whether erroneous sensorimotor processing is an underlying transdiagnostic mechanism in chronic (functional) pain. Method: A total of 13 patients with chronic (functional) pain [three patients with chronic (functional) pain disorder, F45.40, ICD-10; 10 patients with chronic pain disorder with somatic and psychological factors, F45.41, ICD-10]; and 15 healthy controls performed large combined eye-head gaze shifts toward visual targets, naturally and with increased head moment of inertia. We simultaneously measured participants' eye and head movements to assess head oscillations at the end of the gaze shift, which are an established indicator of (transdiagnostic) sensorimotor processing deficits of head control. Results: Using a Bayesian analysis protocol, we found that patients with chronic (functional) pain and control participants stabilized their heads equally well (Bayes Factor 01 = 3.7, Bayes Factor exclusion = 5.23; corresponding to substantial evidence) during all sessions of the experiment. Conclusion: Our results suggest that patients with chronic (functional) pain do not show measurable symptom-unspecific sensorimotor processing deficits.}, language = {en} } @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{LehnenRamaioliToddetal., author = {Lehnen, Nadine and Ramaioli, Cecilia and Todd, Nicholas Sean and Bartl, Klaus and Kohlbecher, Stefan and Jahn, Klaus and Schneider, Erich}, title = {Clinical and video head impulses: a simple bedside test in children}, series = {Journal of Neurology}, volume = {264}, journal = {Journal of Neurology}, number = {5}, issn = {1432-1459}, doi = {10.1007/s00415-017-8450-y}, pages = {1002 -- 1004}, language = {en} } @misc{LehnenSchneiderJahn, author = {Lehnen, Nadine and Schneider, Erich and Jahn, Klaus}, title = {Do neurologists need the head impulse test?}, series = {Nervenarzt}, volume = {84}, journal = {Nervenarzt}, number = {8}, issn = {0028-2804}, doi = {10.1007/s00115-013-3822-8}, pages = {973 -- 974}, language = {de} } @misc{SchroederWerderRamaiolietal., author = {Schr{\"o}der, Lena and Werder, Dina von and Ramaioli, Cecilia and Wachtler, Thomas and Henningsen, Peter and Glasauer, Stefan and Lehnen, Nadine}, title = {Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders}, series = {Frontiers in Neuroscience}, volume = {15}, journal = {Frontiers in Neuroscience}, issn = {1662-453X}, doi = {10.3389/fnins.2021.685590}, abstract = {Objective: We are still lacking a pathophysiological mechanism for functional disorders explaining the emergence and manifestation of characteristic, severely impairing bodily symptoms like chest pain or dizziness. A recent hypothesis based on the predictive coding theory of brain function suggests that in functional disorders, internal expectations do not match the actual sensory body states, leading to perceptual dysregulation and symptom perception. To test this hypothesis, we investigated the account of internal expectations and sensory input on gaze stabilization, a physiologically relevant parameter of gaze shifts, in functional dizziness. Methods: We assessed gaze stabilization in eight functional dizziness patients and 11 healthy controls during two distinct epochs of large gaze shifts: during a counter- rotation epoch (CR epoch), where the brain can use internal models, motor planning, and resulting internal expectations to achieve internally driven gaze stabilization; and during an oscillation epoch (OSC epoch), where, due to terminated motor planning, no movement expectations are present, and gaze is stabilized by sensory input alone. Results: Gaze stabilization differed between functional patients and healthy controls only when internal movement expectations were involved [F(1,17) = 14.63, p = 0.001, and partial η2 = 0.463]: functional dizziness patients showed reduced gaze stabilization during the CR (p = 0.036) but not OSC epoch (p = 0.26). Conclusion: While sensory-driven gaze stabilization is intact, there are marked, well- measurable deficits in internally-driven gaze stabilization in functional dizziness pointing at internal expectations that do not match actual body states. This experimental evidence supports the perceptual dysregulation hypothesis of functional disorders and is an important step toward understanding the underlying pathophysiology.}, language = {en} } @misc{LehnenSchneiderJahn, author = {Lehnen, Nadine and Schneider, Erich and Jahn, Klaus}, title = {Klinische Untersuchungen bei Schwindel: Kopfimpulstest und dynamische Sehsch{\"a}rfe}, series = {Neurotransmitter}, volume = {24}, journal = {Neurotransmitter}, number = {4}, issn = {2196-6397}, pages = {39 -- 43}, language = {de} } @misc{LuisLehnenMunozetal., author = {Luis, L. and Lehnen, Nadine and Mu{\~n}oz, E. and Carvalho, M. de and Schneider, Erich}, title = {Anticompensatory quick eye movements after head impulses: A peripheral vestibular sign in spontaneous nystagmus}, series = {Journal of Vestibular Research}, volume = {25}, journal = {Journal of Vestibular Research}, number = {5-6}, issn = {0957-4271}, doi = {10.3233/VES-160566}, pages = {267 -- 271}, language = {en} } @misc{SchroederRegnathGlasaueretal., author = {Schr{\"o}der, Lena and Regnath, Franziska and Glasauer, Stefan and Hackenberg, Anna and Hente, Juliane and Weilenmann, Sonja and Pohl, Daniel and K{\"a}nel, Roland von and Lehnen, Nadine}, title = {Altered sensorimotor processing in irritable bowel syndrome: Evidence for a transdiagnostic pathomechanism in functional somatic disorders}, series = {Frontiers in Neuroscience}, volume = {16}, journal = {Frontiers in Neuroscience}, issn = {1662-453X}, doi = {10.3389/fnins.2022.1029126}, abstract = {Objective A recent hypothesis suggests that functional somatic symptoms are due to altered information processing in the brain, with rigid expectations biasing sensorimotor signal processing. First experimental results confirmed such altered processing within the affected symptom modality, e.g., deficient eye-head coordination in patients with functional dizziness. Studies in patients with functional somatic symptoms looking at general, trans-symptomatic processing deficits are sparse. Here, we investigate sensorimotor processing during eye-head gaze shifts in irritable bowel syndrome (IBS) to test whether processing deficits exist across symptom modalities. Methods Study participants were seven patients suffering from IBS and seven age- and gender-matched healthy controls who performed large gaze shifts toward visual targets. Participants performed combined eye-head gaze shifts in the natural condition and with experimentally increased head moment of inertia. Head oscillations as a marker for sensorimotor processing deficits were assessed. Bayes statistics was used to assess evidence for the presence or absence of processing differences between IBS patients and healthy controls. Results With the head moment of inertia increased, IBS patients displayed more pronounced head oscillations than healthy controls (Bayes Factor 10 = 56.4, corresponding to strong evidence). Conclusion Patients with IBS show sensorimotor processing deficits, reflected by increased head oscillations during large gaze shifts to visual targets. In particular, patients with IBS have difficulties to adapt to the context of altered head moment of inertia. Our results suggest general transdiagnostic processing deficits in functional somatic disorders.}, language = {en} } @misc{WerderRegnathSchaeferetal., author = {Werder, Dina von and Regnath, Franziska and Sch{\"a}fer, Daniel and J{\"o}rres, Rudolf and Lehnen, Nadine and Glasauer, Stefan}, title = {Post-COVID breathlessness: a mathematical model of respiratory processing in the brain}, series = {European Archives of Psychiatry and Clinical Neuroscience}, journal = {European Archives of Psychiatry and Clinical Neuroscience}, issn = {0940-1334}, doi = {10.1007/s00406-023-01739-y}, abstract = {Breathlessness is among the most common post-COVID symptoms. In a considerable number of patients, severe breathlessness cannot be explained by peripheral organ impairment. Recent concepts have described how such persistent breathlessness could arise from dysfunctional processing of respiratory information in the brain. In this paper, we present a first quantitative and testable mathematical model of how processing of respiratory-related signals could lead to breathlessness perception. The model is based on recent theories that the brain holds an adaptive and dynamic internal representation of a respiratory state that is based on previous experiences and comprises gas exchange between environment, lung and tissue cells. Perceived breathlessness reflects the brain's estimate of this respiratory state signaling a potentially hazardous disequilibrium in gas exchange. The internal respiratory state evolves from the respiratory state of the last breath, is updated by a sensory measurement of CO2 concentration, and is dependent on the current activity context. To evaluate our model and thus test the assumed mechanism, we used data from an ongoing rebreathing experiment investigating breathlessness in patients with post-COVID without peripheral organ dysfunction (N = 5) and healthy control participants without complaints after COVID-19 (N = 5). Although the observed breathlessness patterns varied extensively between individual participants in the rebreathing experiment, our model shows good performance in replicating these individual, heterogeneous time courses. The model assumes the same underlying processes in the central nervous system in all individuals, i.e., also between patients and healthy control participants, and we hypothesize that differences in breathlessness are explained by different weighting and thus influence of these processes on the final percept. Our model could thus be applied in future studies to provide insight into where in the processing cascade of respiratory signals a deficit is located that leads to (post-COVID) breathlessness. A potential clinical application could be, e.g., the monitoring of effects of pulmonary rehabilitation on respiratory processing in the brain to improve the therapeutic strategies.}, language = {en} }