Prolonged or triggered MdDS is a central vestibular disorder. The peripheral vestibular system is intact. Therefore, vestibular function laboratory tests need to be performed to exclude any peripheral vestibular compromise. The only treatment approach which I use is the one developed by the late Dr M Dai at Mount Sinai hospital NYC. I spent time with him NYC and presume you have read the papers published by the MdDS team at Mt Sinai. Have you excluded peripheral deficits in those prolonged/triggered MdDS patients whom you are trialling inversion therapy? Moreover, these patients may not have bobbing or have this symptoms with other symptoms. Some feel they are being pulled down (drawn)to the core of the earth, others swaying laterally, veering to L/R, weaving when walking etc. How will you objectively test the central otolithic system? I am very familiar with Prof Ian Curthoys work and also Prof Michael Halmagyi both of whom have offered me tremendous support and encouragement in vestibular physiotherapy. They are my mentors and both are wonderful teachers as was Dr Dai. Of all the prolonged MdDS patients I have treated, their symptoms of rocking etc are alleviated when driving or travelling in a moving vehicle. As soon as the vehicle stops their symptoms recur instantly. The same happens if they a symptomatic and travel on a sea worthy vessel. Their symptoms are alleviated and they do not want to return to land! The central circuitry (software) is at fault and more than likely I believe involves more than the otolithic system.
Thank you for sharing your perspective. I appreciate your insights and the opportunity for a thoughtful discussion.
I understand your point that the saccule might not be the primary contributor to the bobbing sensation in MdDS. The complex interplay between different vestibular organs and their connections to the brain certainly makes it challenging to pinpoint the exact source of specific symptoms.
However, in this particular case, the patient's initial presentation of a tilting sensation responded well to the Dai Protocol, suggesting successful recalibration of the utricle and linear VOR. The subsequent emergence of a distinct bobbing sensation, even after improvement in other symptoms, leads me to consider a more specific saccular involvement.
I believe it's worth exploring the possibility that the persistent upright position, typical of our daily lives, might be continuously stimulating the saccule in a way that perpetuates the maladaptive signals contributing to this bobbing sensation. The intricate nature of cross-striolar inhibition within the otolith organs could further complicate the issue, potentially leading to misinterpretations of head movements even after the initial trigger has subsided.
My proposed intervention of controlled saccular inversion aims to provide a reversing stimulus, akin to the adaptation that occurs with inverting glasses or the recalibration of otolithic function observed in astronauts returning from space. This approach could potentially disrupt the maladaptive pattern and facilitate a return to normal saccular function.
I acknowledge that this hypothesis requires further research to validate its effectiveness and safety. However, I believe it's crucial to remain open to innovative approaches, especially for patients who haven't responded to traditional therapies.
I value your expertise and would be very interested in hearing more about your experiences and observations with MdDS patients, particularly those presenting with the bobbing sensation. Perhaps we can collaborate further to delve deeper into the underlying mechanisms and explore innovative treatment options that might benefit these individuals.
Thank you again for your engagement and willingness to share your perspective. I look forward to continuing the conversation and learning from your valuable insights.
Prolonged or triggered MdDS is a central vestibular disorder. The peripheral vestibular system is intact. Therefore, vestibular function laboratory tests need to be performed to exclude any peripheral vestibular compromise. The only treatment approach which I use is the one developed by the late Dr M Dai at Mount Sinai hospital NYC. I spent time with him NYC and presume you have read the papers published by the MdDS team at Mt Sinai. Have you excluded peripheral deficits in those prolonged/triggered MdDS patients whom you are trialling inversion therapy? Moreover, these patients may not have bobbing or have this symptoms with other symptoms. Some feel they are being pulled down (drawn)to the core of the earth, others swaying laterally, veering to L/R, weaving when walking etc. How will you objectively test the central otolithic system? I am very familiar with Prof Ian Curthoys work and also Prof Michael Halmagyi both of whom have offered me tremendous support and encouragement in vestibular physiotherapy. They are my mentors and both are wonderful teachers as was Dr Dai. Of all the prolonged MdDS patients I have treated, their symptoms of rocking etc are alleviated when driving or travelling in a moving vehicle. As soon as the vehicle stops their symptoms recur instantly. The same happens if they a symptomatic and travel on a sea worthy vessel. Their symptoms are alleviated and they do not want to return to land! The central circuitry (software) is at fault and more than likely I believe involves more than the otolithic system.
Thank you for sharing your perspective. I appreciate your insights and the opportunity for a thoughtful discussion.
I understand your point that the saccule might not be the primary contributor to the bobbing sensation in MdDS. The complex interplay between different vestibular organs and their connections to the brain certainly makes it challenging to pinpoint the exact source of specific symptoms.
However, in this particular case, the patient's initial presentation of a tilting sensation responded well to the Dai Protocol, suggesting successful recalibration of the utricle and linear VOR. The subsequent emergence of a distinct bobbing sensation, even after improvement in other symptoms, leads me to consider a more specific saccular involvement.
I believe it's worth exploring the possibility that the persistent upright position, typical of our daily lives, might be continuously stimulating the saccule in a way that perpetuates the maladaptive signals contributing to this bobbing sensation. The intricate nature of cross-striolar inhibition within the otolith organs could further complicate the issue, potentially leading to misinterpretations of head movements even after the initial trigger has subsided.
My proposed intervention of controlled saccular inversion aims to provide a reversing stimulus, akin to the adaptation that occurs with inverting glasses or the recalibration of otolithic function observed in astronauts returning from space. This approach could potentially disrupt the maladaptive pattern and facilitate a return to normal saccular function.
I acknowledge that this hypothesis requires further research to validate its effectiveness and safety. However, I believe it's crucial to remain open to innovative approaches, especially for patients who haven't responded to traditional therapies.
I value your expertise and would be very interested in hearing more about your experiences and observations with MdDS patients, particularly those presenting with the bobbing sensation. Perhaps we can collaborate further to delve deeper into the underlying mechanisms and explore innovative treatment options that might benefit these individuals.
Thank you again for your engagement and willingness to share your perspective. I look forward to continuing the conversation and learning from your valuable insights.