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  1. Article ; Online: Recurrent episodes of confusion, weakness, and unsteadiness.

    Winnifrith, Tabitha / Ibitoye, Richard

    BMJ (Clinical research ed.)

    2023  Volume 381, Page(s) 1073

    MeSH term(s) Humans ; Confusion/etiology ; Frailty
    Language English
    Publishing date 2023-06-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.p1073
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Vestibular loss disrupts visual reactivity in the alpha EEG rhythm.

    Ibitoye, Richard T / Castro, Patricia / Ellmers, Toby J / Kaski, Diego N / Bronstein, Adolfo M

    NeuroImage. Clinical

    2023  Volume 39, Page(s) 103469

    Abstract: The alpha rhythm is a dominant electroencephalographic oscillation relevant to sensory-motor and cognitive function. Alpha oscillations are reactive, being for example enhanced by eye closure, and suppressed following eye opening. The determinants of ... ...

    Abstract The alpha rhythm is a dominant electroencephalographic oscillation relevant to sensory-motor and cognitive function. Alpha oscillations are reactive, being for example enhanced by eye closure, and suppressed following eye opening. The determinants of inter-individual variability in reactivity in the alpha rhythm (e.g. changes with amplitude following eye closure) are not fully understood despite the physiological and clinical applicability of this phenomenon, as indicated by the fact that ageing and neurodegeneration reduce reactivity. Strong interactions between visual and vestibular systems raise the theoretical possibility that the vestibular system plays a role in alpha reactivity. To test this hypothesis, we applied electroencephalography in sitting and standing postures in 15 participants with reduced vestibular function (bilateral vestibulopathy, median age = 70 years, interquartile range = 51-77 years) and 15 age-matched controls. We found participants with reduced vestibular function showed less enhancement of alpha electroencephalography power on eye closure in frontoparietal areas, compared to controls. In participants with reduced vestibular function, video head impulse test gain - as a measure of residual vestibulo-ocular reflex function - correlated with reactivity in alpha power across most of the head. Greater reliance on visual input for spatial orientation ('visual dependence', measured with the rod-and-disc test) correlated with less alpha enhancement on eye closure only in participants with reduced vestibular function, and this was partially moderated by video head impulse test gain. Our results demonstrate for the first time that vestibular function influences alpha reactivity. The results are partly explained by the lack of ascending peripheral vestibular input but also by central reorganisation of processing relevant to visuo-vestibular judgements.
    MeSH term(s) Humans ; Middle Aged ; Aged ; Alpha Rhythm ; Reflex, Vestibulo-Ocular/physiology ; Head Impulse Test ; Bilateral Vestibulopathy ; Electroencephalography
    Language English
    Publishing date 2023-07-11
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2701571-3
    ISSN 2213-1582 ; 2213-1582
    ISSN (online) 2213-1582
    ISSN 2213-1582
    DOI 10.1016/j.nicl.2023.103469
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Vestibular loss disrupts visual reactivity in the alpha EEG rhythm

    Richard T Ibitoye / Patricia Castro / Toby J. Ellmers / Diego N. Kaski / Adolfo M. Bronstein

    NeuroImage: Clinical, Vol 39, Iss , Pp 103469- (2023)

    2023  

    Abstract: The alpha rhythm is a dominant electroencephalographic oscillation relevant to sensory-motor and cognitive function. Alpha oscillations are reactive, being for example enhanced by eye closure, and suppressed following eye opening. The determinants of ... ...

    Abstract The alpha rhythm is a dominant electroencephalographic oscillation relevant to sensory-motor and cognitive function. Alpha oscillations are reactive, being for example enhanced by eye closure, and suppressed following eye opening. The determinants of inter-individual variability in reactivity in the alpha rhythm (e.g. changes with amplitude following eye closure) are not fully understood despite the physiological and clinical applicability of this phenomenon, as indicated by the fact that ageing and neurodegeneration reduce reactivity. Strong interactions between visual and vestibular systems raise the theoretical possibility that the vestibular system plays a role in alpha reactivity. To test this hypothesis, we applied electroencephalography in sitting and standing postures in 15 participants with reduced vestibular function (bilateral vestibulopathy, median age = 70 years, interquartile range = 51–77 years) and 15 age-matched controls. We found participants with reduced vestibular function showed less enhancement of alpha electroencephalography power on eye closure in frontoparietal areas, compared to controls. In participants with reduced vestibular function, video head impulse test gain – as a measure of residual vestibulo-ocular reflex function – correlated with reactivity in alpha power across most of the head. Greater reliance on visual input for spatial orientation (‘visual dependence’, measured with the rod-and-disc test) correlated with less alpha enhancement on eye closure only in participants with reduced vestibular function, and this was partially moderated by video head impulse test gain. Our results demonstrate for the first time that vestibular function influences alpha reactivity. The results are partly explained by the lack of ascending peripheral vestibular input but also by central reorganisation of processing relevant to visuo-vestibular judgements.
    Keywords Vestibular ; Alpha rhythm ; Reactivity ; Vestibulopathy ; Visual Dependence ; Computer applications to medicine. Medical informatics ; R858-859.7 ; Neurology. Diseases of the nervous system ; RC346-429
    Subject code 610
    Language English
    Publishing date 2023-01-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: The human vestibular cortex: functional anatomy of OP2, its connectivity and the effect of vestibular disease.

    Ibitoye, Richard T / Mallas, Emma-Jane / Bourke, Niall J / Kaski, Diego / Bronstein, Adolfo M / Sharp, David J

    Cerebral cortex (New York, N.Y. : 1991)

    2022  Volume 33, Issue 3, Page(s) 567–582

    Abstract: Area OP2 in the posterior peri-sylvian cortex has been proposed to be the core human vestibular cortex. We investigated the functional anatomy of OP2 and adjacent areas (OP2+) using spatially constrained independent component analysis (ICA) of functional ...

    Abstract Area OP2 in the posterior peri-sylvian cortex has been proposed to be the core human vestibular cortex. We investigated the functional anatomy of OP2 and adjacent areas (OP2+) using spatially constrained independent component analysis (ICA) of functional magnetic resonance imaging (fMRI) data from the Human Connectome Project. Ten ICA-derived subregions were identified. OP2+ responses to vestibular and visual motion were analyzed in 17 controls and 17 right-sided vestibular neuritis patients who had previously undergone caloric and optokinetic stimulation during fMRI. In controls, a posterior part of right OP2+ showed: (i) direction-selective responses to visual motion and (ii) activation during caloric stimulation that correlated positively with perceived self-motion, and negatively with visual dependence and peak slow-phase nystagmus velocity. Patients showed abnormal OP2+ activity, with an absence of visual or caloric activation of the healthy ear and no correlations with vertigo or visual dependence-despite normal slow-phase nystagmus responses to caloric stimulation. Activity in a lateral part of right OP2+ correlated with chronic visually induced dizziness in patients. In summary, distinct functional subregions of right OP2+ show strong connectivity to other vestibular areas and a profile of caloric and visual responses, suggesting a central role for vestibular function in health and disease.
    MeSH term(s) Humans ; Photic Stimulation/methods ; Motion Perception/physiology ; Cerebral Cortex/diagnostic imaging ; Cerebral Cortex/physiology ; Vestibular Diseases ; Vestibule, Labyrinth/physiology ; Magnetic Resonance Imaging/methods
    Language English
    Publishing date 2022-02-28
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1077450-6
    ISSN 1460-2199 ; 1047-3211
    ISSN (online) 1460-2199
    ISSN 1047-3211
    DOI 10.1093/cercor/bhac085
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Electroencephalographic response to transient adaptation of vestibular perception.

    Cooke, Josephine I / Guven, Onur / Castro Abarca, Patricia / Ibitoye, Richard T / Pettorossi, Vito E / Bronstein, Adolfo M

    The Journal of physiology

    2022  Volume 600, Issue 15, Page(s) 3517–3535

    Abstract: When given a series of sinusoidal oscillations in which the two hemicycles have equal amplitude but asymmetric velocity, healthy subjects lose perception of the slower hemicycle (SHC), reporting a drift towards the faster hemicycle (FHC). This response ... ...

    Abstract When given a series of sinusoidal oscillations in which the two hemicycles have equal amplitude but asymmetric velocity, healthy subjects lose perception of the slower hemicycle (SHC), reporting a drift towards the faster hemicycle (FHC). This response is not reflected in the vestibular-ocular reflex, suggesting that the adaptation is of higher order. This study aimed to define EEG correlates of this adaptive response. Twenty-five subjects underwent a series of symmetric or asymmetric oscillations and reported their perceived head orientation at the end using landmarks in the testing room; this was converted into total position error (TPE). Thirty-two channel EEG was recorded before, during and after adaptation. Spectral power and coherence were calculated for the alpha, beta, delta and theta frequency bands. Linear mixed models were used to determine a region-by-condition effect of the adaptation. TPE was significantly greater in the asymmetric condition and reported error was always in the direction of the FHC. Regardless of condition, alpha desynchronised in response to stimulation, then rebounded back toward baseline values. This pattern was accelerated and attenuated in the prefrontal and occipital regions, respectively, in the asymmetric condition. Functional connectivity networks were identified in the beta and delta frequency bands; these networks, primarily comprising frontoparietal connections, were more coherent during asymmetric stimulation. These findings suggest that the temporary vestibulo-perceptual 'neglect' induced by asymmetric vestibular stimulation may be mediated by alpha rhythms and frontoparietal attentional networks. The results presented further our understanding of brain rhythms and cortical networks involved in vestibular perception and adaptation. KEY POINTS: Whole-body asymmetric sinusoidal oscillations, which consist of hemicycles with equal amplitude but differing velocities, can induce transient 'neglect' of the slower hemicycle in the vestibular perception of healthy subjects. In this study, we aimed to elucidate EEG correlates of this 'neglect', thereby identifying a cortical role in vestibular perception and adaptation. We identified a desynchronisation-resynchronisation response in the alpha frequency band (8-14 Hz) that was accelerated in the prefrontal region and attenuated in the occipital region when exposed to asymmetric, as compared to symmetric, rotations. We additionally identified functional connectivity networks in the beta (14-30 Hz) and delta (1-4 Hz) frequency bands consisting primarily of frontoparietal connections. These results suggest a prominent role of alpha rhythms and frontoparietal attentional networks in vestibular perception and adaptation.
    MeSH term(s) Adaptation, Physiological/physiology ; Electroencephalography ; Humans ; Perception ; Reflex, Vestibulo-Ocular/physiology ; Vestibule, Labyrinth/physiology
    Language English
    Publishing date 2022-07-07
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3115-x
    ISSN 1469-7793 ; 0022-3751
    ISSN (online) 1469-7793
    ISSN 0022-3751
    DOI 10.1113/JP282470
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  6. Article ; Online: Neurosarcoidosis: a clinical approach to diagnosis and management.

    Ibitoye, Richard T / Wilkins, A / Scolding, N J

    Journal of neurology

    2016  Volume 264, Issue 5, Page(s) 1023–1028

    Abstract: Sarcoidosis is a rare but important cause of neurological morbidity, and neurological symptoms often herald the diagnosis. Our understanding of neurosarcoidosis has evolved from early descriptions of a uveoparotid fever to include presentations involving ...

    Abstract Sarcoidosis is a rare but important cause of neurological morbidity, and neurological symptoms often herald the diagnosis. Our understanding of neurosarcoidosis has evolved from early descriptions of a uveoparotid fever to include presentations involving every part of the neural axis. The diagnosis should be suspected in patients with sarcoidosis who develop new neurological symptoms, those presenting with syndromes highly suggestive of neurosarcoidosis, or neuro-inflammatory disease where more common causes have been excluded. Investigation should look for evidence of neuro-inflammation, best achieved by contrast-enhanced brain magnetic resonance imaging and cerebrospinal fluid analysis. Evidence of sarcoidosis outside the nervous system should be sought in search of tissue for biopsy. Skin lesions should be identified and biopsies taken. Chest radiography including high-resolution computed tomography is often informative. In difficult cases, fluorodeoxyglucose positron emission tomography and gallium-67 imaging may identify subclinical disease and a target for biopsy. Symptomatic patients should be treated with corticosteroids, and if clinically indicated other immunosuppressants such as hydroxychloroquine, azathioprine, cyclophosphamide or methotrexate should be added. Anti-tumour necrosis factor alpha therapies may be considered in refractory disease but caution should be exercised as there is evidence to suggest they may unmask disease.
    MeSH term(s) Central Nervous System Diseases/diagnosis ; Central Nervous System Diseases/epidemiology ; Central Nervous System Diseases/therapy ; Disease Management ; Humans ; Sarcoidosis/diagnosis ; Sarcoidosis/epidemiology ; Sarcoidosis/therapy
    Language English
    Publishing date 2016-11-22
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 187050-6
    ISSN 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    ISSN (online) 1432-1459
    ISSN 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    DOI 10.1007/s00415-016-8336-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: A link between frontal white matter integrity and dizziness in cerebral small vessel disease.

    Ibitoye, Richard T / Castro, Patricia / Cooke, Josie / Allum, John / Arshad, Qadeer / Murdin, Louisa / Wardlaw, Joanna / Kaski, Diego / Sharp, David J / Bronstein, Adolfo M

    NeuroImage. Clinical

    2022  Volume 35, Page(s) 103098

    Abstract: One in three older people (>60 years) complain of dizziness which often remains unexplained despite specialist assessment. We investigated if dizziness was associated with vascular injury to white matter tracts relevant to balance or vestibular self- ... ...

    Abstract One in three older people (>60 years) complain of dizziness which often remains unexplained despite specialist assessment. We investigated if dizziness was associated with vascular injury to white matter tracts relevant to balance or vestibular self-motion perception in sporadic cerebral small vessel disease (age-related microangiopathy). We prospectively recruited 38 vestibular clinic patients with idiopathic (unexplained) dizziness and 36 age-matched asymptomatic controls who underwent clinical, cognitive, balance, gait and vestibular assessments, and structural and diffusion brain MRI. Patients had more vascular risk factors, worse balance, worse executive cognitive function, and worse ankle vibration thresholds in association with greater white matter hyperintensity in frontal deep white matter, and lower fractional anisotropy in the genu of the corpus callosum and the right inferior longitudinal fasciculus. A large bihemispheric white matter network had less structural connectivity in patients. Reflex and perceptual vestibular function was similar in patients and controls. Our results suggest cerebral small vessel disease is involved in the genesis of dizziness through its effect on balance.
    MeSH term(s) Aged ; Anisotropy ; Cerebral Small Vessel Diseases/complications ; Cerebral Small Vessel Diseases/diagnostic imaging ; Diffusion Tensor Imaging ; Dizziness/diagnostic imaging ; Dizziness/etiology ; Humans ; Vertigo ; White Matter/diagnostic imaging
    Language English
    Publishing date 2022-06-23
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2701571-3
    ISSN 2213-1582 ; 2213-1582
    ISSN (online) 2213-1582
    ISSN 2213-1582
    DOI 10.1016/j.nicl.2022.103098
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: First seizure in the adult: management in the emergency department.

    Sarkar, Pamela / Ibitoye, Richard T / Sturman, Steve / Sarkar, Prabodh K

    British journal of hospital medicine (London, England : 2005)

    2013  Volume 74, Issue 1, Page(s) 18–23

    MeSH term(s) Adult ; Age of Onset ; Diagnosis, Differential ; Emergency Service, Hospital ; Epilepsy/diagnosis ; Epilepsy/therapy ; Humans ; Seizures/epidemiology ; Seizures/therapy ; Status Epilepticus/drug therapy
    Language English
    Publishing date 2013-04-16
    Publishing country England
    Document type Journal Article
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2013.74.1.18
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Consensus on Virtual Management of Vestibular Disorders: Urgent Versus Expedited Care.

    Shaikh, Aasef G / Bronstein, Adolfo / Carmona, Sergio / Cha, Yoon-Hee / Cho, Catherine / Ghasia, Fatema F / Gold, Daniel / Green, Kemar E / Helmchen, Christoph / Ibitoye, Richard T / Kattah, Jorge / Kim, Ji-Soo / Kothari, Sudhir / Manto, Mario / Seemungal, Barry M / Straumann, Dominik / Strupp, Michael / Szmulewicz, David / Tarnutzer, Alexander /
    Tehrani, Ali / Tilikete, Caroline / Welgampola, Miriam / Zalazar, Guillermo / Kheradmand, Amir

    Cerebellum (London, England)

    2020  Volume 20, Issue 1, Page(s) 4–8

    Abstract: The virtual practice has made major advances in the way that we care for patients in the modern era. The culture of virtual practice, consulting, and telemedicine, which had started several years ago, took an accelerated leap as humankind was challenged ... ...

    Abstract The virtual practice has made major advances in the way that we care for patients in the modern era. The culture of virtual practice, consulting, and telemedicine, which had started several years ago, took an accelerated leap as humankind was challenged by the novel coronavirus pandemic (COVID19). The social distancing measures and lockdowns imposed in many countries left medical care providers with limited options in evaluating ambulatory patients, pushing the rapid transition to assessments via virtual platforms. In this novel arena of medical practice, which may form new norms beyond the current pandemic crisis, we found it critical to define guidelines on the recommended practice in neurotology, including remote methods in examining the vestibular and eye movement function. The proposed remote examination methods aim to reliably diagnose acute and subacute diseases of the inner-ear, brainstem, and the cerebellum. A key aim was to triage patients into those requiring urgent emergency room assessment versus non-urgent but expedited outpatient management. Physicians who had expertise in managing patients with vestibular disorders were invited to participate in the taskforce. The focus was on two topics: (1) an adequate eye movement and vestibular examination strategy using virtual platforms and (2) a decision pathway providing guidance about which patient should seek urgent medical care and which patient should have non-urgent but expedited outpatient management.
    MeSH term(s) COVID-19 ; Consensus ; Humans ; Neurologic Examination/methods ; SARS-CoV-2 ; Telemedicine/methods ; Triage/methods ; Vestibular Diseases/diagnosis
    Keywords covid19
    Language English
    Publishing date 2020-08-13
    Publishing country United States
    Document type Journal Article ; Practice Guideline ; Review
    ZDB-ID 2112586-7
    ISSN 1473-4230 ; 1473-4222
    ISSN (online) 1473-4230
    ISSN 1473-4222
    DOI 10.1007/s12311-020-01178-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Consensus on Virtual Management of Vestibular Disorders: Urgent Versus Expedited Care

    Shaikh, Aasef G / Bronstein, Adolfo / Carmona, Sergio / Cha, Yoon-Hee / Cho, Catherine / Ghasia, Fatema F / Gold, Daniel / Green, Kemar E / Helmchen, Christoph / Ibitoye, Richard T / Kattah, Jorge / Kim, Ji-Soo / Kothari, Sudhir / Manto, Mario / Seemungal, Barry M / Straumann, Dominik / Strupp, Michael / Szmulewicz, David / Tarnutzer, Alexander /
    Tehrani, Ali / Tilikete, Caroline / Welgampola, Miriam / Zalazar, Guillermo / Kheradmand, Amir

    Cerebellum

    Abstract: The virtual practice has made major advances in the way that we care for patients in the modern era. The culture of virtual practice, consulting, and telemedicine, which had started several years ago, took an accelerated leap as humankind was challenged ... ...

    Abstract The virtual practice has made major advances in the way that we care for patients in the modern era. The culture of virtual practice, consulting, and telemedicine, which had started several years ago, took an accelerated leap as humankind was challenged by the novel coronavirus pandemic (COVID19). The social distancing measures and lockdowns imposed in many countries left medical care providers with limited options in evaluating ambulatory patients, pushing the rapid transition to assessments via virtual platforms. In this novel arena of medical practice, which may form new norms beyond the current pandemic crisis, we found it critical to define guidelines on the recommended practice in neurotology, including remote methods in examining the vestibular and eye movement function. The proposed remote examination methods aim to reliably diagnose acute and subacute diseases of the inner-ear, brainstem, and the cerebellum. A key aim was to triage patients into those requiring urgent emergency room assessment versus non-urgent but expedited outpatient management. Physicians who had expertise in managing patients with vestibular disorders were invited to participate in the taskforce. The focus was on two topics: (1) an adequate eye movement and vestibular examination strategy using virtual platforms and (2) a decision pathway providing guidance about which patient should seek urgent medical care and which patient should have non-urgent but expedited outpatient management.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #718004
    Database COVID19

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