Prevalence of Parkinson symptoms in patients with different peripheral vestibular disorders
J Neurol. 2017 Mar 31. doi: 10.1007/s00415-017-8470-7. [Epub ahead of print]
|Authors/Editors:||Becker-Bense S, Wittmann C, van Wensen E, van Leeuwen RB, Bloem B, Dieterich M.|
Patients in advanced (sometimes earlier) stages of Parkinson’s disease (PD) frequently have balance and gait disorders with consecutive falls. The pathophysiology is multifactorial, involving several contributing factors, e.g., freezing, festination, frontal executive dysfunction, and medication side effects. Dizziness in PD is often attributed to orthostatic hypotension; however, the role of vestibular causes of vertigo and dizziness in this particular patient group is largely unknown. A carefully conducted cohort study in a parkinsonism outpatient clinic recently reported that 5.3% of patients with PD (mean age 72 years) and up to 11% of PD patients who reported dizziness symptoms may have benign paroxysmal positional vertigo (BPPV). BPPV is a mechanical disorder of the inner ear mostly caused by dislodged otoconia that move from the otolith macula beds into a semicircular canal (canalolithiasis). Characteristically, brief attacks of vertigo are elicited by rapid changes in head position relative to gravity. The reasons for the increased prevalence of BPPV in PD (up to 11%) are unclear; hypo-/bradykinesia is suggested to predispose to canalo- and cupulolithiasis and/or to reduce spontaneous repositioning maneuvers during physiological head movements. A multicenter observational study found that recurrent BPPV significantly increased comorbid disorders in the elderly (i.e., hypertension and diabetes). It was suggested that a systemic disease might negatively affect the posterior labyrinth, frequently causing otolith detachment. Consequently, the presence of the systemic disease PD might also be an independent risk factor for BPPV.