Holt’s Syndrome

This post is a personal, work-in-progress record, distilling the most important information from my experience with a multitude of vestibular issues. These are loose notes.

Looking back at the compounding vestibular issues I was suffering with, and still do, I'm now fairly certain that I stumbled into something that hasn't been specifically recorded in the medical literature, but has been covered on a more general basis. Even though this is controversial, I will name it Holt’s Syndrome, just to give it a very specific definition.

PPPD is the term used as a cover-all for neurological maladaptation issues - with ‘dizziness’ persisting after vestibular events in a variety of confusing sensory scenarios, but the spectrum of symptoms is quite broad.

The specific symptoms I am referring to are:

  • After a period of maladaptation from inappropriate signals.

    • Or noisy signals from dehiscence.

  • Senses in conflict, creating definitive (often quick onset) mismatch sensations.

    • Often presenting with nystagmus or a sense of disconnect that quickly initiates a vestibular migraine.

Example 1:

  • Laying on a flat surface with hands down, but one hand is on an extra piece of cloth.

  • Eyes closed to remove visual reference.

  • Either the head will spin quickly, or nystagmus (eye spasming) will start to appear.

  • Brain expects a flat surface while laying down, but hand on cloth defies expectation.

Example 2:

  • Standing in a shower, floor is uneven with dents to prevent slipping.

  • Foot is placed over a dent, providing pressure on one foot.

  • Head down, eyes closed, mismatch sensation occurs (with or without nystagmus).

  • Becoming lightheaded, feeling the entry to a vestibular migraine.

  • Brain expects flat floor, but foot gives pressure signal which defies expectation.

  • Signal mismatch begins to trigger vestibular migraine event.

Example 3:

  • Sitting at a desk, looking at a computer monitor. The monitor screen and desk are stable.

  • Slouching in the chair, turning one foot sideways on the ground.

  • Taking the other foot and resting it on top of the sideways foot.

  • While eyes are open, pressure is applied to the sideways foot, and suddenly the head starts spinning.

  • Brain expects flat surface, as eyes are looking at a screen that is not moving, but feet are describing a world which has turned.

Example 3 (Reversed):

  • Sitting at a desk, looking at a computer monitor. The monitor screen and desk are stable.

  • There is a microphone hanging over the desk that is prone to wobbling.

  • As the user moves around, the microphone wobbles.

  • Despite looking at a stable screen, the wobbling microphone produces a fast-onset mismatch sensation (as though balance is separating from body).

  • Unlike example 3, the feet may be flat on the ground here. The conflict in this case may still be between the body and vision - the feet are stable, but the microphone is describing a world that is moving. The mismatch sensation is unlike motion sickness, instead onsetting with great speed and involuntarily adjusting vision.

I need to emphasize here that the mismatch sensations do not feel like motion sickness. They are definite, very obvious sensations of balance ‘separating from the body’.

Questions:

  • In the above examples, 'body' signals (kinetic) are a key factor in initiating a mismatch.

  • If the brain has experienced noisy, inappropriate signals from the inner ear, does it place a greater emphasis on the body to retrieve position?

    • Findings:

      • Yes, from personal study over the course of a year. Extended use of alcohol and caffeine substances changes the pattern of vestibular signals from the inner ear. This heightens the symptoms for a while until adaptation corrects the difference (from a period of being off the substances). When coming off the substances, the symptoms are worsened again until adaptation corrects the difference (this may take anywhere from a few days to a few weeks). Strictly speaking, being on or off substances on a daily basis does not cause the issues, rather: adjusting to the other state causes a change in expectation. The greater difference between mechanical signals and neural expectation is what causes symptoms to appear.

  • How much overlap does this have with Space Adaptation Syndrome?

The two core components in predicting these events are:

  • Mechanical signals (inner ear).

  • Neural expectations for signals (issues may be referred to as 'neural circuit dizziness', which is another cover-all term that has been used by others undergoing personal studies, or those providing help services to people who fall outside of the medical sphere).

Resolution:

  • Electrolyte supplementation to assist with the regulation of neurological signals (and promote inner ear fluid health).

  • Avoid substances that alter vestibular signals to reduce the corrective difference of adaptation.

  • Exposure. Vestibular rehabilitation is not actively required. Life itself will provide stimulation for adaptation.

Gratuitously, I will refer to this specific form of maladaptation-mismatch as Holt's Syndrome, until someone tells me off.

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