TY - GEN A1 - Lehnen, Nadine A1 - Heuser, Fabian A1 - Sağlam, Murat A1 - Schulz, Christian M. A1 - Wagner, Klaus J. A1 - Taki, Masakatsu A1 - Kochs, Eberhard F. A1 - Jahn, Klaus A1 - Schneider, Erich T1 - Opioid-induced nausea involves a vestibular problem preventable by head-rest T2 - PLoS one Y1 - 2015 U6 - https://doi.org/10.1371/journal.pone.0135263 SN - 1932-6203 VL - 10 IS - 8 SP - e0135263 ER - TY - GEN A1 - Heuberger, Maria A1 - Sağlam, Murat A1 - Todd, Nicholas Sean A1 - Jahn, Klaus A1 - Schneider, Erich A1 - Lehnen, Nadine T1 - Covert anti-compensatory quick eye movements during head impulses T2 - PLoS One Y1 - 2014 U6 - https://doi.org/10.1371/journal.pone.0093086 SN - 1932-6203 VL - 9 IS - 4 SP - e93086 ER - TY - GEN A1 - Helmchen, Christoph A1 - Machner, Björn A1 - Lehnen, Nadine A1 - Jahn, Klaus A1 - Schneider, Erich T1 - Current state of diagnostic management of acute vertigo: a survey of neurologists in Germany T2 - Journal of Neurology Y1 - 2014 U6 - https://doi.org/10.1007/s00415-014-7405-9 SN - 0340-5354 SN - 1432-1459 VL - 261 IS - 8 SP - 1638 EP - 1640 ER - TY - GEN A1 - Agrawal, Yuri A1 - Schubert, Michael C. A1 - Migliaccio, Americo A. A1 - Zee, David S. A1 - Schneider, Erich A1 - Lehnen, Nadine T1 - Evaluation of quantitative head impulse testing using search coils versus video-oculography in older individuals T2 - Otology & neurotology Y1 - 2014 U6 - https://doi.org/10.1097/MAO.0b013e318287f343 SN - 1537-4505 VL - 35 IS - 2 SP - 283 EP - 288 ER - TY - GEN A1 - Bartl, Klaus A1 - Lehnen, Nadine A1 - Kohlbecher, Stefan A1 - Schneider, Erich T1 - Head impulse testing using video-oculography T2 - Annals of the New York Academy of Sciences Y1 - 2009 U6 - https://doi.org/10.1111/j.1749-6632.2009.03850.x SN - 1749-6632 SN - 0077-8923 VL - 1164 SP - 331 EP - 333 ER - TY - GEN A1 - Heuser, Fabian A1 - Schulz, Christian A1 - Sağlam, Murat A1 - Ramaioli, Cecilia A1 - Heuberger, Maria A1 - Wagner, Klaus J. A1 - Jahn, Klaus A1 - Schneider, Erich A1 - Brandt, Thomas A1 - Glasauer, Stefan A1 - Lehnen, Nadine T1 - Preventing opioid-induced nausea and vomiting: Rest your head and close your eyes? T2 - PloS one Y1 - 2017 U6 - https://doi.org/10.1371/journal.pone.0173925 SN - 1932-6203 VL - 12 IS - 3 SP - e0173925 ER - TY - GEN A1 - Lehnen, Nadine A1 - Ramaioli, Cecilia A1 - Henningsen, Peter A1 - Glasauer, Stefan T1 - An experimental litmus test of the emerging hypothesis that persistent physical symptoms can be explained as perceptual dysregulation T2 - Journal of Psychosomatic Research Y1 - 2018 U6 - https://doi.org/10.1016/j.jpsychores.2018.08.007 SN - 1879-1360 SN - 0022-3999 VL - 114 SP - 15 EP - 17 ER - TY - GEN A1 - Lehnen, Nadine A1 - Kellerer, Silvy A1 - Knorr, Alexander G. A1 - Schlick, Cornelia A1 - Jahn, Klaus A1 - Schneider, Erich A1 - Heuberger, Maria A1 - Ramaioli, Cecilia T1 - Head-Movement-Emphasized Rehabilitation in Bilateral Vestibulopathy T2 - Frontiers in Neurology Y1 - 2018 U6 - https://doi.org/10.3389/fneur.2018.00562 SN - 1664-2295 VL - 9 ER - TY - GEN A1 - Heuberger, Maria A1 - Grill, Eva A1 - Saglam, Murat A1 - Ramaioli, Cecilia A1 - Müller, Martin A1 - Strobl, Ralf A1 - Holle, Rolf A1 - Peters, Annette A1 - Schneider, Erich A1 - Lehnen, Nadine T1 - Usability of the Video Head Impulse Test: Lessons from the Population-Based Prospective KORA Study T2 - Frontiers in Neurology Y1 - 2018 U6 - https://doi.org/10.3389/fneur.2018.00659 SN - 1664-2295 VL - 9 ER - TY - GEN A1 - Lehnen, Nadine A1 - Schröder, Lena A1 - Henningsen, Peter A1 - Glasauer, Stefan A1 - Ramaioli, Cecilia T1 - Deficient head motor control in functional dizziness: Experimental evidence of central sensory-motor dysfunction in persistent physical symptoms T2 - Progress in Brain Research N2 - 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. Y1 - 2019 U6 - https://doi.org/10.1016/bs.pbr.2019.02.006 SN - 1875-7855 SN - 0079-6123 VL - 249 SP - 385 EP - 400 ER - TY - GEN A1 - Glasauer, Stefan A1 - Lehnen, Nadine A1 - Radziej, Katharina A1 - Weigel, Angelika A1 - Känel, Roland von A1 - Pitron, Victor A1 - Van den Bergh, Omer A1 - Löwe, Bernd A1 - Lehmann, Marco A1 - Henningsen, Peter T1 - Complementing conceptual models of persistent somatic symptoms with mathematical formalization T2 - Psychosomatic Medicine Y1 - 2020 U6 - https://doi.org/10.1097/PSY.0000000000000801 SN - 1534-7796 ER - TY - GEN A1 - Grill, Eva A1 - Heuberger, Maria A1 - Strobl, Ralf A1 - Saglam, Murat A1 - Holle, Rolf A1 - Linkohr, Birgit A1 - Ladwig, Karl-Heinz A1 - Peters, Annette A1 - Schneider, Erich A1 - Jahn, Klaus A1 - Lehnen, Nadine T1 - Prevalence, determinants, and consequences of vestibular hypofunction. results from the kora-ff4 survey T2 - Frontiers in Neurology N2 - 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. Y1 - 2018 U6 - https://doi.org/10.3389/fneur.2018.01076 SN - 1664-2295 VL - 9 ER - TY - GEN A1 - Regnath, Franziska A1 - Biersack, Katharina A1 - Jäger, Nina A1 - Glasauer, Stefan A1 - Lehnen, Nadine T1 - Not a general, symptom-unspecific, transdiagnostic marker for functional symptoms: sensorimotor processing of head control is intact in chronic pain T2 - Frontiers in Neurology N2 - 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. Y1 - 2023 U6 - https://doi.org/10.3389/fneur.2023.1294702 SN - 1664-2295 VL - 14 ER - TY - GEN A1 - Aubele, Maria A1 - Grill, Eva A1 - Eggert, Thomas A1 - Schneider, Erich A1 - Strobl, Ralf A1 - Jahn, Klaus A1 - Müller, Martin A1 - Holle, Rolf A1 - Linkohr, Birgit A1 - Heier, Margit A1 - Ladwig, Karl-Heinz A1 - Lehnen, Nadine T1 - Symptoms in unilatral vestibular hypofunction are associated with number of catch-up saccades and retinal errors: results from the population-based KORA FF4study T2 - Frontiers in Neurology N2 - 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. KW - video head impulse test, vHIT, catch-up saccades, unilateral vestibular hypofunction, retinal error, vestibulo-ocular reflex, VOR, population-based survey Y1 - 2023 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715252/ SN - 1664-2295 VL - 2023 IS - 14 ER - TY - GEN A1 - Lehnen, Nadine A1 - Ramaioli, Cecilia A1 - Todd, Nicholas Sean A1 - Bartl, Klaus A1 - Kohlbecher, Stefan A1 - Jahn, Klaus A1 - Schneider, Erich T1 - Clinical and video head impulses: a simple bedside test in children T2 - Journal of Neurology KW - Head Velocity KW - Head Impulse KW - Head Impulse Testing KW - Rotational Chair KW - Vestibular Function Test Y1 - 2017 U6 - https://doi.org/10.1007/s00415-017-8450-y SN - 1432-1459 VL - 264 IS - 5 SP - 1002 EP - 1004 ER - TY - GEN A1 - Lehnen, Nadine A1 - Schneider, Erich A1 - Jahn, Klaus T1 - Do neurologists need the head impulse test? T1 - Braucht der Neurologe den Kopfimpulstest? T2 - Nervenarzt Y1 - 2013 U6 - https://doi.org/10.1007/s00115-013-3822-8 SN - 0028-2804 SN - 1433-0407 VL - 84 IS - 8 SP - 973 EP - 974 ER - TY - GEN A1 - Schröder, Lena A1 - Werder, Dina von A1 - Ramaioli, Cecilia A1 - Wachtler, Thomas A1 - Henningsen, Peter A1 - Glasauer, Stefan A1 - Lehnen, Nadine T1 - Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders T2 - Frontiers in Neuroscience N2 - 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. Y1 - 2021 U6 - https://doi.org/10.3389/fnins.2021.685590 SN - 1662-453X SN - 1662-4548 VL - 15 ER - TY - GEN A1 - Lehnen, Nadine A1 - Schneider, Erich A1 - Jahn, Klaus T1 - Klinische Untersuchungen bei Schwindel: Kopfimpulstest und dynamische Sehschärfe T2 - Neurotransmitter Y1 - 2013 SN - 2196-6397 SN - 1436-123X VL - 24 IS - 4 SP - 39 EP - 43 ER - TY - GEN A1 - Luis, L. A1 - Lehnen, Nadine A1 - Muñoz, E. A1 - Carvalho, M. de A1 - Schneider, Erich T1 - Anticompensatory quick eye movements after head impulses: A peripheral vestibular sign in spontaneous nystagmus T2 - Journal of Vestibular Research Y1 - 2016 U6 - https://doi.org/10.3233/VES-160566 SN - 0957-4271 SN - 1878-6464 VL - 25 IS - 5-6 SP - 267 EP - 271 ER - TY - GEN A1 - Schröder, Lena A1 - Regnath, Franziska A1 - Glasauer, Stefan A1 - Hackenberg, Anna A1 - Hente, Juliane A1 - Weilenmann, Sonja A1 - Pohl, Daniel A1 - Känel, Roland von A1 - Lehnen, Nadine T1 - Altered sensorimotor processing in irritable bowel syndrome: Evidence for a transdiagnostic pathomechanism in functional somatic disorders T2 - Frontiers in Neuroscience N2 - 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. KW - irritable bowel syndrome (IBS) KW - functional somatic disorders KW - somatoform disorders KW - predictive processing KW - transdiagnostic mechanism KW - gaze shift Y1 - 2022 U6 - https://doi.org/10.3389/fnins.2022.1029126 SN - 1662-453X VL - 16 ER - TY - GEN A1 - Werder, Dina von A1 - Regnath, Franziska A1 - Schäfer, Daniel A1 - Jörres, Rudolf A1 - Lehnen, Nadine A1 - Glasauer, Stefan T1 - Post-COVID breathlessness: a mathematical model of respiratory processing in the brain T2 - European Archives of Psychiatry and Clinical Neuroscience N2 - 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. KW - Pharmacology (medical) KW - Biological Psychiatry KW - Psychiatry and Mental health KW - General Medicine Y1 - 2024 U6 - https://doi.org/10.1007/s00406-023-01739-y SN - 0940-1334 ER -