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State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma

Saman, Y; McLellan, L; McKenna, L; Dutia, MB; Obholzer, R; Libby, G; Gleeson, M; (2016) State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma. Frontiers in Neurology , 7 , Article 101. 10.3389/fneur.2016.00101. Green open access

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INTRODUCTION: Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety, and there is a relationship between increased state anxiety and worsening balance function. AIMS: (1) To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit. (2) To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap. METHODS: Two separate cohorts of vestibular schwannoma (VS) patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials, and caloric responses) and questionnaire assessments [vertigo handicap questionnaire (VHQ), vertigo symptom scale (VSS), and state-trait anxiety inventory (STAIY)]. Fifteen post-resection VS patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1). Forty-five patients with VS in situ formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (N = 15) with a complete post-resection unilateral vestibular deafferentation completed a state anxiety questionnaire before caloric assessment and again afterward with the point of maximal vertigo as the reference (Aim 1). Experiment 2: state anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of patients with VS in situ presenting with balance symptoms (Group 1, N = 26) and without balance symptoms (Group 2, N = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS–VER. RESULTS: In Experiment 1, a significant difference (p < 0.01) was found when comparing STAIY at baseline and at the peak of the subjective vertiginous response in post-resection patients with a unilateral vestibular deafferentation. In Experiment 2, VS in situ patients with balance symptoms had significantly worse state anxiety at the peak vertiginous response than patients without balance symptoms (p < 0.001), as did patients with a balance-related handicap (p < 0.001). CONCLUSION: Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function.

Type: Article
Title: State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma
Open access status: An open access version is available from UCL Discovery
DOI: 10.3389/fneur.2016.00101
Publisher version: http://dx.doi.org/10.3389/fneur.2016.00101
Language: English
Additional information: © 2016 Saman, Mclellan, Mckenna, Dutia, Obholzer, Libby, Gleeson and Bamiou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Keywords: Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Neurosciences, Neurosciences & Neurology, balance, handicap, anxiety, vestibular schwannoma, cognitive behavioral therapy, COGNITIVE-BEHAVIOR THERAPY, PHOBIC POSTURAL VERTIGO, EMOTIONAL DISTRESS, CHRONIC DIZZINESS, CONTROLLED-TRIAL, BALANCE CONTROL, DISORDERS, SYMPTOMS, NEURITIS, DYSFUNCTION
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > The Ear Institute
URI: https://discovery.ucl.ac.uk/id/eprint/1514855
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