One day you wake up and you feel like you are falling forward. You are distressed and confused as you have never had this before. After seeing your general practitioner, you are referred to a cardiologist, as your doctor wants to ensure that these new symptoms have nothing to do with your heart. Following a series of EKG’s and studies by the cardiologist, you find out that all is fine with your heart. Therefore, now your doctor refers you to a neurologist. Following a thorough history and examination, an MRI and CT scan is performed. Ironically, you are told everything is normal. There are no signs of you having a tumor in your brain or a recent stroke. There are no signs that you have an inner ear disorder. However, you continue to feel dizzy and as though you are falling forward. Your doctor therefore refers you to an Ear, Nose and Throat specialist. In fact, this particular ENT focuses their entire practice on helping patients with dizziness and vertigo, and has a set of physical therapists working with them to rehabilitate your balance center in your brain. After going through weeks of therapy consisting of balancing exercises, looking at objects and turning your head, turning your head while walking, and bending side to side, you still feel just as dizzy. You are disheartened.
For dizziness patient’s this can be an all too familiar story. The diagnostic routine outlined in the patient illustrated above is the standard procedure, as it is the job of the patient’s neurologists and ENT’s to screen the patient for inner ear disorders such as benign paroxysmal positional vertigo, Meniere’s Disease, laborynthitis and vestibular neuronitis, basilar migraine, acoustic neuromas, strokes involving the cerebellum or the graviceptive pathways, and paraneoplastic syndromes to name a few. Literally, the last sentence was abbreviated and if not could go on for many more lines as there are a plethora of conditions that have to be ruled out. However, too often dizziness can be a nonspecific entity. Unfortunately, dizziness can be present in up to 17% of those below 80 years of age and 32% in those above 80 years of age. Dizziness can be difficult for patient’s to define as well. As was detailed in the case above, some patient’s feel as though they are falling forward, some perceive they are floating, and others perceive they are rocking side to side. Ultimately, the individual’s brain loses sight of where they are in relationship to their surroundings.
Lack of dizziness is based on the individual using primarily three senses; vision, vestibular (inner ear), and proprioception from the neck (little receptors in the muscles and joints of the neck inform the brain of where the head is in relationship to the neck). It is then the job of the cerebellum, which is a walnut shaped part of the brain sitting at the bottom of the skull, to create a picture of where you are in space. To summarize, this highly important structure termed the cerebellum, has to formulate an understanding of where you are relative to your surroundings by compiling information from your eyes, ears, and neck. Sometimes due to age or other factors, this part of the brain does not do its job so to speak, and as a result the individual becomes dizzy.
Fortunately, research is showing that this area of the brain can be stimulated, and for all intents and purposes strengthened through what is known as neuroplasticity. This concept termed neuroplasticity means that when areas of the brain are excited they have the potential to reinforce their connections and become stronger in how they function. This is positive, as it can allow practitioners to change your cerebellum’s frame of reference concerning where you are. As was detailed in the case above, the person felt as though they were falling forward. Well this can be due to the sensation that they are actually falling backwards, therefore the natural tendency is to pull themselves forwards. Nonetheless, the exciting aspect about all of this is that the cerebellum can be retrained to learn where an individual’s “center of gravity” is located, and as a result a positive change in the individual’s dizziness can be made.
Now back to the original case. It appears as though you will have to live with this for the rest of your life. One day you are searching about dizziness on the internet, and you decide to see an individual practicing functional neuology. Though you are skeptical, at this point you have nothing to lose, so you give it a try. After four weeks of specific exercises to address your cerebellum’s faulty reference of where you are, your dizziness is 70% gone.
Functional Neurology works with patients who have dizziness, and helping those with dizziness can be fulfilling for not only the patient but also the practitioner.
References:
Olsson M. et al. Prevalence and predictors of falls and dizziness in people younger and older than 80 years of age-A longitudinal cohort study. Arch Gerontol Geriatr. 2012 Sep 18. pii: S0167-4943(12)00192-6. doi: 10.1016/j.archger.2012.08.013. [Epub ahead of print]
Rayport SG, Kandel ER. Development of plastic mechanisms related to learning at identified chemical synaptic connections in Aplysia. Neuroscience. 1986 Feb;17(2):283-94.
