Role of the Insula and Vestibular System in Patients with Chronic Subjective Dizziness: An fMRI Study Using Sound-Evoked Vestibular Stimulation
Open accessAbstract
Chronic subjective dizziness (CSD) is a common vestibular disorder characterized by persistent non-vertiginous dizziness, unsteadiness, and heightened sensitivity to motion stimuli that may last for months to years after events that cause acute vestibular symptoms or disrupt balance. CSD is not associated with abnormalities of basic vestibular or oculomotor reflexes. Rather, it is thought to arise from persistent use of high-threat postural control strategies and greater reliance on visual cues for spatial orientation (i.e., visual dependence), long after triggering events resolve. Anxiety-related personality traits confer vulnerability to CSD. Anomalous interactions between the central vestibular system and neural structures related to anxiety may sustain it. Vestibular- and anxiety-related processes overlap in the brain, particularly in the insula and hippocampus. Alterations in activity and connectivity in these brain regions in response to vestibular stimuli may be the neural basis of CSD. We examined this hypothesis by comparing brain activity from 18 patients with CSD and 18 healthy controls measured by functional magnetic resonance imaging during loud short tone bursts, which are auditory stimuli that evoke robust vestibular responses. Relative to controls, patients with CSD showed reduced activations to sound-evoked vestibular stimulation in the parieto-insular vestibular cortex (PIVC) including the posterior insula, and in the anterior insula, inferior frontal gyrus, hippocampus, and anterior cingulate cortex. Patients with CSD also showed altered connectivity between the anterior insula and PIVC, anterior insula and middle occipital cortex, hippocampus and PIVC, and anterior cingulate cortex and PIVC. We conclude that reduced activation in PIVC, hippocampus, anterior insula, inferior frontal gyrus, and anterior cingulate cortex, as well as connectivity changes among these regions, may be linked to long-term vestibular symptoms in patients with CSD. Furthermore, altered connectivity between the anterior insula and middle occipital cortex may underlie the greater reliance on visual cues for spatial orientation in CSD patients relative to controls.
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Studies of PPV, VV, SMD, and CSD identified a number of functional alterations in vestibular and balance mechanisms associated with these clinical entities.
“Studies of PPV, VV, SMD, and CSD identified a number of functional alterations in vestibular and balance mechanisms [33, 37, 46, 59, 67, 68, 71, 88, 98] associated with these clinical entities.”
Alterations in postural control strategies, shifts in multi-sensory integration, and reduced cortical integration of spatial orientation and threat assessment networks may be sustaining mechanisms.
“Alterations in postural control strategies [33, 46, 59, 67, 68, 71], shifts in multi-sensory integration [23], and reduced cortical integration of spatial orientation and threat assessment networks [37, 88] may be sustaining mechanisms.”
Patients with CSD had more negative connectivity between the PIVC and the anterior insula, anterior cingulate cortex, and hippocampus, as well as between the anterior insula and middle occipital cortex.
“They also had more negative connectivity between the PIVC and the anterior insula, anterior cingulate cortex, and hippocampus, as well as between the anterior insula and middle occipital cortex.”
Patients with CSD showed reduced stimulus-related activity in the parieto-insular vestibular cortex (PIVC), anterior insula, inferior frontal gyrus, hippocampus, and anterior cingulate cortex compared to normal individuals.
“Patients with CSD showed reduced stimulus-related activity in the parieto-insular vestibular cortex (PIVC), anterior insula, inferior frontal gyrus, hippocampus, and anterior cingulate cortex compared to normal individuals.”
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- Authors
- Indovina, I., Riccelli, R., Chiarella, G., Petrolo, C., Augimeri, A., Giofrè, L., Lacquaniti, F., Staab, J. P., & Passamonti, L.
- Affiliations
- University of Rome Tor Vergata (IT)
- Magna Graecia University (IT)
- Mayo Clinic (US)
- University of Cambridge (GB)
- Corresponding author
- Indovina, Iole
- Passamonti, Luca
- ORCID
- Venue
- Frontiers in Behavioral Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2015-12-09
- Volume
- 9
- Pages
- 334-334
- ISSN
- 1662-5153 (ISSN-L)
- PMC
- PMC4673311
- OpenAlex
- W2245814053
- Cited by
- 140
- References
- 88
- Citations by year
- 2026: 16 · 2025: 18 · 2024: 11 · 2023: 12 · 2022: 16 · 2021: 15 · 2020: 22 · 2019: 6 · 2018: 9 · 2017: 11 · 2016: 4
- FWCI
- 4.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Behavioral Neuroscience (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Agenzia Spaziale Italiana
- COREA grant
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Surgery › Nausea and vomiting management
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- insula, vestibular system, parieto-insular vestibular cortex, anterior insula, hippocampus, anterior cingulate cortex, inferior frontal gyrus, visual dependence, anxiety, neuronal connectivity, postural control
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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