AUTHOR=Saman Yougan , Mclellan Lucie , Mckenna Laurence , Dutia Mayank B. , Obholzer Rupert , Libby Gerald , Gleeson Michael , Bamiou Doris-Eva 

TITLE=State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma

JOURNAL=Frontiers in Neurology

VOLUME=7

YEAR=2016

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2016.00101

DOI=10.3389/fneur.2016.00101

ISSN=1664-2295

ABSTRACT=<sec id="ST1"><title>Introduction</title><p>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.</p></sec><sec id="ST2"><title>Aims</title><p>(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.</p></sec><sec id="ST3"><title>Methods</title><p>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 <italic>in situ</italic> formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (<italic>N</italic> = 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, <italic>N</italic> = 26) and without balance symptoms (Group 2, <italic>N</italic> = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS–VER.</p></sec><sec id="ST4"><title>Results</title><p>In Experiment 1, a significant difference (<italic>p</italic> &lt; 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 <italic>in situ</italic> patients with balance symptoms had significantly worse state anxiety at the peak vertiginous response than patients without balance symptoms (<italic>p</italic> &lt; 0.001), as did patients with a balance-related handicap (<italic>p</italic> &lt; 0.001).</p></sec><sec id="ST5"><title>Conclusion</title><p>Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function.</p></sec>