JP6482583B2 - A method to assist in the diagnosis of the etiology of vertigo in vertigo patients - Google Patents

Description

  The present invention relates to a method for assisting diagnosis of gravity-sensitive dysfunction, which is one of the causes of vertigo.

  Many dizziness patients often complain of the so-called fluffy feeling that their bodies feel fluffy. It is thought that the essential cause of this fluffy feeling is mainly due to the fact that gravity sensing by otolith tools is not functioning properly.

  For evaluating the function of the otolith, for example, the linear translation method (Non-patent document 1), the off-vertical axis rotation method (Non-patent document 2), the eccentric rotation (Eccentric rotation) ) Method (non-patent document 3), vestibular evoked myogenic potential (vemp) method (non-patent document 4), and the like are known.

  The linear motion stimulation method evaluates the sensitivity of eye movement as an index of otolith function, because horizontal eye movement is induced by otolith stimulation when the subject is moved in a sine wave-like linear motion in the left-right direction using a linear motion stimulation device. It is a technique to do. However, there is a problem that an eye movement measurement during the head linear movement requires a skilled measurement technique.

  The partial vertical rotation method is a method that evaluates the gain of eye movement as an index of otolith function because horizontal eye movement is induced by otolith stimulation when the subject is tilted horizontally while rotating the subject horizontally. . However, there is a problem that measurement of horizontal eye movement is not safe.

  In the eccentric rotation method, the semicircular canal is stimulated when the subject is rotated horizontally with the subject placed at the center of the rotation axis, and the semicircular canal and otolith are stimulated when the rotation is shifted from the center of the rotation axis and the horizontal rotation is performed. This method evaluates the difference in movement as an index of otolith function. However, the apparatus has a problem that it is large and expensive.

  The vestibular evoked myoelectric method is a method for measuring the sternocleidomastoid muscle and the myoelectric potential around the eye induced by loud sound stimulation, and is a method for evaluating these myoelectric potential changes as an index of otolith function. This method is superior to other testing methods in that the existing auditory brainstem reaction testing device can be used and the otolith can be evaluated separately on the left and right. However, for the measurement, it is necessary to keep the muscle tone, and it may be difficult to carry out by a subject with weak muscle strength such as an elderly person. Also. There is a problem that strong sound stimulation may adversely affect hearing.

Human vestibuloocular reflex and its interactions with vision and fixation distance during linear and angular head movement; Paige GD, Telford L, Seidman SH, Barnes GR; J Neurophysiol. 1998 Nov; 80 (5): 2391-404 .; November 1998 Evaluation of the vestibulo-ocular reflex using sinusoidal off-vertical axis rotation in patients with acoustic neurinoma .; Sugita-Kitajima A, Koizuka I .; Neurosci Lett. 2009 Oct 2; 462 (1): 6-9 .; 2009 10 Moon Centric and eccentric VOR tests in patients with Meniere's disease and vestibular Meniere's disease .; Koizuka I, Takeda N, Sato S, Sakagami M, Matsunaga T .; Acta Otolaryngol Suppl. 1991; 481: 55-8; 1991 Assessment of the otolith-ocular reflex using ocular vestibular evoked myogenic potentials in patients with episodic lateral tilt sensation .; Murofushi T, Nakahara H, Yoshimura E .; NeurosciLett. 2012 May 2; 515 (2): 103-6; 2012-5 Moon

  The present invention has been made in view of such problems, and an object thereof is to provide a method for assisting diagnosis of the etiology of vertigo in dizziness patients.

A method for assisting diagnosis of vertigo etiology of a vertigo patient according to the present invention is as follows.
The head tilt sensation Y expressed by the following general formula (1) is calculated,
Y = X−A (1)
(In Formula (1), X is a head inclination angle that is an inclination angle of the subject's head with respect to the actual gravity direction when the subject's head is inclined to the left or right side, and A Is the subjective visual vertical position, which is the angle between the direction in which the subject feels the direction of gravity and the actual direction of gravity when the subject's head is tilted to the left or right.)
Plot the data with the head tilt angle X as the horizontal axis coordinate and the head tilt sense Y as the vertical axis coordinate to obtain a straight line, and define the slope of the straight line as Z that is the head tilt sense gain;
Head tilt sense gain Z is, for 1.20 or more or 0.90, it is determined that the failure of gravity sensitive functions dizziness etiology dizziness patient consists deep portion sensory receptors.

  ADVANTAGE OF THE INVENTION According to this invention, the novel diagnosis assistance method of the pathogenesis of vertigo is obtained.

It is a figure which shows the measurement result of a head inclination sense. It is a schematic diagram of the measurement state of head inclination sense. It is a figure which shows the excessive type of a head inclination sense gain. It is a figure which shows the under type of a head inclination sense gain. It is a figure which shows the left-right difference type of head inclination sense gain. It is a figure which shows the histogram of a head inclination sense gain. It is a figure which shows the head inclination sensation gain of the patient of a right-and-left difference type, (a) is a patient suffering from right chronic otitis media, (b) is a patient of unknown origin, (c) is both A patient with Meniere's disease. It is a figure which shows the head inclination sensory gain of an oversized type patient, (a) is a patient suffering from both Meniere's disease, (b) is a patient suffering from right Meniere's disease, ( c) is an unknown patient. It is a figure which shows the head inclination sense gain of an undersized patient, (a) is a patient suffering from right Meniere's disease, (b) is a patient of unknown cause.

  Hereinafter, embodiments of the present invention will be specifically described with reference to the accompanying drawings. However, the embodiments are for facilitating understanding of the principle of the present invention, and the scope of the present invention is as follows. The present invention is not limited to the embodiments, and other embodiments in which those skilled in the art appropriately replace the configurations of the following embodiments are also included in the scope of the present invention.

  The head tilt angle X is the tilt angle of the subject's head relative to the actual gravity direction when the subject's head is tilted to the left or right. Subjective visual vertical (hereinafter abbreviated as SVV) A is the direction in which the subject feels the direction of gravity and the actual gravity when the subject's head is tilted to the left or right. It is the angle that makes a deviation from the direction.

The head tilt sensation Y is represented by the following general formula (1).
Y = X−A (1)
Then, a straight line is obtained by plotting data with the head tilt angle X as the horizontal axis coordinate and the head tilt sense Y as the vertical axis coordinate, and a head tilt sensory gain (hereinafter referred to as HTP _Gain) which is the inclination of the straight line. Z) is obtained. As a result of intensive studies, the present inventor has found that when the head tilt sensation gain Z is 1.20 or more or 0.90 or less, it can be determined that there is an abnormality in the subject's otolith.

  The semicircular canal captures the rotation of the head, while the otolith is an organ that senses the tilt of the head. The otolith is composed of an otolith made of calcium carbonate, an oval sac made of hair cells, and a spherical sac. When the head is standing vertically, the oval sac stands horizontally and the spherical sac stands vertically, but when the head is tilted, the two otoliths are misaligned and the adjacent hair cells catch the misalignment. It is possible to sense the inclination of the head.

  The measurement of the subjective visual vertical position A is performed, for example, by making a bar that shines at various angles vertical (direction in which the subject feels the direction of gravity) with a controller at hand in a darkened room. The subjective visual vertical position A may be measured when the head is tilted or when the entire body is tilted. In an experiment in which only the head is tilted, SVV can be measured after actively tilting the roll within the range of 0 to 60 degrees left and right and maintaining the same angle for about 30 seconds.

  The head tilt angle X is measured by, for example, a linear acceleration sensor. Head tilt sensation involves otolith, visual, and deep sensation inputs, but when measuring under conditions where visual information is blocked, visual input is 0%. Otolith input (mainly oval sac) is considered to be about 85%, deep neck sensory input about 15%.

  When the data is plotted with the head tilt angle X as the horizontal axis coordinate and the head tilt sense Y as the vertical axis coordinate, when the head is tilted alone or the entire body is tilted, a straight line is obtained. Become. The inclination of the straight line is defined as the head inclination sense gain Z.

FIG. 1 shows a measurement result of the sense of head tilt as an example. As a specific example, FIG. 1 shows a measurement example in which HTP _Gain is 0.92 when the left head is tilted and 1.10 when the right head is tilted. The slope of the straight line is obtained, and the slope becomes 1 if the sense of inclination coincides with the head inclination angle, but slope <1 if it is underestimated, and slope> 1 if it is overestimated.

FIG. 2 is a schematic diagram of a measurement state of a head tilt sense as an example. FIG. 2 also shows a measurement example in which HTP _Gain is 0.92 when the left head is tilted and 1.10 when the right head is tilted. In FIG. 2, there is a left-right difference in the sense of tilting the head. In addition, since deep part sense information from the lower body is further added in the standing position, the involvement of the deep part sensory information from the lower body to the head tilt sense can be examined by comparing the head tilt sense gain between the sitting position and the standing position.

The present inventor measured the HTP _gain for a plurality of healthy persons, and no difference was found between the HTP _gains when the left and right heads were tilted, so the histogram of the results of combining the left and right HTP _gains From the result of the histogram, it was found as a new finding that when the head tilt sensation gain Z is 1.20 or more or 0.90 or less, it can be determined that the subject's otolith is abnormal. Since semicircular canal function tests are widely used in clinical practice, it is easy to diagnose the presence of semicircular canal disorders in vertigo disease. On the other hand, since the functional test of otolith tools has been delayed in practical use, it is not easy to diagnose the presence or absence of otolith tools in dizziness. Therefore, according to the present invention, it is possible to find an otolithic disease that does not have a clear disease name by simply and inexpensively and safely testing the function of the otolith.

  There are several types of otolith abnormalities. (i) A subject whose head tilt sense gain Z when tilted to the left is 1.2 or more and whose head tilt sense gain Z when tilted to the right is 1.2 or more It can be determined that the type is excessive as shown in FIG. (ii) A subject whose head tilt sense gain Z when tilted to the left is 0.90 or less and whose head tilt sense gain Z when tilted to the right is 0.90 or less It can be determined that the type is too small as shown in FIG. (iii) The head tilt sense gain Z when tilted to the left or right is 1.2 or more, and the head tilt sense gain Z when tilted to the right or left is 0.90 or less. The subject in this case can be determined as the left-right difference type as shown in FIG.

  According to the present invention, the abnormal type of the otolith can be easily and accurately determined, and therefore it is possible to more accurately cure the abnormal otolith by applying a treatment method for each abnormal type.

Example 1
In a standing or sitting position, put a head cap with a linear acceleration sensor (CXL04M3, manufactured by Crossbow) on the subject and watch on the LCD monitor placed at a distance of 50 cm in front of the face in 1 degree increments. A bar (60 x 2 mm) that can be rotated counterclockwise was presented. The field-of-view goggles were worn in the dark so that subjects could not see any scenery other than bar. With the trunk upright, only the head is upright (6 times), tilted to the left (4 times), and tilted to the right (4 times) in a random order. Instructed to adjust bar to the direction of the gravity axis (SVV). The signal from the linear acceleration sensor is converted to the head tilt angle by the data acquisition device (PowerLab, ADInstruments) and recorded, and the head tilt angle on the left and right is 30 ± 10 degrees while monitoring the value during measurement. It was adjusted.

After the measurement, SVV and head tilt angle under the 14 recorded conditions were obtained, and the angle formed by both was evaluated as the head tilt sensation. When the horizontal axis is the head tilt angle and the vertical axis is the head tilt sensation, the data is plotted in a straight line relationship with the left and right head tilts. Therefore, the slope of the approximate straight line is defined as the head tilt sense gain (HTP _Gain ) ( The sign is positive on the right and negative on the left).

So far, 107 healthy individuals (19-66 years old, average 27.2 years old, 68 males, 39 females) have been measured for HTP _Gain in the standing position. FIG. 6 shows a histogram (n = 214) as a result of combining the left and right HTP _gains . As shown in FIG. 6, the HTP _gain was in the range of 0.69-1.38, and the average was 1.06. There was a tendency for head tilt sensation to be slightly overestimated than actual head tilt. When the head tilt sense gain Z was 1.2 or more or 0.90 or less, it was determined that the subject's otolith was abnormal.

(Example 2)
The HTP _gain of 21 dizziness / balanced persons was measured. The normal value of HTP _Gain is 0.90 to 1.20, and it is classified into 7 normal type (33%), left and right difference type 9 (43%), oversized 3 (14%), undersized 2 (10%). I was able to.

Of the 9 patients with left-right difference type, the HTP _Gain of patients with right chronic otitis media is shown in Fig. 7 (a), the HTP _Gain of patients with unknown cause is shown in Fig. 7 (b), and both Meniel's disease is affected. FIG. 7 (c) shows the HTP _Gain of the patient who is doing this.

Among the three oversized patients, the HTP _gain of patients suffering from both Meniere's disease is shown in FIG. 8 (a), and the HTP _gain of patients suffering from right Meniere's disease is shown in FIG. 8 (b). FIG. 8C shows the HTP _{gain of an} unknown patient.

FIG. 9A shows the HTP _gain of a patient suffering from right Meniere's disease, and FIG. 9B shows the HTP _gain of a patient whose cause is unknown among the two undersized patients.

  As described above, according to the present invention, the causes of various dizziness / balance disorders can be classified from a new point of view, so even in the case of a symptom that has been diagnosed as unknown and treatment has not been established. By applying treatments according to abnormal types, it is possible to cure abnormalities of otoliths more accurately.

  It can be used as a method for testing the function of gravity sensitivity.

Claims (2)

A method for assisting in the diagnosis of the etiology of vertigo in vertigo patients,
The head tilt sensation Y expressed by the following general formula (1) is calculated,
Y = X−A (1)
(In Formula (1), X is a head inclination angle that is an inclination angle of the subject's head with respect to the actual gravity direction when the subject's head is inclined to the left or right side, and A Is the subjective visual vertical position, which is the angle between the direction in which the subject feels the direction of gravity and the actual direction of gravity when the subject's head is tilted to the left or right.)
Plot the data with the head tilt angle X as the horizontal axis coordinate and the head tilt sense Y as the vertical axis coordinate to obtain a straight line, and define the slope of the straight line as Z that is the head tilt sense gain;
Head tilt sense gain Z is, for 1.20 or more or 0.90, it is determined that the failure of gravity sensitive functions dizziness etiology dizziness patient consists deep portion sensory receptors, dizziness patient dizziness Diagnosis assistance method of etiology.   The method for assisting diagnosis of vertigo etiology of a vertigo patient according to claim 1, wherein the etiology of the vertigo patient is unknown.

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