title: Deficient high-acceleration vestibular function in patients with polyneuropathy.
abstract: BACKGROUND
  Unsteadiness during standing and walking is a frequent complaint of patients with polyneuropathy (PNP).
  
  
  OBJECTIVE
  To determine whether balance disorders in patients with PNP may be caused by reduced proprioceptive input from the feet alone or whether impaired vestibular input, resulting from involvement of the vestibular nerve, can be an additional factor.
  
  
  METHODS
  A total of 37 patients (mean age 65 years +/- 12 SD; 12 women) with electrodiagnostically confirmed PNP (predominantly axonal: 18; predominantly demyelinating: 19) underwent horizontal search-coil head-impulse testing, which assesses the high-acceleration vestibulo-ocular reflex (VOR).
  
  
  RESULTS
  Relative to a healthy comparison group, the gains (eye velocity divided by head velocity) of the horizontal VOR were reduced in 27 of 37 patients (unilateral: 13; bilateral: 14). The percentages of patients with unilateral or bilateral VOR deficits were not significantly different between patients with axonal or demyelinating PNP.
  
  
  CONCLUSIONS
  Two thirds of patients with axonal or demyelinating polyneuropathy (PNP) showed unilateral (approximately 50%) or bilateral (approximately 50%) gain reductions of the horizontal high-acceleration vestibulo-ocular reflex. This finding suggests that, in many patients with PNP, the neuropathic process includes the vestibular nerve. Such information is highly relevant for subsequent physical therapy, since vestibular exercise improves balance control and reduces disability.
authors.affiliation: Neurology Department, Zurich University Hospital, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland. antpalla@access.unizh.ch
authors.forename: A
authors.initials: A
authors.lastname: Palla
authors.forename: A
authors.initials: A
authors.lastname: Schmid-Priscoveanu
authors.forename: A
authors.initials: A
authors.lastname: Studer
authors.forename: K
authors.initials: K
authors.lastname: Hess
authors.forename: D
authors.initials: D
authors.lastname: Straumann
mesh_terms: D000054:Acceleration; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010525:Peripheral Nerves / Q000503:physiopathology; D011115:Polyneuropathies / Q000150:complications* / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology; D011237:Predictive Value of Tests; D011434:Proprioception / Q000502:physiology; D012021:Reflex, Abnormal / Q000502:physiology; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology; D012680:Sensitivity and Specificity; D020886:Somatosensory Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014724:Vestibular Function Tests / Q000379:methods*; D014725:Vestibular Nerve / Q000503:physiopathology*; D000160:Vestibulocochlear Nerve Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*